451
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Lenehan PJ, Ramudu E, Venkatakrishnan AJ, Berner G, McMurry R, O'Horo JC, Badley AD, Morice W, Halamka J, Soundararajan V. Anemia during SARS-CoV-2 infection is associated with rehospitalization after viral clearance. iScience 2021; 24:102780. [PMID: 34189429 PMCID: PMC8225287 DOI: 10.1016/j.isci.2021.102780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/01/2021] [Accepted: 06/22/2021] [Indexed: 12/29/2022] Open
Abstract
Patients with COVID-19 can experience symptoms and complications after viral clearance. It is important to identify clinical features of patients who are likely to experience these prolonged effects. We conducted a retrospective study to compare longitudinal laboratory test measurements (hemoglobin, hematocrit, estimated glomerular filtration rate, serum creatinine, and blood urea nitrogen) in patients rehospitalized after PCR-confirmed SARS-CoV-2 clearance (n = 104) versus patients not rehospitalized after viral clearance (n = 278). Rehospitalized patients had lower median hemoglobin levels in the year prior to COVID-19 diagnosis (Cohen's D = -0.50; p = 1.2 × 10-3) and during their active SARS-CoV-2 infection (Cohen's D = -0.71; p = 4.6 × 10-8). Rehospitalized patients were also more likely to be diagnosed with moderate or severe anemia during their active infection (Odds Ratio = 4.07; p = 4.99 × 10-9). These findings suggest that anemia-related laboratory tests should be considered in risk stratification algorithms for patients with COVID-19.
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Affiliation(s)
| | | | | | | | - Reid McMurry
- nference, One Main Street, Cambridge, MA 02142, USA
| | | | | | - William Morice
- Mayo Clinic, Rochester, MN 55902, USA.,Mayo Clinic Laboratories, Rochester, MN 55902, USA
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452
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Bliddal S, Banasik K, Pedersen OB, Nissen J, Cantwell L, Schwinn M, Tulstrup M, Westergaard D, Ullum H, Brunak S, Tommerup N, Feenstra B, Geller F, Ostrowski SR, Grønbæk K, Nielsen CH, Nielsen SD, Feldt-Rasmussen U. Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients. Sci Rep 2021; 11:13153. [PMID: 34162913 PMCID: PMC8222239 DOI: 10.1038/s41598-021-92045-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/27/2021] [Indexed: 12/18/2022] Open
Abstract
Reports of persistent symptoms after hospitalization with COVID-19 have raised concern of a "long COVID" syndrome. This study aimed at determining the prevalence of and risk factors for acute and persistent symptoms in non-hospitalized patients with polymerase chain reaction (PCR) confirmed COVID-19. We conducted a cohort study of non-hospitalized participants identified via the Danish Civil Registration System with a SARS-CoV-2-positive PCR-test and available biobank samples. Participants received a digital questionnaire on demographics and COVID-19-related symptoms. Persistent symptoms: symptoms > 4 weeks (in sensitivity analyses > 12 weeks). We included 445 participants, of whom 34% were asymptomatic. Most common acute symptoms were fatigue, headache, and sneezing, while fatigue and reduced smell and taste were most severe. Persistent symptoms, most commonly fatigue and memory and concentration difficulties, were reported by 36% of 198 symptomatic participants with follow-up > 4 weeks. Risk factors for persistent symptoms included female sex (women 44% vs. men 24%, odds ratio 2.7, 95% CI 1.4-5.1, p = 0.003) and BMI (odds ratio 1.1, 95% CI 1.0-1.2, p = 0.001). In conclusion, among non-hospitalized PCR-confirmed COVID-19 patients one third were asymptomatic while one third of symptomatic participants had persistent symptoms illustrating the heterogeneity of disease presentation. These findings should be considered in health care planning and policy making related to COVID-19.
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Affiliation(s)
- Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Birger Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Janna Nissen
- Department of Clinical Immunology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Lisa Cantwell
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Schwinn
- Department of Clinical Immunology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Morten Tulstrup
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Biotech Research and Innovation Centre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Westergaard
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Recurrent Pregnancy Loss Unit, Department of Fertility, Copenhagen University Hospital, Rigshospitalet, Fertility Clinic 4071, 2100, Copenhagen Ø, Denmark
- Recurrent Pregnancy Loss Unit, Department of Obstetrics and Gynecology, Hvidovre Hospital, 2650, Hvidovre, Denmark
- Methods and Analysis, Statistics Denmark, 2100, Copenhagen Ø, Denmark
| | - Henrik Ullum
- Management Section, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Tommerup
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bjarke Feenstra
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Frank Geller
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Biotech Research and Innovation Centre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark.
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453
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Health-related quality of life issues, including symptoms, in patients with active COVID-19 or post COVID-19; a systematic literature review. Qual Life Res 2021; 30:3367-3381. [PMID: 34146226 PMCID: PMC8214069 DOI: 10.1007/s11136-021-02908-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/13/2022]
Abstract
Purpose This systematic review was performed to identify all relevant health-related quality of life (HRQoL) issues associated with COVID-19. Methods A systematic literature search was undertaken in April 2020. In four teams of three reviewers each, all abstracts were independently reviewed for inclusion by two reviewers. Using a pre-defined checklist of 93 criteria for each publication, data extraction was performed independently by two reviewers and subsequently compared and discussed. If necessary, a third reviewer resolved any discrepancies. The search was updated in February 2021 to retrieve new publications on HRQoL issues including issues related to the long-term consequences of COVID-19. Results The search in April 2020 identified 3342 potentially relevant publications, and 339 publications were selected for full-text review and data extraction. We identified 75 distinct symptoms and other HRQoL issues categorized into 12 thematic areas; from general symptoms such as fever, myalgia, and fatigue, to neurological and psychological issues. The updated search revealed three extra issues experienced during active disease and long-term problems with fatigue, psychological issues and impaired cognitive function. Conclusion This first comprehensive systematic review provides a detailed overview of the wide range of HRQoL issues experienced by patients with COVID-19 throughout the course of the disease. It demonstrates the devastating impact of the disease and provides critically important information for clinicians, to enable them to better recognize the disease and to provide knowledge important for treatment and follow-up. The results provided the foundation for the international development of a COVID-19 specific patient-reported HRQoL questionnaire. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02908-z.
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454
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Utay NS, Asmuth DM, Gharakhanian S, Contreras M, Warner CD, Detzel CJ. Potential use of serum-derived bovine immunoglobulin/protein isolate for the management of COVID-19. Drug Dev Res 2021; 82:873-879. [PMID: 34110032 PMCID: PMC9293029 DOI: 10.1002/ddr.21841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/13/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022]
Abstract
COVID‐19 manifests as a mild disease in most people but can progress to severe disease in nearly 20% of individuals. Disease progression is likely driven by a cytokine storm, either directly stimulated by SARS‐CoV‐2 or by increased systemic inflammation in which the gut might play an integral role. SARS‐CoV‐2 replication in the gut may cause increased intestinal permeability, alterations to the fecal microbiome, and increased inflammatory cytokines. Each effect may lead to increased systemic inflammation and the transport of cytokines and inflammatory antigens from the gut to the lung. Few interventions are being studied to treat people with mild disease and prevent the cytokine storm. Serumderived bovine immunoglobulin/protein isolate (SBI) may prevent progression by (1) binding and neutralizing inflammatory antigens, (2) decreasing gut permeability, (3) interfering with ACE2 binding by viral proteins, and (4) improving the fecal microbiome. SBI is therefore a promising intervention to prevent disease progression in COVID‐19 patients.
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Affiliation(s)
- Netanya S Utay
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David M Asmuth
- Department of Internal Medicine, University of California Davis, Sacramento, California, USA
| | - Shahin Gharakhanian
- Pharmaceutical Medicine & Infectious Diseases, Shahin Gharakhanian MD Consulting LLC, Cambridge Innovation Center (CIC), Cambridge, Massachusetts, USA
| | - Moises Contreras
- Department of Research and Development, Entera Health, LLC, Ankeny, Iowa, USA
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455
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Taylor RR, Trivedi B, Patel N, Singh R, Ricketts WM, Elliott K, Yarwood M, White V, Hylton H, Allen R, Thomas G, Kapil V, McGuckin R, Pfeffer PE. Post-COVID symptoms reported at asynchronous virtual review and stratified follow-up after COVID-19 pneumonia. Clin Med (Lond) 2021; 21:e384-e391. [PMID: 34103378 DOI: 10.7861/clinmed.2021-0037] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The COVID-19 pandemic has strained healthcare systems and how best to address post-COVID health needs is uncertain. Here we describe the post-COVID symptoms of 675 patients followed up using a virtual review pathway, stratified by severity of acute COVID infection. METHODS COVID-19 survivors completed an online/telephone questionnaire of symptoms after 12+ weeks and a chest radiograph. Dependent on findings at virtual review, patients were provided information leaflets, attended for investigations and/or were reviewed face-to-face. Outcomes were compared between patients following high-risk and low-risk admissions for COVID pneumonia, and community referrals. RESULTS Patients reviewed after hospitalisation for COVID pneumonia had a median of two ongoing physical health symptoms post-COVID. The most common was fatigue (50.3% of high-risk patients). Symptom burden did not vary significantly by severity of hospitalised COVID pneumonia but was highest in community referrals. Symptoms suggestive of depression, anxiety and post-traumatic stress disorder were common (depression occurred in 24.9% of high-risk patients). Asynchronous virtual review facilitated triage of patients at highest need of face-to-face review. CONCLUSION Many patients continue to have a significant burden of post-COVID symptoms irrespective of severity of initial pneumonia. How best to assess and manage long COVID will be of major importance over the next few years.
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Affiliation(s)
| | | | | | | | - William M Ricketts
- Barts Health NHS Trust, London, UK, and hon clinical senior lecturer, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | | | | | | | | | | | | | - Vikas Kapil
- Barts Health NHS Trust, London, UK, and clinical senior lecturer, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | | | - Paul E Pfeffer
- Barts Health NHS Trust, London, UK, and hon senior lecturer, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
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456
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González-Hermosillo JA, Martínez-López JP, Carrillo-Lampón SA, Ruiz-Ojeda D, Herrera-Ramírez S, Amezcua-Guerra LM, Martínez-Alvarado MDR. Post-Acute COVID-19 Symptoms, a Potential Link with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A 6-Month Survey in a Mexican Cohort. Brain Sci 2021; 11:760. [PMID: 34201087 PMCID: PMC8227652 DOI: 10.3390/brainsci11060760] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 01/17/2023] Open
Abstract
The aim of this study was to describe the clinical evolution during 6 months of follow-up of adults recovered from COVID-19. We tried to determine how many met the definition of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). A total of 130 patients (51.0 ± 14 years, 34.6% female) were enrolled. Symptoms were common, participants reported a median number of 9 (IQR 5-14) symptoms. Fatigue was the most common symptom (61/130; 46.9%). Patients with fatigue were older 53.9 ± 13.5 years compared with 48.5 ± 13.3 years in those without fatigue (p = 0.02) and had a longer length of hospital stay, 17 ± 14 days vs. 13 ± 10 days (p = 0.04). There was no difference in other comorbidities between patients with fatigue and those without it, and no association between COVID-19 severity and fatigue. After multivariate adjustment of all baseline clinical features, only age 40 to 50 years old was positively associated with fatigue, OR 2.5 (95% CI 1.05-6.05) p = 0.03. In our survey, only 17 (13%) patients met the Institute of Medicine's criteria for "systemic exertion intolerance disease," the new name of ME/CFS. In conclusion, in some patients, the features of post-acute COVID-19 syndrome overlap with the clinical features of ME/CFS.
