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Comprehensive Clinical Characterisation of Brain Fog in Adults Reporting Long COVID Symptoms. J Clin Med 2022; 11:jcm11123440. [PMID: 35743516 PMCID: PMC9224578 DOI: 10.3390/jcm11123440] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Introduction: A subset of individuals experiencing long COVID symptoms are affected by ‘brain fog’, a lay term that often refers to general cognitive dysfunction but one that is still poorly characterised. In this study, a comprehensive clinical characterisation of self-reported brain fog was conducted vis-à-vis other long COVID symptoms and parameters of mental, cognitive, and physical health. (2) Methodology: Adult participants reporting long COVID symptoms were recruited from hospital clinics and as self-referrals. Participants completed a battery of questionnaires and clinical assessments, including COVID-19 history, symptomatology, self-reported scales (Chalder Fatigue Scale [CFQ], Center for Epidemiological Studies Depression Scale, and Impact of Events Scale–Revised), computer-based cognitive assessments (simple response time and choice reaction time tasks), physical performance tests (gait velocity and muscle strength assessments), and an orthostatic active stand test. A systematic comparison between participants with and without self-reported brain fog was conducted, and a backwards binary logistic regression model was computed to identify the strongest independent associations with brain fog. This was complemented by an automatic cluster analysis to rank the importance of associations. Finally, a structural equation model was postulated with a causal model of key symptomatic indicators and functional consequences of brain fog as a latent variable. (3) Results: Of 108 participants assessed, brain fog was a self-reported symptom in 71 (65.7%) participants. Those with brain fog were at a longer point in time since COVID-19 onset and reported longer duration of low activity during the acute illness. When assessed, those with brain fog had higher frequencies of subjective memory impairment, word-finding difficulties, dizziness, myalgia, arthralgia, hyperhidrosis, cough, voice weakness, throat pain, visual and hearing problems, dysosmia, paraesthesia, chest pain, skin rashes, and hair loss; mean scores in fatigue, depression, and post-traumatic stress scales were higher; performance in both computer-based cognitive tasks was poorer; and measured gait speed and grip strength were lower. The logistic regression suggested that the best independent associations with brain fog were memory impairment, CFQ, and myalgia. The cluster analysis suggested that the most important associations with brain fog were CFQ, dizziness, myalgia, reduced gait speed, word-finding difficulties, reduced grip strength, and memory impairment. The SEM was consistent with key indicators of brain fog being CFQ, dizziness, myalgia, word-finding difficulties, and memory impairment; and reduced grip strength, gait speed, and cognitive response times its functional consequences. (4) Conclusions: The findings indicate that self-reported brain fog in long COVID is a recognisable symptom cluster primarily characterised by fatigue, dizziness, myalgia, word-finding difficulties, and memory impairment and has adverse psychological and psychomotor correlates. In long COVID, brain fog should be regarded as a wide-ranging symptom and addressed holistically with medical, psychological, and rehabilitative supports as guided by individual needs.
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Abstract
Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or long coronavirus disease (COVID) is an emerging syndrome characterized by multiple persisting or newly emergent symptoms following the acute phase of SARS-CoV-2 infection. For affected patients, these prolonged symptoms can have a relapsing and remitting course and may be associated with disability and frequent health care utilization. Although many symptom-driven treatments are available, management remains challenging and often requires a multidisciplinary approach. This article summarizes the emerging consensus on definitions, epidemiology, and pathophysiology of long COVID and discusses what is understood about prevention, evaluation, and treatment of this syndrome.
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Affiliation(s)
- Aluko A Hope
- Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Oregon Health & Science University (OHSU), 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239, USA.
| | - Teresa H Evering
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, 413 East 69th Street, Belfer Research Building, BB-512, New York, NY 10021, USA.