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Affiliation(s)
- J Antonio González-Hermosillo
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-H.); (J.P.M.-L.); (S.A.C.-L.); (D.R.-O.); (S.H.-R.)
| | - Jhanea Patricia Martínez-López
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-H.); (J.P.M.-L.); (S.A.C.-L.); (D.R.-O.); (S.H.-R.)
| | - Sofía Antonieta Carrillo-Lampón
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-H.); (J.P.M.-L.); (S.A.C.-L.); (D.R.-O.); (S.H.-R.)
| | - Dayanara Ruiz-Ojeda
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-H.); (J.P.M.-L.); (S.A.C.-L.); (D.R.-O.); (S.H.-R.)
| | - Sharon Herrera-Ramírez
- Department of Cardiovascular Dysautonomia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.A.G.-H.); (J.P.M.-L.); (S.A.C.-L.); (D.R.-O.); (S.H.-R.)
| | - Luis M. Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
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457
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Aksoy Poyraz C, Faruk Demirel Ö, Çağrı Poyraz B, M. Dursun S. A Multi-Dimensional Psychiatric Perspective on the Impact of the COVID-19 Pandemic. PSYCHIAT CLIN PSYCH 2021; 31:219-225. [PMID: 38765226 PMCID: PMC11079654 DOI: 10.5152/pcp.2021.21222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/03/2021] [Indexed: 05/21/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) arose in Wuhan, China in December 2019 and spread worldwide rapidly, and was declared a global pandemic by the World Health Organization as of March 2020. As the SARS-CoV-2 pandemic has spread worldwide, its impact is increasingly being recognized among vulnerable groups and also by the public in general. Recent findings indicate that patients with mental health disorders are among the groups most vulnerable to psychological stress and social hardships related to the current pandemic. Studies also indicate an increased risk of infection by SARS-CoV-2 in subjects with psychiatric disorders. Patients affected by SARS-CoV-2 may present to the psychiatrist with delirium, psychotic symptoms, depression, anxiety, post-traumatic stress disorder, and insomnia. Some patients will develop persistent somatic symptoms such as fatigue after the acute infection. In this article, we summarize the preliminary findings related to the effects of the SARS-CoV-2 pandemic on patients with mental health disorders, as well as recent research on psychiatric presentations in patients affected by SARS-CoV-2.
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Affiliation(s)
- Cana Aksoy Poyraz
- Department of Psychiatry, İstanbul University- Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Ömer Faruk Demirel
- Department of Psychiatry, İstanbul University- Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Burç Çağrı Poyraz
- Department of Psychiatry, İstanbul University- Cerrahpaşa School of Medicine, Istanbul, Turkey
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458
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Taylor AK, Kingstone T, Briggs TA, O'Donnell CA, Atherton H, Blane DN, Chew‐Graham CA. 'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID. Health Expect 2021; 24:833-842. [PMID: 33749957 PMCID: PMC8235894 DOI: 10.1111/hex.13223] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has had far-reaching effects upon lives, healthcare systems and society. Some who had an apparently 'mild' COVID-19 infection continue to suffer from persistent symptoms, including chest pain, breathlessness, fatigue, cognitive impairment, paraesthesia, muscle and joint pains. This has been labelled 'long COVID'. This paper reports the experiences of doctors with long COVID. METHODS A qualitative study; interviews with doctors experiencing persistent symptoms were conducted by telephone or video call. Interviews were transcribed and analysis conducted using an inductive and thematic approach. RESULTS Thirteen doctors participated. The following themes are reported: making sense of symptoms, feeling let down, using medical knowledge and connections, wanting to help and be helped, combining patient and professional identity. Experiencing long COVID can be transformative: many expressed hope that good would come of their experiences. Distress related to feelings of being 'let down' and the hard work of trying to access care. Participants highlighted that they felt better able to care for, and empathize with, patients with chronic conditions, particularly where symptoms are unexplained. CONCLUSIONS The study adds to the literature on the experiences of doctors as patients, in particular where evidence is emerging and the patient has to take the lead in finding solutions to their problems and accessing their own care. PATIENT AND PUBLIC CONTRIBUTION The study was developed with experts by experience (including co-authors HA and TAB) who contributed to the protocol and ethics application, and commented on analysis and implications. All participants were given the opportunity to comment on findings.
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Affiliation(s)
- Anna K. Taylor
- School of MedicineLeeds Institute of Health SciencesFaculty of Medicine and Health, University of LeedsLeedsUK
| | - Tom Kingstone
- School of MedicineFaculty of Medicine and Health SciencesKeele UniversityKeeleUK
- Research and Innovation DepartmentSt George's HospitalMidlands Partnership NHS Foundation TrustStaffordUK
| | - Tracy A. Briggs
- Division of Evolution and Genomic SciencesSchool of Biological SciencesManchester UniversityManchesterUK
| | - Catherine A. O'Donnell
- General Practice & Primary CareInstitute of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Helen Atherton
- Unit of Academic Primary CareWarwick Medical SchoolUniversity of WarwickCoventryUK
| | - David N. Blane
- General Practice & Primary CareInstitute of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Carolyn A. Chew‐Graham
- School of MedicineFaculty of Medicine and Health SciencesKeele UniversityKeeleUK
- Research and Innovation DepartmentSt George's HospitalMidlands Partnership NHS Foundation TrustStaffordUK
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459
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Schumm-Draeger PM. Post-COVID - Nachsorgekonzepte gesucht! INFO DIABETOLOGIE 2021. [PMCID: PMC8210956 DOI: 10.1007/s15034-021-3714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Petra-Maria Schumm-Draeger
- Endokrinologie\/Diabetologie\/Angiologie\/Gastroenterologie, Theatiner Straße 15, 80333 München, Germany
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460
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Iqbal FM, Lam K, Sounderajah V, Clarke JM, Ashrafian H, Darzi A. Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and meta-analysis. EClinicalMedicine 2021; 36:100899. [PMID: 34036253 PMCID: PMC8141371 DOI: 10.1016/j.eclinm.2021.100899] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A significant proportion of individuals experience lingering and debilitating symptoms following acute COVID-19 infection. The National Institute for Health and Care Excellence (NICE) have coined the persistent cluster of symptoms as post-COVID syndrome. This has been further sub-categorised into acute post-COVID syndrome for symptoms persisting three weeks beyond initial infection and chronic post-COVID syndrome for symptoms persisting beyond twelve weeks. The aim of this review was to detail the prevalence of clinical features and identify potential predictors for acute and chronic post-COVID syndrome. METHODS A systematic literature search, with no language restrictions, was performed to identify studies detailing characteristics and outcomes related to survivorship of post-COVID syndrome. The last search was performed on 6 March 2021 and all pre-dating published articles included. A means of proportion meta-analysis was performed to quantify characteristics of acute and chronic post-COVID syndrome. Study quality was assessed with a specific risk of bias tool. PROSPERO Registration: CRD42020222855. FINDINGS A total of 43 studies met the eligibility criteria; of which, 38 allowed for meta-analysis. Fatigue and dyspnoea were the most prevalent symptoms in acute post-COVID (0·37 and 0·35) and fatigue and sleep disturbance in chronic post-COVID syndrome (0·48 and 0·44), respectively. The available evidence is generally of poor quality, with considerable risk of bias, and are of observational design. INTERPRETATION In conclusion, this review highlights that flaws in data capture and interpretation, noted in the uncertainty within our meta-analysis, affect the applicability of current knowledge. Policy makers and researchers must focus on understanding the impact of this condition on individuals and society with appropriate funding initiatives and global collaborative research.
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Affiliation(s)
- Fahad M Iqbal
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
| | - Kyle Lam
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
| | - Jonathan M Clarke
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
- EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London SW7 2AZ, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
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461
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Girón-Pérez DA, Benitez-Trinidad AB, Ruiz-Manzano RA, Toledo-Ibarra GA, Ventura-Ramón GH, Covantes-Rosales CE, Ojeda-Durán AJ, Díaz-Reséndiz KJG, Mercado-Salgado U, Girón-Pérez MI. Correlation of hematological parameters and cycle threshold in ambulatory patients with SARS-CoV-2 infection. Int J Lab Hematol 2021; 43:873-880. [PMID: 34075710 PMCID: PMC8239643 DOI: 10.1111/ijlh.13606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 12/23/2022]
Abstract
Introduction Former studies have shown that hematologic parameters are affected by the SARS‐CoV‐2 infection which has caused a global health problem. Therefore, this research aims to identify the most frequent symptoms and comorbidities in SARS‐CoV‐2 infected outpatients; besides, to analyze hematological parameters and their correlation with cycle threshold (Ct) values. Methods We analyzed a total of sixty outpatients with SARS‐CoV‐2 infection. They were divided according to sex. Afterward, a questionnaire was carried out to find out their symptoms and comorbidities. Additionally, blood biometry data were correlated with the Ct value, respectively. Results Sixty patients were analyzed; the mean age was 43 years. All patients were from Nayarit, Mexico. The frequency index showed that the main symptoms were headache and anosmia, and the comorbidities were obesity and smoking. The analysis of blood biometry showed a clear increase in red blood cells (RBC) related parameters in women. In both sexes an increase in the number of white blood cells (WBC) was observed. Also, all the hematological alterations correlated with the grade of infection. Conclusion Headache and anosmia are the most common symptoms according to the frequency index, the main comorbidities were obesity and smoking. Also, there is a Ct value correlation with hematological parameters (WBC, mean corpuscular volume, mean corpuscular hemoglobin, hemoglobin); they can be used as a prognostic marker of infection.
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Affiliation(s)
- Daniel Alberto Girón-Pérez
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
| | - Alma Betsaida Benitez-Trinidad
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
| | - Rocio Alejandra Ruiz-Manzano
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
| | - Gladys Alejandra Toledo-Ibarra
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
| | - Guadalupe Herminia Ventura-Ramón
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
| | - Carlos Eduardo Covantes-Rosales
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
| | - Ansonny Jhovany Ojeda-Durán
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
| | | | - Ulises Mercado-Salgado
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
| | - Manuel Iván Girón-Pérez
- Laboratorio Nacional de Investigación para la Inocuidad Alimentaria (LANIIA) Unidad Nayarit, Universidad Autónoma de Nayarit, Tepic, México
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Romero-Duarte Á, Rivera-Izquierdo M, Guerrero-Fernández de Alba I, Pérez-Contreras M, Fernández-Martínez NF, Ruiz-Montero R, Serrano-Ortiz Á, González-Serna RO, Salcedo-Leal I, Jiménez-Mejías E, Cárdenas-Cruz A. Sequelae, persistent symptomatology and outcomes after COVID-19 hospitalization: the ANCOHVID multicentre 6-month follow-up study. BMC Med 2021; 19:129. [PMID: 34011359 PMCID: PMC8134820 DOI: 10.1186/s12916-021-02003-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Long-term effects of COVID-19, also called Long COVID, affect more than 10% of patients. The most severe cases (i.e. those requiring hospitalization) present a higher frequency of sequelae, but detailed information on these effects is still lacking. The objective of this study is to identify and quantify the frequency and outcomes associated with the presence of sequelae or persistent symptomatology (SPS) during the 6 months after discharge for COVID-19. METHODS Retrospective observational 6-month follow-up study conducted in four hospitals of Spain. A cohort of all 969 patients who were hospitalized with PCR-confirmed SARS-CoV-2 from March 1 to April 15, 2020, was included. We collected all the SPS during the 6 months after discharge reported by patients during follow-up from primary care records. Cluster analyses were performed to validate the measures. The main outcome measures were return to the Emergency Services, hospital readmission and post-discharge death. Surviving patients' outcomes were collected through clinical histories and primary care reports. Multiple logistic regression models were applied. RESULTS The 797 (82.2%) patients who survived constituted the sample followed, while the rest died from COVID-19. The mean age was 63.0 years, 53.7% of them were men and 509 (63.9%) reported some sequelae during the first 6 months after discharge. These sequelae were very diverse, but the most frequent were respiratory (42.0%), systemic (36.1%), neurological (20.8%), mental health (12.2%) and infectious (7.9%) SPS, with some differences by sex. Women presented higher frequencies of headache and mental health SPS, among others. A total of 160 (20.1%) patients returned to the Emergency Services, 35 (4.4%) required hospital readmission and 8 (1.0%) died during follow-up. The main factors independently associated with the return to Emergency Services were persistent fever, dermatological SPS, arrythmia or palpitations, thoracic pain and pneumonia. CONCLUSIONS COVID-19 cases requiring hospitalization during the first wave of the pandemic developed a significant range of mid- to long-term SPS. A detailed list of symptoms and outcomes is provided in this multicentre study. Identification of possible factors associated with these SPS could be useful to optimize preventive follow-up strategies in primary care for the coming months of the pandemic.
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Affiliation(s)
| | - Mario Rivera-Izquierdo
- Service of Preventive Medicine and Public Health, Hospital Universitario Clínico San Cecilio, Granada, Spain.
- Department of Preventive Medicine and Public Health, University of Granada, Avda. de la Investigación n°11, 18016, Granada, Spain.
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.
| | - Inmaculada Guerrero-Fernández de Alba
- Service of Preventive Medicine and Public Health, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Service of Preventive Medicine and Public Health, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Marina Pérez-Contreras
- Service of Preventive Medicine and Public Health, Hospital Universitario de Puerto Real, Puerto Real, Cádiz, Spain
| | - Nicolás Francisco Fernández-Martínez
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Rafael Ruiz-Montero
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Álvaro Serrano-Ortiz
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Rocío Ortiz González-Serna
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Inmaculada Salcedo-Leal
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, Spain
| | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, University of Granada, Avda. de la Investigación n°11, 18016, Granada, Spain
- Chair of Teaching and Research in Family Medicine, SEMERGEN-UGR, University of Granada, Granada, Spain
| | - Antonio Cárdenas-Cruz
- School of Medicine, University of Granada, Granada, Spain
- Intensive Care Unit, Hospital de Poniente, El Ejido, Almería, Spain
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Todt BC, Szlejf C, Duim E, Linhares AOM, Kogiso D, Varela G, Campos BA, Baghelli Fonseca CM, Polesso LE, Bordon INS, Cabral BT, Amorim VLP, Piza FMT, Degani-Costa LH. Clinical outcomes and quality of life of COVID-19 survivors: A follow-up of 3 months post hospital discharge. Respir Med 2021; 184:106453. [PMID: 34010740 PMCID: PMC8116128 DOI: 10.1016/j.rmed.2021.106453] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Over 66 million people worldwide have been diagnosed with COVID-19. Therefore, understanding their clinical evolution beyond hospital discharge is essential not only from an individual standpoint, but from a populational level. OBJECTIVES Our primary aim was to assess the impact of COVID-19 on health-related quality of life (HRQoL) 3 months after hospital discharge. Additionally, we screened for anxiety and depression and assessed important clinical outcomes. METHODS This was a single-center cohort study performed in Sao Paulo (Brazil), in which participants were contacted by telephone to answer a short survey. EQ-5D-3L was used to assess HRQoL and clinical data from patients' index admission were retrieved from medical records. RESULTS We contacted 251 participants (59.8% males, mean age 53 years old), 69.7% of which had presented with severe COVID-19. At 3 months of follow-up, 6 patients had died, 51 (20.3%) had visited the emergency department again and 17 (6.8%) had been readmitted to hospital. Seventy patients (27.9%) persisted with increased dyspnoea and 81 had a positive screening for anxiety/depression. Similarly, patients reported an overall worsening of EQ-5D-3L single summary index at 3 months compared to before the onset of COVID-19 symptoms (0.8012 (0.7368 - 1.0) vs. 1.0(0.7368 - 1.0), p < 0.001). This affected all 5 domains, but especially pain/discomfort and anxiety/depression. Only female sex and intensive care requirement were independently associated with worsening of HRQoL. CONCLUSION Patients hospitalized for COVID-19 frequently face persistent clinical and mental health problems up to 3 months following hospital discharge, with significant impact on patients' HRQoL.
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Affiliation(s)
- Beatriz Costa Todt
- Internal Medicine Residency Program, Hospital Israelita Albert Einstein, Brazil
| | - Claudia Szlejf
- Department of Big Data, Hospital Israelita Albert Einstein, Brazil
| | - Etienne Duim
- Department of Diagnostic and Ambulatory Medicine, Hospital Israelita Albert Einstein, Brazil
| | | | | | | | | | | | | | | | | | - Victor L P Amorim
- Hospital Municipal Dr. Moysés Deutsch, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Internal Medicine Department, Hospital Israelita Albert Einstein, Brazil
| | - Felipe M T Piza
- Hospital Municipal Dr. Moysés Deutsch, Brazil; Intensive Care Unit, Hospital Israelita Albert Einstein, Brazil
| | - Luiza Helena Degani-Costa
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Internal Medicine Department, Hospital Israelita Albert Einstein, Brazil.
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464
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Townsend L, Dyer AH, Naughton A, Kiersey R, Holden D, Gardiner M, Dowds J, O’Brien K, Bannan C, Nadarajan P, Dunne J, Martin-Loeches I, Fallon PG, Bergin C, O’Farrelly C, Cheallaigh CN, Bourke NM, Conlon N. Longitudinal Analysis of COVID-19 Patients Shows Age-Associated T Cell Changes Independent of Ongoing Ill-Health. Front Immunol 2021; 12:676932. [PMID: 34025675 PMCID: PMC8138306 DOI: 10.3389/fimmu.2021.676932] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives The immunological and inflammatory changes following acute COVID-19 are hugely variable. Persistent clinical symptoms following resolution of initial infection, termed long COVID, are also hugely variable, but association with immunological changes has not been described. We investigate changing immunological parameters in convalescent COVID-19 and interrogate their potential relationships with persistent symptoms. Methods We performed paired immunophenotyping at initial SARS-CoV-2 infection and convalescence (n=40, median 68 days) and validated findings in 71 further patients at median 101 days convalescence. Results were compared to 40 pre-pandemic controls. Fatigue and exercise tolerance were assessed as cardinal features of long COVID using the Chalder Fatigue Scale and 6-minute-walk test. The relationships between these clinical outcomes and convalescent immunological results were investigated. Results We identify persistent expansion of intermediate monocytes, effector CD8+, activated CD4+ and CD8+ T cells, and reduced naïve CD4+ and CD8+ T cells at 68 days, with activated CD8+ T cells remaining increased at 101 days. Patients >60 years also demonstrate reduced naïve CD4+ and CD8+ T cells and expanded activated CD4+ T cells at 101 days. Ill-health, fatigue, and reduced exercise tolerance were common in this cohort. These symptoms were not associated with immune cell populations or circulating inflammatory cytokines. Conclusion We demonstrate myeloid recovery but persistent T cell abnormalities in convalescent COVID-19 patients more than three months after initial infection. These changes are more marked with age and are independent of ongoing subjective ill-health, fatigue and reduced exercise tolerance.
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Affiliation(s)
- Liam Townsend
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Adam H. Dyer
- Department of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Aifric Naughton
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Rachel Kiersey
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Dean Holden
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Mary Gardiner
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Joanne Dowds
- Department of Physiotherapy, St James’s Hospital, Dublin, Ireland
| | - Kate O’Brien
- Department of Physiotherapy, St James’s Hospital, Dublin, Ireland
| | - Ciaran Bannan
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | | | - Jean Dunne
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | | | - Padraic G. Fallon
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Colm Bergin
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Cliona O’Farrelly
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Cliona Ni Cheallaigh
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M. Bourke
- Department of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St James’s Hospital, Dublin, Ireland
- Department of Immunology, School of Medicine, Trinity College, Dublin, Ireland
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465
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Stanculescu D, Larsson L, Bergquist J. Theory: Treatments for Prolonged ICU Patients May Provide New Therapeutic Avenues for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Front Med (Lausanne) 2021; 8:672370. [PMID: 34026797 PMCID: PMC8137963 DOI: 10.3389/fmed.2021.672370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
We here provide an overview of treatment trials for prolonged intensive care unit (ICU) patients and theorize about their relevance for potential treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Specifically, these treatment trials generally target: (a) the correction of suppressed endocrine axes, notably through a "reactivation" of the pituitary gland's pulsatile secretion of tropic hormones, or (b) the interruption of the "vicious circle" between inflammation, oxidative and nitrosative stress (O&NS), and low thyroid hormone function. There are significant parallels in the treatment trials for prolonged critical illness and ME/CFS; this is consistent with the hypothesis of an overlap in the mechanisms that prevent recovery in both conditions. Early successes in the simultaneous reactivation of pulsatile pituitary secretions in ICU patients-and the resulting positive metabolic effects-could indicate an avenue for treating ME/CFS. The therapeutic effects of thyroid hormones-including in mitigating O&NS and inflammation and in stimulating the adreno-cortical axis-also merit further studies. Collaborative research projects should further investigate the lessons from treatment trials for prolonged critical illness for solving ME/CFS.
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Affiliation(s)
| | - Lars Larsson
- Basic and Clinical Muscle Biology, Department of Physiology and Pharmacology, Karolinska Institute, Solna, Sweden
| | - Jonas Bergquist
- Analytical Chemistry and Neurochemistry, Department of Chemistry–Biomedical Center, Uppsala University, Uppsala, Sweden
- The Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Collaborative Research Centre at Uppsala University, Uppsala, Sweden
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466
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Lawler NG, Gray N, Kimhofer T, Boughton B, Gay M, Yang R, Morillon AC, Chin ST, Ryan M, Begum S, Bong SH, Coudert JD, Edgar D, Raby E, Pettersson S, Richards T, Holmes E, Whiley L, Nicholson JK. Systemic Perturbations in Amine and Kynurenine Metabolism Associated with Acute SARS-CoV-2 Infection and Inflammatory Cytokine Responses. J Proteome Res 2021; 20:2796-2811. [PMID: 33724837 PMCID: PMC7986977 DOI: 10.1021/acs.jproteome.1c00052] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 01/06/2023]
Abstract
We performed quantitative metabolic phenotyping of blood plasma in parallel with cytokine/chemokine analysis from participants who were either SARS-CoV-2 (+) (n = 10) or SARS-CoV-2 (-) (n = 49). SARS-CoV-2 positivity was associated with a unique metabolic phenotype and demonstrated a complex systemic response to infection, including severe perturbations in amino acid and kynurenine metabolic pathways. Nine metabolites were elevated in plasma and strongly associated with infection (quinolinic acid, glutamic acid, nicotinic acid, aspartic acid, neopterin, kynurenine, phenylalanine, 3-hydroxykynurenine, and taurine; p < 0.05), while four metabolites were lower in infection (tryptophan, histidine, indole-3-acetic acid, and citrulline; p < 0.05). This signature supports a systemic metabolic phenoconversion following infection, indicating possible neurotoxicity and neurological disruption (elevations of 3-hydroxykynurenine and quinolinic acid) and liver dysfunction (reduction in Fischer's ratio and elevation of taurine). Finally, we report correlations between the key metabolite changes observed in the disease with concentrations of proinflammatory cytokines and chemokines showing strong immunometabolic disorder in response to SARS-CoV-2 infection.
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Affiliation(s)
- Nathan G. Lawler
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Nicola Gray
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Torben Kimhofer
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Berin Boughton
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Melvin Gay
- Bruker Pty Ltd., Preston,
VIC 3072, Australia
| | - Rongchang Yang
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Aude-Claire Morillon
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Sung-Tong Chin
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Monique Ryan
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Sofina Begum
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
- Department of Metabolism Digestion and Reproduction,
Faculty of Medicine, Imperial College London, Sir Alexander
Fleming Building, South Kensington, London SW7 2AZ, U.K.
| | - Sze How Bong
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
| | - Jerome D. Coudert
- Centre for Molecular Medicine & Innovative
Therapeutics, Murdoch University, Perth, WA 6150,
Australia
| | - Dale Edgar
- State Adult Burn Unit, Fiona Stanley
Hospital, Murdoch, WA 6150, Australia
- Burn Injury Research Node, The University of
Notre Dame, Fremantle, WA 6160, Australia
- Fiona Wood Foundation,
Murdoch, WA 6150, Australia
| | - Edward Raby
- Department of Microbiology, PathWest
Laboratory Medicine, Perth, WA 6009, Australia
- Department of Infectious Diseases, Fiona
Stanley Hospital, Perth, WA 6150, Australia
| | - Sven Pettersson
- Singapore National Neuro Science
Centre, Singapore Mandalay Road, Singapore 308232,
Singapore
- Lee Kong Chian School of Medicine,
Nanyang Technological University, Mandalay Road, Singapore
308232, Singapore
- Department of Life Science Centre,
Sunway University, 55100 Kuala Lumpur,
Malaysia
| | - Toby Richards
- Medical School, Faculty of Health and Medical
Sciences, University of Western Australia, Nedlands, WA 6009,
Australia
| | - Elaine Holmes
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
- Department of Metabolism Digestion and Reproduction,
Faculty of Medicine, Imperial College London, Sir Alexander
Fleming Building, South Kensington, London SW7 2AZ, U.K.
| | - Luke Whiley
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
- Perron Institute for Neurological and
Translational Science, Nedlands, WA 6009,
Australia
| | - Jeremy K. Nicholson
- Australian National Phenome Centre, Computational and
Systems Medicine, Health Futures Institute, Murdoch University,
Harry Perkins Building, Perth, WA 6150, Australia
- Medical School, Faculty of Health and Medical
Sciences, University of Western Australia, Nedlands, WA 6009,
Australia
- Institute of Global Health Innovation,
Imperial College London, Level 1, Faculty Building South
Kensington Campus, London SW7 2AZ, U.K.
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467
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Jason LA, Islam M, Conroy K, Cotler J, Torres C, Johnson M, Mabie B. COVID-19 Symptoms Over Time: Comparing Long-Haulers to ME/CFS. FATIGUE : BIOMEDICINE, HEALTH & BEHAVIOR 2021; 9:59-68. [PMID: 34484973 PMCID: PMC8411893 DOI: 10.1080/21641846.2021.1922140] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Our objective was to determine which symptoms among long-hauler COVID-19 patients change over time, and how their symptoms compare to another chronic illness group. 278 long-haulers completed two symptom questionnaires at one time point, with one recounting experiences from an average of 21.7 weeks prior. METHODS We used a comparison group of 502 patients diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Participants completed a standardized symptom questionnaire and a list of additional CDC COVID-19 symptoms. RESULTS Over time, the long-haulers reported an overall reduction of most symptoms including unrefreshing sleep and post-exertional malaise, but an intensification of neurocognitive symptoms. When compared to ME/CFS, the COVID-19 sample was initially more symptomatic for the immune and orthostatic domains but over time, the long-haulers evidenced significantly less severe symptoms than those with ME/CFS, except in the orthostatic domain. Among the COVID-19 long haulers, several neurocognitive symptoms got worse over time, whereas improvements occurred in most other areas. CONCLUSIONS These types of differential patterns of symptoms over time might contribute to helping better understand the pathophysiology of those reporting prolonged illness following COVID-19.
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468
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Salamanna F, Veronesi F, Martini L, Landini MP, Fini M. Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data. Front Med (Lausanne) 2021; 8:653516. [PMID: 34017846 PMCID: PMC8129035 DOI: 10.3389/fmed.2021.653516] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/10/2021] [Indexed: 01/08/2023] Open
Abstract
Whilst the entire world is battling the second wave of COVID-19, a substantial proportion of patients who have suffered from the condition in the past months are reporting symptoms that last for months after recovery, i. e., long-term COVID-19 symptoms. We aimed to assess the current evidence on the long-term symptoms in COVID-19 patients. We did a systematic review on PubMed, Web of Science, EMBASE, and Google Scholar from database inception to February 15, 2021, for studies on long-term COVID-19 symptoms. We included all type of papers that reported at least one long-term COVID-19 symptom. We screened studies using a standardized data collection form and pooled data from published studies. Cohort cross-sectional, case-report, cases-series, case-control studies, and review were graded using specific quality assessment tools. Of 11,361 publications found following our initial search we assessed 218 full-text articles, of which 145 met all selection criteria. We found that 20.70% of reports on long-term COVID-19 symptoms were on abnormal lung functions, 24.13% on neurologic complaints and olfactory dysfunctions, and 55.17% on specific widespread symptoms, mainly chronic fatigue, and pain. Despite the relatively high heterogeneity of the reviewed studies, our findings highlighted that a noteworthy proportion of patients who have suffered from SARS-CoV-2 infection present a "post-COVID syndrome." The multifaceted understanding of all aspects of the COVID-19 pandemic, including these long-term symptoms, will allow us to respond to all the global health challenges, thus paving the way to a stronger public health.
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Affiliation(s)
- Francesca Salamanna
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | - Francesca Veronesi
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | - Lucia Martini
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
| | | | - Milena Fini
- IRCCS Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Bologna, Italy
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469
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Nasserie T, Hittle M, Goodman SN. Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19: A Systematic Review. JAMA Netw Open 2021; 4:e2111417. [PMID: 34037731 PMCID: PMC8155823 DOI: 10.1001/jamanetworkopen.2021.11417] [Citation(s) in RCA: 411] [Impact Index Per Article: 137.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Infection with COVID-19 has been associated with long-term symptoms, but the frequency, variety, and severity of these complications are not well understood. Many published commentaries have proposed plans for pandemic control that are primarily based on mortality rates among older individuals without considering long-term morbidity among individuals of all ages. Reliable estimates of such morbidity are important for patient care, prognosis, and development of public health policy. OBJECTIVE To conduct a systematic review of studies examining the frequency and variety of persistent symptoms after COVID-19 infection. EVIDENCE REVIEW A search of PubMed and Web of Science was conducted to identify studies published from January 1, 2020, to March 11, 2021, that examined persistent symptoms after COVID-19 infection. Persistent symptoms were defined as those persisting for at least 60 days after diagnosis, symptom onset, or hospitalization or at least 30 days after recovery from the acute illness or hospital discharge. Search terms included COVID-19, SARS-CoV-2, coronavirus, 2019-nCoV, long-term, after recovery, long-haul, persistent, outcome, symptom, follow-up, and longitudinal. All English-language articles that presented primary data from cohort studies that reported the prevalence of persistent symptoms among individuals with SARS-CoV-2 infection and that had clearly defined and sufficient follow-up were included. Case reports, case series, and studies that described symptoms only at the time of infection and/or hospitalization were excluded. A structured framework was applied to appraise study quality. FINDINGS A total of 1974 records were identified; of those, 1247 article titles and abstracts were screened. After removal of duplicates and exclusions, 92 full-text articles were assessed for eligibility; 47 studies were deemed eligible, and 45 studies reporting 84 clinical signs or symptoms were included in the systematic review. Of 9751 total participants, 5266 (54.0%) were male; 30 of 45 studies reported mean or median ages younger than 60 years. Among 16 studies, most of which comprised participants who were previously hospitalized, the median proportion of individuals experiencing at least 1 persistent symptom was 72.5% (interquartile range [IQR], 55.0%-80.0%). Individual symptoms occurring most frequently included shortness of breath or dyspnea (26 studies; median frequency, 36.0%; IQR, 27.6%-50.0%), fatigue or exhaustion (25 studies; median frequency, 40.0%; IQR, 31.0%-57.0%), and sleep disorders or insomnia (8 studies; median 29.4%, IQR, 24.4%-33.0%). There were wide variations in the design and quality of the studies, which had implications for interpretation and often limited direct comparability and combinability. Major design differences included patient populations, definitions of time zero (ie, the beginning of the follow-up interval), follow-up lengths, and outcome definitions, including definitions of illness severity. CONCLUSIONS AND RELEVANCE This systematic review found that COVID-19 symptoms commonly persisted beyond the acute phase of infection, with implications for health-associated functioning and quality of life. Current studies of symptom persistence are highly heterogeneous, and future studies need longer follow-up, improved quality, and more standardized designs to reliably quantify risks.
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Affiliation(s)
- Tahmina Nasserie
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Michael Hittle
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Steven N. Goodman
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
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470
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Miskowiak KW, Johnsen S, Sattler SM, Nielsen S, Kunalan K, Rungby J, Lapperre T, Porsberg CM. Cognitive impairments four months after COVID-19 hospital discharge: Pattern, severity and association with illness variables. Eur Neuropsychopharmacol 2021; 46:39-48. [PMID: 33823427 PMCID: PMC8006192 DOI: 10.1016/j.euroneuro.2021.03.019] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
The ongoing Coronavirus Disease 2019 (COVID-19) pandemic has affected more than 100 million people and clinics are being established for diagnosing and treating lingering symptoms, so called long-COVID. A key concern are neurological and long-term cognitive complications. At the same time, the prevalence and nature of the cognitive sequalae of COVID-19 are unclear. The present study aimed to investigate the frequency, pattern and severity of cognitive impairments 3-4 months after COVID-19 hospital discharge, their relation to subjective cognitive complaints, quality of life and illness variables. We recruited patients at their follow-up visit at the respiratory outpatient clinic, Copenhagen University Hospital, Bispebjerg, approximately four months after hospitalisation with COVID-19. Patients underwent pulmonary, functional and cognitive assessments. Twenty-nine patients were included. The percentage of patients with clinically significant cognitive impairment ranged from 59% to 65% depending on the applied cut-off for clinical relevance of cognitive impairment, with verbal learning and executive functions being most affected. Objective cognitive impairment scaled with subjective cognitive complaints, lower work function and poorer quality of life. Cognitive impairments were associated with d-dimer levels during acute illness and residual pulmonary dysfunction. In conclusion, these findings provide new evidence for frequent cognitive sequelae of COVID-19 and indicate an association with the severity of the lung affection and potentially restricted cerebral oxygen delivery. Further, the associations with quality of life and functioning call for systematic cognitive screening of patients after recovery from severe COVID-19 illness and implementation of targeted treatments for patients with persistent cognitive impairments.
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Affiliation(s)
- K W Miskowiak
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; NEAD Group, Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | - S Johnsen
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - S M Sattler
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - S Nielsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; NEAD Group, Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - K Kunalan
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - J Rungby
- Department of Endocrinology, Bispebjerg University Hospital, Denmark; Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark
| | - T Lapperre
- Department of Pulmonology, University Hospital Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - C M Porsberg
- Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark; Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
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471
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Graham EL, Clark JR, Orban ZS, Lim PH, Szymanski AL, Taylor C, DiBiase RM, Jia DT, Balabanov R, Ho SU, Batra A, Liotta EM, Koralnik IJ. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 "long haulers". Ann Clin Transl Neurol 2021; 8:1073-1085. [PMID: 33755344 PMCID: PMC8108421 DOI: 10.1002/acn3.51350] [Citation(s) in RCA: 378] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Most SARS-CoV-2-infected individuals never require hospitalization. However, some develop prolonged symptoms. We sought to characterize the spectrum of neurologic manifestations in non-hospitalized Covid-19 "long haulers". METHODS This is a prospective study of the first 100 consecutive patients (50 SARS-CoV-2 laboratory-positive (SARS-CoV-2+ ) and 50 laboratory-negative (SARS-CoV-2- ) individuals) presenting to our Neuro-Covid-19 clinic between May and November 2020. Due to early pandemic testing limitations, patients were included if they met Infectious Diseases Society of America symptoms of Covid-19, were never hospitalized for pneumonia or hypoxemia, and had neurologic symptoms lasting over 6 weeks. We recorded the frequency of neurologic symptoms and analyzed patient-reported quality of life measures and standardized cognitive assessments. RESULTS Mean age was 43.2 ± 11.3 years, 70% were female, and 48% were evaluated in televisits. The most frequent comorbidities were depression/anxiety (42%) and autoimmune disease (16%). The main neurologic manifestations were: "brain fog" (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), and myalgias (55%), with only anosmia being more frequent in SARS-CoV-2+ than SARS-CoV-2- patients (37/50 [74%] vs. 18/50 [36%]; p < 0.001). Moreover, 85% also experienced fatigue. There was no correlation between time from disease onset and subjective impression of recovery. Both groups exhibited impaired quality of life in cognitive and fatigue domains. SARS-CoV-2+ patients performed worse in attention and working memory cognitive tasks compared to a demographic-matched US population (T-score 41.5 [37, 48.25] and 43 [37.5, 48.75], respectively; both p < 0.01). INTERPRETATION Non-hospitalized Covid-19 "long haulers" experience prominent and persistent "brain fog" and fatigue that affect their cognition and quality of life.
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Affiliation(s)
- Edith L. Graham
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jeffrey R. Clark
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Zachary S. Orban
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Patrick H. Lim
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - April L. Szymanski
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Carolyn Taylor
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Rebecca M. DiBiase
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Dan Tong Jia
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Roumen Balabanov
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Sam U. Ho
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ayush Batra
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Eric M. Liotta
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Igor J. Koralnik
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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472
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Raveendran AV, Jayadevan R, Sashidharan S. Long COVID: An overview. Diabetes Metab Syndr 2021; 15:869-875. [PMID: 33892403 PMCID: PMC8056514 DOI: 10.1016/j.dsx.2021.04.007] [Citation(s) in RCA: 414] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Long COVID is the collective term to denote persistence of symptoms in those who have recovered from SARS-CoV-2 infection. METHODS WE searched the pubmed and scopus databases for original articles and reviews. Based on the search result, in this review article we are analyzing various aspects of Long COVID. RESULTS Fatigue, cough, chest tightness, breathlessness, palpitations, myalgia and difficulty to focus are symptoms reported in long COVID. It could be related to organ damage, post viral syndrome, post-critical care syndrome and others. Clinical evaluation should focus on identifying the pathophysiology, followed by appropriate remedial measures. In people with symptoms suggestive of long COVID but without known history of previous SARS-CoV-2 infection, serology may help confirm the diagnosis. CONCLUSIONS This review will helps the clinicians to manage various aspects of Long COVID.
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Affiliation(s)
- A V Raveendran
- Govt. Medical College, Manjeri,Kottayam, Kozhikode, Kerala, India; Specialist in Internal Medicine, Badr Al Samaa, Barka, Oman.
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473
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Petracek LS, Suskauer SJ, Vickers RF, Patel NR, Violand RL, Swope RL, Rowe PC. Adolescent and Young Adult ME/CFS After Confirmed or Probable COVID-19. Front Med (Lausanne) 2021; 8:668944. [PMID: 33996867 PMCID: PMC8116546 DOI: 10.3389/fmed.2021.668944] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction: Fatigue is a common acute symptom following SARS-CoV-2 infection (COVID-19). The presence of persistent fatigue and impaired daily physical and cognitive function has led to speculation that like SARS-CoV-1 infection, COVID-19 will be followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Methods and Results: We describe three adolescent and young adult patients who had confirmed or probable COVID-19 infections early on during the pandemic and were referred for evaluation to the Chronic Fatigue Clinic at the Johns Hopkins Children's Center. All patients reported orthostatic intolerance symptoms within the first 2 weeks of illness, and 10-min passive standing tests were consistent with postural tachycardia syndrome. After 6 months of illness, all three patients met criteria for ME/CFS. Clinical features of interest included strong histories of allergies in all three patients, two of whom had elevations in plasma histamine. Each demonstrated limitations in symptom-free range of motion of the limbs and spine and two presented with pathological Hoffman reflexes. These comorbid features have been reported in adolescents and young adults with ME/CFS. Conclusion: ME/CFS can be triggered by COVID-19 in adolescents and young adults. Further work is needed to determine the pathogenesis of ME/CFS after COVID-19 and optimal methods of treating these patients. Our preliminary study calls attention to several comorbid features that deserve further attention as potential targets for intervention. These include neuromuscular limitations that could be treated with manual forms of therapy, orthostatic intolerance and POTS for which there are multiple medications and non-pharmacologic therapies, treatable allergic and mast cell phenomena, and neurologic abnormalities that may require specific treatment. Larger studies will need to ascertain the prevalence of these abnormalities.
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Affiliation(s)
- Lindsay S. Petracek
- Departments of Pediatrics, The Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, United States
| | - Stacy J. Suskauer
- Departments of Pediatrics, The Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, United States
- Departments of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, United States
| | | | - Neel R. Patel
- Central Florida Heart Care, Maitland, FL, United States
| | | | - Renee L. Swope
- Departments of Pediatrics, The Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, United States
| | - Peter C. Rowe
- Departments of Pediatrics, The Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, United States
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474
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Tran VT, Riveros C, Clepier B, Desvarieux M, Collet C, Yordanov Y, Ravaud P. Development and validation of the long covid symptom and impact tools, a set of patient-reported instruments constructed from patients' lived experience. Clin Infect Dis 2021; 74:278-287. [PMID: 33912905 PMCID: PMC8135558 DOI: 10.1093/cid/ciab352] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 01/07/2023] Open
Abstract
Objectives To develop and validate patient-reported instruments, based on patients' lived experiences, for monitoring the symptoms and impact of long covid. Design The long covid Symptom and Impact Tools (ST and IT) were constructed from the answers to a survey with open-ended questions to 492 patients with long COVID. Validation of the tools involved adult patients with suspected or confirmed COVID-19 and symptoms extending over three weeks after onset. Construct validity was assessed by examining the relations of the ST and IT scores with health related quality of life (EQ-5D-5L), function (PCFS, post-COVID functional scale), and perceived health (MYMOP2). Reliability was determined by a test-retest. The "patient acceptable symptomatic state" (PASS) was determined by the percentile method. Results Validation involved 1022 participants (55% with confirmed COVID-19, 79% female, and 12.5% hospitalized for COVID-19). The long COVID ST and IT scores were strongly correlated with the EQ-5D-5L (rs = -0.45 and rs = -0.59 respectively), the PCFS (rs = -0.39 and rs = -0.55), and the MYMOP2 (rs = -0.40 and rs = -0.59). Reproducibility was excellent with an interclass correlation coefficient of 0.83 (95% confidence interval 0.80 to 0.86) for the ST score and 0.84 (0.80 to 0.87) for the IT score. In total, 793 (77.5%) patients reported an unacceptable symptomatic state, thereby setting the PASS for the long covid IT score at 30 (28 to 33). Conclusions The long covid ST and IT tools, constructed from patients’ lived experiences, provide the first validated and reliable instruments for monitoring the symptoms and impact of long covid.
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Affiliation(s)
- Viet-Thi Tran
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Caroline Riveros
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | | | - Moïse Desvarieux
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
| | | | - Youri Yordanov
- Service d'Accueil des Urgences, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Philippe Ravaud
- Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, 22 W 168th St, New York, NY, USA
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475
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Wong TL, Weitzer DJ. Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)-A Systemic Review and Comparison of Clinical Presentation and Symptomatology. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:418. [PMID: 33925784 PMCID: PMC8145228 DOI: 10.3390/medicina57050418] [Citation(s) in RCA: 193] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/14/2022]
Abstract
Background and Objectives: Long COVID defines a series of chronic symptoms that patients may experience after resolution of acute COVID-19. Early reports from studies with patients with long COVID suggests a constellation of symptoms with similarities to another chronic medical illness-myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). A review study comparing and contrasting ME/CFS with reported symptoms of long COVID may yield mutualistic insight into the characterization and management of both conditions. Materials and Methods: A systemic literature search was conducted in MEDLINE and PsycInfo through to 31 January 2021 for studies related to long COVID symptomatology. The literature search was conducted in accordance with PRISMA methodology. Results: Twenty-one studies were included in the qualitative analysis. Long COVID symptoms reported by the included studies were compared to a list of ME/CFS symptoms compiled from multiple case definitions. Twenty-five out of 29 known ME/CFS symptoms were reported by at least one selected long COVID study. Conclusions: Early studies into long COVID symptomatology suggest many overlaps with clinical presentation of ME/CFS. The need for monitoring and treatment for patients post-COVID is evident. Advancements and standardization of long COVID research methodologies would improve the quality of future research, and may allow further investigations into the similarities and differences between long COVID and ME/CFS.
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Affiliation(s)
- Timothy L. Wong
- Department of Psychiatry, Rowan University School of Osteopathic Medicine, Mt. Laurel, NJ 08054, USA;
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476
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Armange L, Bénézit F, Picard L, Pronier C, Guillot S, Lentz PA, Carré F, Tattevin P, Revest M. Prevalence and characteristics of persistent symptoms after non-severe COVID-19: a prospective cohort study. Eur J Clin Microbiol Infect Dis 2021; 40:2421-2425. [PMID: 33893570 PMCID: PMC8064701 DOI: 10.1007/s10096-021-04261-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022]
Abstract
We performed a prospective cohort study of 311 outpatients with non-severe COVID-19 (187 women, median age 39 years). Of the 214 (68.8%) who completed the 6-week follow-up questionnaire, 115 (53.7%) had recovered. Others mostly reported dyspnea (n = 86, 40.2%), weight loss (n = 83, 38.8%), sleep disorders (n = 68, 31.8%), and anxiety (n = 56, 26.2%). Of those who developed ageusia and anosmia, these symptoms were still present at week 6 in, respectively, 11/111 (9.9%) and 19/114 (16.7%). Chest CT scan and lung function tests found no explanation in the most disabled patients (n = 23). This study confirms the high prevalence of persistent symptoms after non-severe COVID-19.
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Affiliation(s)
- Lucas Armange
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rue Henri Le Guilloux, 35033, Rennes, France
| | - François Bénézit
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rue Henri Le Guilloux, 35033, Rennes, France
| | - Léa Picard
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rue Henri Le Guilloux, 35033, Rennes, France
| | | | - Stéphanie Guillot
- Respiratory Physiology, Pontchaillou University Hospital, Rennes, France
| | | | - François Carré
- Cardiology and Sport Medicine, Pontchaillou University Hospital, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rue Henri Le Guilloux, 35033, Rennes, France.
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rue Henri Le Guilloux, 35033, Rennes, France
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477
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COVID-19 and fatigue: Where do we go from here? Response to Ortelli et al. J Neurol Sci 2021; 426:117470. [PMID: 33930693 PMCID: PMC8062907 DOI: 10.1016/j.jns.2021.117470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/05/2022]
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478
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Bilich T, Nelde A, Heitmann JS, Maringer Y, Roerden M, Bauer J, Rieth J, Wacker M, Peter A, Hörber S, Rachfalski D, Märklin M, Stevanović S, Rammensee HG, Salih HR, Walz JS. T cell and antibody kinetics delineate SARS-CoV-2 peptides mediating long-term immune responses in COVID-19 convalescent individuals. Sci Transl Med 2021; 13:eabf7517. [PMID: 33723016 PMCID: PMC8128286 DOI: 10.1126/scitranslmed.abf7517] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/14/2021] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
Long-term immunological memory to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial for the development of population-level immunity, which is the aim of vaccination approaches. Reports on rapidly decreasing antibody titers have led to questions regarding the efficacy of humoral immunity alone. The relevance of T cell memory after coronavirus disease 2019 (COVID-19) remains unclear. Here, we investigated SARS-CoV-2 antibody and T cell responses in matched samples of COVID-19 convalescent individuals up to 6 months after infection. Longitudinal analysis revealed decreasing and stable spike- and nucleocapsid-specific antibody responses, respectively. In contrast, functional T cell responses remained robust, and even increased, in both frequency and intensity. Single peptide mapping of T cell diversity over time identified open reading frame-independent, dominant T cell epitopes mediating long-term SARS-CoV-2 T cell responses. Identification of these epitopes may be fundamental for COVID-19 vaccine design.
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Affiliation(s)
- Tatjana Bilich
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
| | - Annika Nelde
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
| | - Jonas S Heitmann
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
| | - Yacine Maringer
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
| | - Malte Roerden
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Jens Bauer
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
| | - Jonas Rieth
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
| | - Marcel Wacker
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
| | - Andreas Peter
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Sebastian Hörber
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
| | - David Rachfalski
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Melanie Märklin
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
| | - Stefan Stevanović
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tübingen, 72076 Tübingen, Germany
| | - Hans-Georg Rammensee
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tübingen, 72076 Tübingen, Germany
| | - Helmut R Salih
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tübingen, 72076 Tübingen, Germany
| | - Juliane S Walz
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany.
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology and Robert Bosch Center for Tumor Diseases (RBCT), 70376 Stuttgart, Germany
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479
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Chun HJ, Coutavas E, Pine A, Lee AI, Yu V, Shallow M, Giovacchini CX, Mathews A, Stephenson B, Que LG, Lee PJ, Kraft BD. Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33564789 PMCID: PMC7872384 DOI: 10.1101/2021.01.31.21250870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Subjects recovering from COVID-19 frequently experience persistent respiratory ailments; however, little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID-19 severity. Methods: We performed a prospective cohort study of subjects with persistent symptoms after acute COVID-19, collecting clinical data, pulmonary function tests, and plasma samples used for multiplex profiling of inflammatory, metabolic, angiogenic, and fibrotic factors. Results: Sixty-one subjects were enrolled across two academic medical centers at a median of 9 weeks (interquartile range 6–10) after COVID-19 illness: n=13 subjects (21%) mild/non-hospitalized, n=30 (49%) hospitalized/non-critical, and n=18 subjects (30%) hospitalized/intensive care (“ICU”). Fifty-three subjects (85%) had lingering symptoms, most commonly dyspnea (69%) and cough (58%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity for carbon monoxide (DLCO) declined as COVID-19 severity increased (P<0.05), but did not correlate with respiratory symptoms. Partial least-squares discriminant analysis of plasma biomarker profiles clustered subjects by past COVID-19 severity. Lipocalin 2 (LCN2), matrix metalloproteinase-7 (MMP-7), and hepatocyte growth factor (HGF) identified by the model were significantly higher in the ICU group (P<0.05) and inversely correlated with FVC and DLCO (P<0.05), and were confirmed in a separate validation cohort (n=53). Conclusions: Subjective respiratory symptoms are common after acute COVID-19 illness but do not correlate with COVID-19 severity or pulmonary function. Host response profiles reflecting neutrophil activation (LCN2), fibrosis signaling (MMP-7), and alveolar repair (HGF) track with lung impairment and may be novel therapeutic or prognostic targets. Funding: The study was funded in part by the NHLBI (K08HL130557 to BDK and R01HL142818 to HJC), the DeLuca Foundation Award (AP), a donation from Jack Levin to the Benign Hematology Program at Yale, and Divisional/Departmental funds from Duke University.
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Affiliation(s)
- Hyung J Chun
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510
| | - Elias Coutavas
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710
| | - Alexander Pine
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510
| | - Alfred I Lee
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510
| | - Vanessa Yu
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510
| | - Marcus Shallow
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510
| | - Coral X Giovacchini
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710
| | - Anne Mathews
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710
| | - Brian Stephenson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710
| | - Loretta G Que
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710
| | - Patty J Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710
| | - Bryan D Kraft
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710
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480
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Sisó-Almirall A, Brito-Zerón P, Conangla Ferrín L, Kostov B, Moragas Moreno A, Mestres J, Sellarès J, Galindo G, Morera R, Basora J, Trilla A, Ramos-Casals M. Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4350. [PMID: 33923972 PMCID: PMC8073248 DOI: 10.3390/ijerph18084350] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/02/2021] [Accepted: 04/16/2021] [Indexed: 01/08/2023]
Abstract
Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors' clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.
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Affiliation(s)
- Antoni Sisó-Almirall
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain; (L.C.F.); (J.M.)
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), 08028 Barcelona, Spain;
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Pilar Brito-Zerón
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, 08036 Barcelona, Spain; (P.B.-Z.); (M.R.-C.)
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, 08034 Barcelona, Spain
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, 08036 Barcelona, Spain
| | - Laura Conangla Ferrín
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain; (L.C.F.); (J.M.)
| | - Belchin Kostov
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), 08028 Barcelona, Spain;
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), 08034 Barcelona, Spain
| | - Anna Moragas Moreno
- Jaume I Health Centre, Institut Català de la Salut, Universitat Rovira i Virgili, 43005 Tarragona, Spain;
| | - Jordi Mestres
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain; (L.C.F.); (J.M.)
| | | | - Gisela Galindo
- Permanent Board of the Spanish Society of Family and Community Medicine (semFYC), 08009 Barcelona, Spain;
| | - Ramon Morera
- Board of Spanish Society of Managers of Primary Care (SEDAP), 28026 Madrid, Spain;
| | | | - Antoni Trilla
- Faculty of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain;
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, 08036 Barcelona, Spain; (P.B.-Z.); (M.R.-C.)
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, 08036 Barcelona, Spain
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481
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Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms. Viruses 2021; 13:v13040700. [PMID: 33919537 PMCID: PMC8072585 DOI: 10.3390/v13040700] [Citation(s) in RCA: 192] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic has infected millions worldwide, leaving a global burden for long-term care of COVID-19 survivors. It is thus imperative to study post-COVID (i.e., short-term) and long-COVID (i.e., long-term) effects, specifically as local and systemic pathophysiological outcomes of other coronavirus-related diseases (such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS)) were well-cataloged. We conducted a comprehensive review of adverse post-COVID health outcomes and potential long-COVID effects. We observed that such adverse outcomes were not localized. Rather, they affected different human systems, including: (i) immune system (e.g., Guillain–Barré syndrome, rheumatoid arthritis, pediatric inflammatory multisystem syndromes such as Kawasaki disease), (ii) hematological system (vascular hemostasis, blood coagulation), (iii) pulmonary system (respiratory failure, pulmonary thromboembolism, pulmonary embolism, pneumonia, pulmonary vascular damage, pulmonary fibrosis), (iv) cardiovascular system (myocardial hypertrophy, coronary artery atherosclerosis, focal myocardial fibrosis, acute myocardial infarction, cardiac hypertrophy), (v) gastrointestinal, hepatic, and renal systems (diarrhea, nausea/vomiting, abdominal pain, anorexia, acid reflux, gastrointestinal hemorrhage, lack of appetite/constipation), (vi) skeletomuscular system (immune-mediated skin diseases, psoriasis, lupus), (vii) nervous system (loss of taste/smell/hearing, headaches, spasms, convulsions, confusion, visual impairment, nerve pain, dizziness, impaired consciousness, nausea/vomiting, hemiplegia, ataxia, stroke, cerebral hemorrhage), (viii) mental health (stress, depression and anxiety). We additionally hypothesized mechanisms of action by investigating possible molecular mechanisms associated with these disease outcomes/symptoms. Overall, the COVID-19 pathology is still characterized by cytokine storm that results to endothelial inflammation, microvascular thrombosis, and multiple organ failures.
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482
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Beghi E, Michael BD, Solomon T, Westenberg E, Winkler AS. Approaches to understanding COVID-19 and its neurological associations. Ann Neurol 2021; 89:1059-1067. [PMID: 33836104 PMCID: PMC8250622 DOI: 10.1002/ana.26076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/26/2021] [Accepted: 03/28/2021] [Indexed: 12/13/2022]
Abstract
There is an accumulating volume of research into neurological manifestations of COVID-19. However, inconsistent study designs, inadequate controls, poorly-validated tests, and differing settings, interventions, and cultural norms weaken study quality, comparability, and thus the understanding of the spectrum, burden and pathophysiology of these complications. Therefore, a global COVID-19 Neuro Research Coalition, together with the WHO, has reviewed reports of COVID-19 neurological complications and harmonised clinical measures for future research. This will facilitate well-designed studies using precise, consistent case definitions of SARS-CoV2 infection and neurological complications, with standardised forms for pooled data analyses that non-specialists can use, including in low-income settings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ettore Beghi
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Benedict D. Michael
- Institute of Infection, Veterinary and Ecological Sciences, University of LiverpoolLiverpoolUK
- NIHR Health Protection Research Unit in Emerging and Zoonotic InfectionsLiverpoolUK
- The Walton Centre NHS Foundation TrustLiverpoolUK
| | - Tom Solomon
- NIHR Health Protection Research Unit in Emerging and Zoonotic InfectionsLiverpoolUK
- The Walton Centre NHS Foundation TrustLiverpoolUK
- Faculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - Erica Westenberg
- Department of NeurologyCenter for Global Health, Klinikum rechts der Isar, Technical University of MunichMunichGermany
| | - Andrea S. Winkler
- Department of NeurologyCenter for Global Health, Klinikum rechts der Isar, Technical University of MunichMunichGermany
- Centre for Global Health, Institute of Health and Society, University of OsloOsloNorway
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483
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Betschart M, Rezek S, Unger I, Beyer S, Gisi D, Shannon H, Sieber C. Feasibility of an Outpatient Training Program after COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3978. [PMID: 33918887 PMCID: PMC8069591 DOI: 10.3390/ijerph18083978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023]
Abstract
Long-term physical consequences of coronavirus disease 2019 (COVID-19) are currently being reported. As a result, the focus is turning towards interventions that support recovery after hospitalization. To date, the feasibility of an outpatient program for people recovering from COVID-19 has not been investigated. This study presents data for a physiotherapy-led, comprehensive outpatient pulmonary rehabilitation (PR) program. Patients were recruited after hospital discharge. Training consisted of twice weekly, interval-based aerobic cycle endurance (ACE) training, followed by resistance training (RT); 60-90 min per session at intensities of 50% peak work rate; education and physical activity coaching were also provided. Feasibility outcomes included: recruitment and dropout rates, number of training sessions undertaken, and tolerability for dose and training mode. Of the 65 patients discharged home during the study period, 12 were successfully enrolled onto the program. Three dropouts (25%) were reported after 11-19 sessions. Tolerability of interval-based training was 83% and 100% for exercise duration of ACE and RT, respectively; 92% for training intensity, 83% progressive increase of intensity, and 83% mode in ACE. We tentatively suggest from these preliminary findings that the PR protocol used may be both feasible, and confer benefits to a small subgroup of patients recovering from COVID-19.
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Affiliation(s)
- Martina Betschart
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.R.); (I.U.); (D.G.)
| | - Spencer Rezek
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.R.); (I.U.); (D.G.)
| | - Ines Unger
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.R.); (I.U.); (D.G.)
| | - Swantje Beyer
- Department of Medicine, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.B.); (C.S.)
| | - David Gisi
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.R.); (I.U.); (D.G.)
| | - Harriet Shannon
- Department of Physiotherapy, University College London, London WC1N 1EH, UK;
| | - Cornel Sieber
- Department of Medicine, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.B.); (C.S.)
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484
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Yeoh YK, Zuo T, Lui GCY, Zhang F, Liu Q, Li AYL, Chung ACK, Cheung CP, Tso EYK, Fung KSC, Chan V, Ling L, Joynt G, Hui DSC, Chow KM, Ng SSS, Li TCM, Ng RWY, Yip TCF, Wong GLH, Chan FKL, Wong CK, Chan PKS, Ng SC. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut 2021; 70:698-706. [PMID: 33431578 PMCID: PMC7804842 DOI: 10.1136/gutjnl-2020-323020] [Citation(s) in RCA: 706] [Impact Index Per Article: 235.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/27/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although COVID-19 is primarily a respiratory illness, there is mounting evidence suggesting that the GI tract is involved in this disease. We investigated whether the gut microbiome is linked to disease severity in patients with COVID-19, and whether perturbations in microbiome composition, if any, resolve with clearance of the SARS-CoV-2 virus. METHODS In this two-hospital cohort study, we obtained blood, stool and patient records from 100 patients with laboratory-confirmed SARS-CoV-2 infection. Serial stool samples were collected from 27 of the 100 patients up to 30 days after clearance of SARS-CoV-2. Gut microbiome compositions were characterised by shotgun sequencing total DNA extracted from stools. Concentrations of inflammatory cytokines and blood markers were measured from plasma. RESULTS Gut microbiome composition was significantly altered in patients with COVID-19 compared with non-COVID-19 individuals irrespective of whether patients had received medication (p<0.01). Several gut commensals with known immunomodulatory potential such as Faecalibacterium prausnitzii, Eubacterium rectale and bifidobacteria were underrepresented in patients and remained low in samples collected up to 30 days after disease resolution. Moreover, this perturbed composition exhibited stratification with disease severity concordant with elevated concentrations of inflammatory cytokines and blood markers such as C reactive protein, lactate dehydrogenase, aspartate aminotransferase and gamma-glutamyl transferase. CONCLUSION Associations between gut microbiota composition, levels of cytokines and inflammatory markers in patients with COVID-19 suggest that the gut microbiome is involved in the magnitude of COVID-19 severity possibly via modulating host immune responses. Furthermore, the gut microbiota dysbiosis after disease resolution could contribute to persistent symptoms, highlighting a need to understand how gut microorganisms are involved in inflammation and COVID-19.
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Affiliation(s)
- Yun Kit Yeoh
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong,Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tao Zuo
- Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Fen Zhang
- Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Qin Liu
- Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Amy YL Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Arthur CK Chung
- Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chun Pan Cheung
- Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eugene YK Tso
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
| | - Kitty SC Fung
- Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong
| | - Veronica Chan
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gavin Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Susanna So Shan Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rita WY Ng
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Terry CF Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Francis KL Chan
- Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chun Kwok Wong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Paul KS Chan
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong,Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Siew C Ng
- Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong .,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.,State Key Laboratory for digestive disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Shatin, Hong Kong
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485
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Townsend L, Fogarty H, Dyer A, Martin-Loeches I, Bannan C, Nadarajan P, Bergin C, O'Farrelly C, Conlon N, Bourke NM, Ward SE, Byrne M, Ryan K, O'Connell N, O'Sullivan JM, Ni Cheallaigh C, O'Donnell JS. Prolonged elevation of D-dimer levels in convalescent COVID-19 patients is independent of the acute phase response. J Thromb Haemost 2021; 19:1064-1070. [PMID: 33587810 PMCID: PMC8013297 DOI: 10.1111/jth.15267] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Persistent fatigue, breathlessness, and reduced exercise tolerance have been reported following acute COVID-19 infection. Although immuno-thrombosis has been implicated in acute COVID-19 pathogenesis, the biological mechanisms underpinning long COVID remain unknown. We hypothesized that pulmonary microvascular immuno-thrombosis may be important in this context. METHODS One hundred fifty COVID-19 patients were reviewed at St James's Hospital Dublin between May and September 2020 at a median of 80.5 (range 44-155) days after initial diagnosis. These included patients hospitalized during initial illness (n = 69) and others managed entirely as out-patients (n = 81). Clinical examination, chest x-ray, and 6-min walk tests were performed. In addition, a range of coagulation and inflammatory markers were assessed. RESULTS Increased D-dimer levels (>500 ng/ml) were observed in 25.3% patients up to 4 months post-SARS-CoV-2 infection. On univariate analysis, elevated convalescent D-dimers were more common in COVID-19 patients who had required hospital admission and in patients aged more than 50 years (p < .001). Interestingly, we observed that 29% (n = 11) of patients with elevated convalescent D-dimers had been managed exclusively as out-patients during their illness. In contrast, other coagulation (prothrombin time, activated partial thromboplastin time, fibrinogen, platelet count) and inflammation (C-reactive protein, interleukin-6, and sCD25) markers had returned to normal in >90% of convalescent patients. CONCLUSIONS Elucidating the biological mechanisms responsible for sustained D-dimer increases may be of relevance in long COVID pathogenesis and has implications for clinical management of these patients.
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Affiliation(s)
- Liam Townsend
- Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Helen Fogarty
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Adam Dyer
- Department of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Ciaran Bannan
- Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
| | | | - Colm Bergin
- Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
| | - Cliona O'Farrelly
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Biochemistry & Immunology, Trinity College Dublin, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St James's Hospital, Dublin, Ireland
- Department of Immunology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M Bourke
- Department of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Soracha E Ward
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Byrne
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Kevin Ryan
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Niamh O'Connell
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Jamie M O'Sullivan
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cliona Ni Cheallaigh
- Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - James S O'Donnell
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
- National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
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486
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Variability in Forest Visit Numbers in Different Regions and Population Segments before and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073469. [PMID: 33810557 PMCID: PMC8037241 DOI: 10.3390/ijerph18073469] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
In view of the prevailing preferences for health and recreation revealed by previous studies as the main expected benefits of forest visits, the research presented herein focuses on whether such expectations would translate into a significant increase in the number of forest visits (NFV) following pandemic outbreaks. In this context, a Slovak nationwide survey on forests was conducted, with the main objective of casting light on possible changes in NFV as a coping mechanism or behavioral response to the discomfort and severe restrictions stemming from coronavirus disease 2019 (COVID-19) and the related measures. The survey was administered on a statistically representative sample after the pandemic’s first wave ebbed and restrictions were eased in the summer months of 2020. Collected data were assessed using ANOVA, the results of which supported the importance of forests as places providing opportunities for restoration of mental and physical resources. Forest accessibility as represented by forest coverage and settlement size emerged as a paramount factor affecting NFV rates both before and during the COVID-19 pandemic. The pandemic and its accompanying measures affected the relationships between NFV and average per capita income, type of employment, and most importantly age, highlighting possible vulnerabilities and disadvantages in certain population segments.
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487
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Rando HM, Bennett TD, Byrd JB, Bramante C, Callahan TJ, Chute CG, Davis HE, Deer R, Gagnier J, Koraishy FM, Liu F, McMurry JA, Moffitt RA, Pfaff ER, Reese JT, Relevo R, Robinson PN, Saltz JH, Solomonides A, Sule A, Topaloglu U, Haendel MA. Challenges in defining Long COVID: Striking differences across literature, Electronic Health Records, and patient-reported information. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.20.21253896. [PMID: 33791733 PMCID: PMC8010765 DOI: 10.1101/2021.03.20.21253896] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since late 2019, the novel coronavirus SARS-CoV-2 has introduced a wide array of health challenges globally. In addition to a complex acute presentation that can affect multiple organ systems, increasing evidence points to long-term sequelae being common and impactful. The worldwide scientific community is forging ahead to characterize a wide range of outcomes associated with SARS-CoV-2 infection; however the underlying assumptions in these studies have varied so widely that the resulting data are difficult to compareFormal definitions are needed in order to design robust and consistent studies of Long COVID that consistently capture variation in long-term outcomes. Even the condition itself goes by three terms, most widely "Long COVID", but also "COVID-19 syndrome (PACS)" or, "post-acute sequelae of SARS-CoV-2 infection (PASC)". In the present study, we investigate the definitions used in the literature published to date and compare them against data available from electronic health records and patient-reported information collected via surveys. Long COVID holds the potential to produce a second public health crisis on the heels of the pandemic itself. Proactive efforts to identify the characteristics of this heterogeneous condition are imperative for a rigorous scientific effort to investigate and mitigate this threat.
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Affiliation(s)
- Halie M. Rando
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tellen D. Bennett
- Center for Health AI and Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
| | | | | | - Tiffany J. Callahan
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Computational Bioscience, University of Colorado Anschutz Medical Campus, Boulder, CO, USA
| | - Christopher G. Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Rachel Deer
- The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Joel Gagnier
- Computational Bioscience, University of Colorado Anschutz Medical Campus, Boulder, CO, USA
| | | | - Feifan Liu
- University of Massachusetts Medical School Worcester, Worcester, MA, USA
| | - Julie A. McMurry
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard A. Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Emily R. Pfaff
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Justin T. Reese
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Rose Relevo
- Oregon Health & Science University, Portland, OR, USA
| | - Peter N. Robinson
- The Jackson Laboratory For Genomic Medicine, Farmington, CT, USA
- Institute for Systems Genomics, University of Connecticut, Farmington, CT, USA
| | - Joel H. Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | | | - Anupam Sule
- Saint Joseph Mercy Health System, Ypsilanti, MI, USA
| | - Umit Topaloglu
- School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Melissa A. Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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488
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Versace V, Sebastianelli L, Ferrazzoli D, Romanello R, Ortelli P, Saltuari L, D'Acunto A, Porrazzini F, Ajello V, Oliviero A, Kofler M, Koch G. Intracortical GABAergic dysfunction in patients with fatigue and dysexecutive syndrome after COVID-19. Clin Neurophysiol 2021; 132:1138-1143. [PMID: 33774378 PMCID: PMC7954785 DOI: 10.1016/j.clinph.2021.03.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022]
Abstract
Objective A high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations. Methods Twelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABAA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABAB receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level. Results Post-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished. Conclusions The present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome. Significance TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.
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Affiliation(s)
- Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Roberto Romanello
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Alessia D'Acunto
- Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Francesco Porrazzini
- Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Valentina Ajello
- Department of Cardiac Anesthesia, Tor Vergata University Hospital, Rome, Italy
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit/Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
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489
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Humphreys H, Kilby L, Kudiersky N, Copeland R. Long COVID and the role of physical activity: a qualitative study. BMJ Open 2021; 11:e047632. [PMID: 33692189 PMCID: PMC7948149 DOI: 10.1136/bmjopen-2020-047632] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/03/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To explore the lived experience of long COVID with particular focus on the role of physical activity. DESIGN Qualitative study using semistructured interviews. PARTICIPANTS 18 people living with long COVID (9 men, 9 women; aged between 18-74 years; 10 white British, 3 white Other, 3 Asian, 1 black, 1 mixed ethnicity) recruited via a UK-based research interest database for people with long COVID. SETTING Telephone interviews with 17 participants living in the UK and 1 participant living in the USA. RESULTS Four themes were generated. Theme 1 describes how participants struggled with drastically reduced physical function, compounded by the cognitive and psychological effects of long COVID. Theme 2 highlights challenges associated with finding and interpreting advice about physical activity that was appropriately tailored. Theme 3 describes individual approaches to managing symptoms including fatigue and 'brain fog' while trying to resume and maintain activities of daily living and other forms of exercise. Theme 4 illustrates the battle with self-concept to accept reduced function (even temporarily) and the fear of permanent reduction in physical and cognitive ability. CONCLUSIONS This study provides insight into the challenges of managing physical activity alongside the extended symptoms associated with long COVID. Findings highlight the need for greater clarity and tailoring of physical activity-related advice for people with long COVID and improved support to resume activities important to individual well-being.
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Affiliation(s)
- Helen Humphreys
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Laura Kilby
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Nik Kudiersky
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
- National Centre for Sport and Exercise Medicine, Sheffield Hallam University, Sheffield, UK
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490
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Theoharides TC, Cholevas C, Polyzoidis K, Politis A. Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue. Biofactors 2021; 47:232-241. [PMID: 33847020 PMCID: PMC8250989 DOI: 10.1002/biof.1726] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 leads to severe respiratory problems, but also to long-COVID syndrome associated primarily with cognitive dysfunction and fatigue. Long-COVID syndrome symptoms, especially brain fog, are similar to those experienced by patients undertaking or following chemotherapy for cancer (chemofog or chemobrain), as well in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or mast cell activation syndrome (MCAS). The pathogenesis of brain fog in these illnesses is presently unknown but may involve neuroinflammation via mast cells stimulated by pathogenic and stress stimuli to release mediators that activate microglia and lead to inflammation in the hypothalamus. These processes could be mitigated by phytosomal formulation (in olive pomace oil) of the natural flavonoid luteolin.
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Affiliation(s)
- Theoharis C. Theoharides
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of ImmunologyTufts University School of MedicineBostonMassachusettsUSA
- School of Graduate Biomedical SciencesTufts University School of MedicineBostonMassachusettsUSA
- Department of Internal MedicineTufts University School of Medicine and Tufts Medical CenterBostonMassachusettsUSA
- Department of PsychiatryTufts University School of Medicine and Tufts Medical CenterBostonMassachusettsUSA
- BrainGateThessalonikiGreece
| | | | | | - Antonios Politis
- First Department of PsychiatryEginition Hospital, National and Kapodistrian UniversityAthensGreece
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491
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Moreno-Pérez O, Merino E, Leon-Ramirez JM, Andres M, Ramos JM, Arenas-Jiménez J, Asensio S, Sanchez R, Ruiz-Torregrosa P, Galan I, Scholz A, Amo A, González-delaAleja P, Boix V, Gil J. Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect 2021; 82:378-383. [PMID: 33450302 PMCID: PMC7802523 DOI: 10.1016/j.jinf.2021.01.004] [Citation(s) in RCA: 354] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aims to analyze the incidence of Post-acute COVID-19 syndrome (PCS) and its components, and to evaluate the acute infection phase associated risk factors. METHODS A prospective cohort study of adult patients who had recovered from COVID-19 (27th February to 29th April 2020) confirmed by PCR or subsequent seroconversion, with a systematic assessment 10-14 weeks after disease onset. PCS was defined as the persistence of at least one clinically relevant symptom, or abnormalities in spirometry or chest radiology. Outcome predictors were analyzed by multiple logistic regression (OR; 95%CI). RESULTS Two hundred seventy seven patients recovered from mild (34.3%) or severe (65.7%) forms of SARS-CoV-2 infection were evaluated 77 days (IQR 72-85) after disease onset. PCS was detected in 141 patients (50.9%; 95%CI 45.0-56.7%). Symptoms were mostly mild. Alterations in spirometry were noted in 25/269 (9.3%), while in radiographs in 51/277 (18.9%). No baseline clinical features behaved as independent predictors of PCS development. CONCLUSIONS A Post-acute COVID-19 syndrome was detected in a half of COVID19 survivors. Radiological and spirometric changes were mild and observed in less than 25% of patients. No baseline clinical features behaved as independent predictors of Post-acute COVID-19 syndrome development.
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Affiliation(s)
- Oscar Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine department, Miguel Hernández University, Elche, Spain.
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital, Alicante Institute of Health and Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Jose-Manuel Leon-Ramirez
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Mariano Andres
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Rheumatology department, Alicante General University Hospital Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Jose Manuel Ramos
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Juan Arenas-Jiménez
- Radiology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Santos Asensio
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Rosa Sanchez
- Neurology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Paloma Ruiz-Torregrosa
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Irene Galan
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Alexander Scholz
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Antonio Amo
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pilar González-delaAleja
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Unit of Infectious Diseases, Alicante General University Hospital, Alicante Institute of Health and Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Joan Gil
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
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492
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Alwani M, Yassin A, Al-Zoubi RM, Aboumarzouk OM, Nettleship J, Kelly D, Al-Qudimat AR, Shabsigh R. Sex-based differences in severity and mortality in COVID-19. Rev Med Virol 2021; 31:e2223. [PMID: 33646622 PMCID: PMC8014761 DOI: 10.1002/rmv.2223] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 01/08/2023]
Abstract
The current coronavirus disease (COVID‐19) pandemic caused by novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has a male bias in severity and mortality. This is consistent with previous coronavirus pandemics such as SARS‐CoV and MERS‐CoV, and viral infections in general. Here, we discuss the sex‐disaggregated epidemiological data for COVID‐19 and highlight underlying differences that may explain the sexual dimorphism to help inform risk stratification strategies and therapeutic options.
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Affiliation(s)
- Mustafa Alwani
- Surgical Research Section, Hamad Medical Corporation, Doha, Qatar.,Jordan University of Science and Technology, School of Medicine, Irbid, Jordan
| | - Aksam Yassin
- Surgical Research Section, Hamad Medical Corporation, Doha, Qatar.,Department of Surgery, Hamad Medical Corporation, Division of Urology/Andrology & Men's Health, Doha, Qatar.,Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
| | - Raed M Al-Zoubi
- Surgical Research Section, Hamad Medical Corporation, Doha, Qatar.,Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M Aboumarzouk
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,College of Medicine, University of Glasgow, Glasgow, UK
| | - Joanne Nettleship
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | - Daniel Kelly
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK.,Biomolecular Research Centre, Sheffield Hallam University, Sheffield, UK
| | | | - Ridwan Shabsigh
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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493
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Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A, Villapol S. More Than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-Analysis. RESEARCH SQUARE 2021:rs.3.rs-266574. [PMID: 33688642 PMCID: PMC7941645 DOI: 10.21203/rs.3.rs-266574/v1] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. Methods . LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. All articles with original data for detecting long-term COVID-19 published before 1 st of January 2021 and with a minimum of 100 patients were included. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. Heterogeneity was assessed using I 2 statistics. This systematic review followed Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines, although the study protocol was not registered. Results. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. The follow-up time ranged from 14 to 110 days post-viral infection. The age of the study participants ranged between 17 and 87 years. It was estimated that 80% (95% CI 65-92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). All meta-analyses showed medium (n=2) to high heterogeneity (n=13). Conclusions . In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, the severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.
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Affiliation(s)
| | | | - Carol Perelman
- National Autonomous University of Mexico: Universidad Nacional Autonoma de Mexico
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494
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Valencia BM, Cvejic E, Vollmer-Conna U, Hickie IB, Wakefield D, Li H, Pedergnana V, Rodrigo C, Lloyd AR. The severity of the pathogen-induced acute sickness response is affected by polymorphisms in genes of the NLRP3 inflammasome pathway. Brain Behav Immun 2021; 93:186-193. [PMID: 33434563 PMCID: PMC7794598 DOI: 10.1016/j.bbi.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 12/27/2022] Open
Abstract
The acute sickness response (ASR) is a stereotyped set of symptoms including fatigue, pain, and disturbed mood, which are present in most acute infections. The immunological mechanisms of the ASR are conserved, with variations in severity determined partly by the pathogen, but also by polymorphisms in host genes. The ASR was characterised in three different serologically-confirmed acute infections in Caucasians (n = 484) across four symptom domains or endophenotypes (termed 'Fatigue', 'Musculoskeletal pain', 'Mood disturbance', and 'Acute sickness'). Correlations were sought with functional single nucleotide polymorphisms in the NLRP3 inflammasone pathway and severity of the endophenotypes. Individuals with severe Fatigue, Musculoskeletal pain, or Mood endophenotypes were more likely to have prior episodes of significant fatigue (11.4 vs. 3.8%, p = 0.07), pain (14.3 vs. 1.2%, p = 0.001), or Mood disturbance (13 vs 1%, p=0.001), suggesting trait characteristics. The high functioning allele of the rs35829419 SNP in NLRP3 was more common in those with severe Fatigue (OR = 13.3, 95% CI: 1.7-104), particularly in a dominant inheritance pattern (OR = 13.4, 95% CI: 1.8-586.3). In a multivariable analysis assuming dominant inheritance, both rs35829419 and the rs4848306 SNP in Interleukin(IL)-1β, were independently associated with severe Fatigue (OR = 29.6, 95% CI: 2.6-330.9 and OR = 13, 95% CI: 2.7-61.8, respectively). The severity of fatigue in acute infection is influenced by genetic polymorphisms in NLRP3 and IL-1β.
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Affiliation(s)
- Braulio M. Valencia
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Erin Cvejic
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27), Fisher Rd, NSW 2006, Australia,Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ute Vollmer-Conna
- Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Camperdown, NSW 2050, Australia
| | - Denis Wakefield
- School of Medical Sciences, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Hui Li
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Vincent Pedergnana
- Laboratoire MIVEGEC, Institut de recherche pour le développement, 39 Avenue Charles Flahault, 34090 Montpellier, France
| | - Chaturaka Rodrigo
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia,School of Medical Sciences, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Andrew R. Lloyd
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia,Corresponding author at: Viral Immunology Systems Program, Kirby Institute, UNSW Sydney, 2052, Australia
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495
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Townsend L, Moloney D, Finucane C, McCarthy K, Bergin C, Bannan C, Kenny RA. Fatigue following COVID-19 infection is not associated with autonomic dysfunction. PLoS One 2021; 16:e0247280. [PMID: 33630906 PMCID: PMC7906457 DOI: 10.1371/journal.pone.0247280] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The long-term clinical and physiological consequences of COVID-19 infection remain unclear. While fatigue has emerged as a common symptom following infection, little is known about its links with autonomic dysfunction. SARS-CoV-2 is known to infect endothelial cells in acute infection, resulting in autonomic dysfunction. Here we set out to test the hypothesis that this results in persistent autonomic dysfunction and is associated with post-COVID fatigue in convalescent patients. METHODS We recruited 20 fatigued and 20 non-fatigued post-COVID patients (median age 44.5 years, 36/40 (90%) female, median time to follow up 166.5 days). Fatigue was assessed using the Chalder Fatigue Scale. These underwent the Ewing's autonomic function test battery, including deep breathing, active standing, Valsalva manoeuvre and cold-pressor testing, with continuous electrocardiogram and blood pressure monitoring, as well as near-infrared spectroscopy-based cerebral oxygenation. 24-hour ambulatory blood pressure monitoring was also conducted, and patients completed the generalised anxiety disorder-7 questionnaire. We assessed between-group differences in autonomic function test results and used unadjusted and adjusted linear regression to investigate the relationship between fatigue, anxiety, and autonomic test results. RESULTS We found no pathological differences between fatigued and non-fatigued patients on autonomic testing or on 24-hour blood pressure monitoring. Symptoms of orthostatic intolerance were reported by 70% of the fatigued cohort at the time of active standing, with no associated physiological abnormality detected. Fatigue was strongly associated with increased anxiety (p <0.001), with no patients having a pre-existing diagnosis of anxiety. CONCLUSIONS These results demonstrate the significant burden of fatigue, symptoms of autonomic dysfunction and anxiety in the aftermath of COVID-19 infection, but reassuringly do not demonstrate pathological findings on autonomic testing.
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Affiliation(s)
- Liam Townsend
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - David Moloney
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Ciaran Finucane
- Falls and Syncope Unit, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
- Department of Medical Physics and Bioengineering, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Kevin McCarthy
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Colm Bergin
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Ciaran Bannan
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Rose-Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
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496
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Baic S. Managing malnutrition in the community during the COVID-19 pandemic. Nurs Stand 2021; 36:61-66. [PMID: 33615758 DOI: 10.7748/ns.2021.e11667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
The prevalence of risk factors for malnutrition has increased during the coronavirus disease 2019 (COVID-19) pandemic. These risk factors include various symptoms and effects of COVID-19, such as breathlessness, coughing, inflammation, sarcopenia, anorexia and loss of taste or smell, as well as the side effects of treatment. In addition, public health infection prevention and control measures can inadvertently reduce access to food and increase social isolation, thus adversely affecting people's nutritional status. This article outlines practical interventions for preventing and managing malnutrition in the community, particularly where it is exacerbated by the social restrictions in place to contain the COVID-19 pandemic.
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Affiliation(s)
- Sue Baic
- Nutrition Basics, Bristol, England
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497
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Prevalence and Determinants of Fatigue after COVID-19 in Non-Hospitalized Subjects: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042030. [PMID: 33669714 PMCID: PMC7921928 DOI: 10.3390/ijerph18042030] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 12/16/2022]
Abstract
This study assessed the prevalence and determinants of fatigue in a population-based cohort of non-hospitalized subjects 1.5-6 months after COVID-19. It was a mixed postal/web survey of all non-hospitalized patients ≥18 years with a positive PCR for SARS-CoV-2 until 1 June 2020 in a geographically defined area. In total, 938 subjects received a questionnaire including the Chalder fatigue scale (CFQ-11) and the energy/fatigue scale of the RAND-36 questionnaire. We estimated z scores for comparison with general population norms. Determinants were analyzed using multivariable logistic and linear regression analysis. In total, 458 subjects (49%) responded to the survey at median 117.5 days after COVID-19 onset, and 46% reported fatigue. The mean z scores of the CFQ-11 total was 0.70 (95% CI 0.58 to 0.82), CFQ-11 physical 0.66 (0.55 to 0.78), CFQ-11 mental 0.47 (0.35 to 0.59) and RAND-36 energy/fatigue -0.20 (-0.31 to -0.1); all CFQ-11 scores differed from those of the norm population (p < 0.001). Female sex, single/divorced/widowed, short time since symptom debut, high symptom load, and confusion during acute COVID-19 were associated with higher multivariable odds of fatigue. In conclusion, the burden of post-viral fatigue following COVID-19 was high, and higher than in a general norm population. Symptoms of fatigue were most prevalent among women, those having a high symptom load, or confusion during the acute phase.
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498
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de Sire A, Andrenelli E, Negrini F, Patrini M, Lazzarini SG, Ceravolo MG. Rehabilitation and COVID-19: a rapid living systematic review by Cochrane Rehabilitation Field updated as of December 31st, 2020 and synthesis of the scientific literature of 2020. Eur J Phys Rehabil Med 2021; 57:181-188. [PMID: 33599442 DOI: 10.23736/s1973-9087.21.06870-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION COVID-19 infection significantly increased mortality risk and the burden of disability in most survivors, regardless of symptom severity at onset. The rehabilitation needs of people infected are receiving growing attention, as evidenced by the increasing number of publications, including those addressing the chronic consequences of infection. This rapid living systematic review reports the evidence published in November and December 2020 and summarises the entire body of literature on rehabilitation in COVID-19 patients published in 2020. EVIDENCE ACQUISITION This update was performed using the methodology reported by the second edition conducted by Cochrane Rehabilitation REH-COVER Action. We searched PubMed, Embase, CINAHL, Scopus, Web of Science, and Pedro databases. Papers related to COVID-19 and rehabilitation were retrieved and summarised descriptively. EVIDENCE SYNTHESIS The search retrieved 4441 studies. After the removal of duplicates and the screening for title and abstract, we retained 105 studies. Of these, we included 54 in the qualitative synthesis of this update. According to OCEBM 2011 levels of evidence table, most studies (64.8%) fall within the category of level 4 evidence. Up to 40.7% of papers included COVID-19 patients in the postacute phase. In 2020, our rapid living systematic review included 230 studies; most of these (73.9%) were level 4 studies, 25.7% were level 3, and only one study was level 2. The evidence level improved over time. While most studies (44.8%) included patients with acute COVID-19, we observed a gradual increase in the number of reports about chronic symptoms and the long-term consequences of the infection. CONCLUSIONS The update of the rapid living systematic review by Cochrane Rehabilitation Field demonstrates an increase in the level of evidence of studies addressing the rehabilitation needs associated with COVID-19 infection. Although most studies are still case reports/series, there is a trend towards conducting prospective investigations of the early natural history of the disease (first months post onset). High-quality-level studies on the efficacy of rehabilitation, and long-term monitoring of the disease and its sequelae are yet to emerge.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, "Politecnica delle Marche" University, Ancona, Italy
| | | | | | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, "Politecnica delle Marche" University, Ancona, Italy
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499
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Yong SJ. Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ACS Chem Neurosci 2021; 12:573-580. [PMID: 33538586 PMCID: PMC7874499 DOI: 10.1021/acschemneuro.0c00793] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
Long-COVID is a postviral illness that can affect survivors of COVID-19, regardless of initial disease severity or age. Symptoms of long-COVID include fatigue, dyspnea, gastrointestinal and cardiac problems, cognitive impairments, myalgia, and others. While the possible causes of long-COVID include long-term tissue damage, viral persistence, and chronic inflammation, the review proposes, perhaps for the first time, that persistent brainstem dysfunction may also be involved. This hypothesis can be split into two parts. The first is the brainstem tropism and damage in COVID-19. As the brainstem has a relatively high expression of ACE2 receptor compared with other brain regions, SARS-CoV-2 may exhibit tropism therein. Evidence also exists that neuropilin-1, a co-receptor of SARS-CoV-2, may be expressed in the brainstem. Indeed, autopsy studies have found SARS-CoV-2 RNA and proteins in the brainstem. The brainstem is also highly prone to damage from pathological immune or vascular activation, which has also been observed in autopsy of COVID-19 cases. The second part concerns functions of the brainstem that overlap with symptoms of long-COVID. The brainstem contains numerous distinct nuclei and subparts that regulate the respiratory, cardiovascular, gastrointestinal, and neurological processes, which can be linked to long-COVID. As neurons do not readily regenerate, brainstem dysfunction may be long-lasting and, thus, is long-COVID. Indeed, brainstem dysfunction has been implicated in other similar disorders, such as chronic pain and migraine and myalgic encephalomyelitis or chronic fatigue syndrome.
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Affiliation(s)
- Shin Jie Yong
- Department of Biological
Sciences, Sunway University, Petaling Jaya, Selangor 47500, Malaysia
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500
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Mondelli V, Pariante CM. What can neuroimmunology teach us about the symptoms of long-COVID? OXFORD OPEN IMMUNOLOGY 2021; 2:iqab004. [PMID: 34192271 PMCID: PMC7928677 DOI: 10.1093/oxfimm/iqab004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/19/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
Long-Coronavirus Disease (Long-COVID) is becoming increasingly recognized due to the persistence of symptoms such as profound fatigue, neurocognitive difficulties, muscle pains and weaknesses and depression, which would last beyond 3-12 weeks following infection with SARS-CoV-2. These particular symptoms have been extensively observed and studied in the context of previous psychoneuroimmunology research. In this short commentary, we discuss how previous neuroimmunology studies could help us to better understand pathways behind the development of these prolonged symptoms. Various mechanisms, including viral neuroinvasion, glial cells activation, neurogenesis, oxidative stress have been shown to explain these symptoms in the context of other disorders. Previous neuroimmunology findings could represent helpful pointers for future research on long-COVID symptoms and suggest potential management strategies for patients suffering with long-COVID.
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Affiliation(s)
- Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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