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Ponce-Campos SD, Díaz JM, Moreno-Agundis D, González-Delgado AL, Andrade-Lozano P, Avelar-González FJ, Hernández-Cuellar E, Torres-Flores F. A Physiotherapy Treatment Plan for Post-COVID-19 Patients That Improves the FEV1, FVC, and 6-Min Walk Values, and Reduces the Sequelae in 12 Sessions. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:907603. [PMID: 36188947 PMCID: PMC9397810 DOI: 10.3389/fresc.2022.907603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of Coronavirus disease 2019 (COVID-19), a pandemic disease declared in 2020. The clinical manifestations of this pathology are heterogeneous including fever, cough, dyspnea, anosmia, headache, fatigue, taste dysfunction, among others. Survivors of COVID-19 have demonstrated several persistent symptoms derived from its multisystemic physiopathology. These symptoms can be fatigue, dyspnea, chest pain, dry and productive cough, respiratory insufficiency, and psychoemotional disturbance. To reduce and recover from the post-COVID-19 sequelae is fundamental an early and multifactorial medical treatment. Integral post-COVID-19 physiotherapy is a tool to reduce dyspnea, improve lung capacity, decrease psychoemotional alterations, as well as increase the muscle strength affected by this disease. Thus, the aim of this study was to establish a novel physiotherapeutic plan for post-COVID-19 patients, evaluating the effect of this treatment in the reduction of the sequelae in terms of lung capacity, cardio-respiratory, and muscular strength improvements. This was a cross-sectional study in which a protocol of 12 sessions in 4 weeks of physiotherapy was implemented in the patients enrolled. We conducted a medical assessment, an interview, a DASS-21 test, a spirometry, a 6-min walk test, and a hand dynamometer test to evaluate the post-COVID condition of patients before and after the sessions. A total of 42 patients participated in the program. Results of this work showed a decrease of around 50% of post-COVID-19 sequelae and an improvement in the psychoemotional status of patients. Also, we observed an increase of 7.16% in the FEV1 value and 7.56% for FVC. In addition, the maximal functional capacity increased by 0.577 METs, the 6-min walk test performance increased by 13%, and the SpO2 improved by 1.40%. Finally, the handgrip strength test showed an improvement in the left hand and right hand of 2.90 and 2.24 Kg, respectively. We developed this study to propose a novel methodology to provide information for a better treatment and management of post-COVID-19 patients.
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Affiliation(s)
- Silvia Denise Ponce-Campos
- Unidad Medico Didáctica, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
- Unidad de Medicina Interna, Adscripción al Servicio de Neumología, Hospital General ISSSTE Aguascalientes, Aguascalientes, Mexico
| | - Juan Manuel Díaz
- Unidad Medico Didáctica, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
- *Correspondence: Juan Manuel Díaz
| | | | | | - Paulina Andrade-Lozano
- Departamento de Medicina, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
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Kooner HK, McIntosh MJ, Matheson AM, Venegas C, Radadia N, Ho T, Haider EA, Konyer NB, Santyr GE, Albert MS, Ouriadov A, Abdelrazek M, Kirby M, Dhaliwal I, Nicholson JM, Nair P, Svenningsen S, Parraga G. 129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised people with post-acute COVID-19 syndrome. BMJ Open Respir Res 2022; 9:9/1/e001235. [PMID: 35584850 PMCID: PMC9119175 DOI: 10.1136/bmjresp-2022-001235] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients often report persistent symptoms beyond the acute infectious phase of COVID-19. Hyperpolarised 129Xe MRI provides a way to directly measure airway functional abnormalities; the clinical relevance of 129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised patients who had COVID-19 has not been ascertained. It remains unclear if persistent symptoms beyond the infectious phase are related to small airways disease and ventilation heterogeneity. Hence, we measured 129Xe MRI ventilation defects, pulmonary function and symptoms in ever-hospitalised and never-hospitalised patients who had COVID-19 with persistent symptoms consistent with post-acute COVID-19 syndrome (PACS). METHODS Consenting participants with a confirmed diagnosis of PACS completed 129Xe MRI, CT, spirometry, multi-breath inert-gas washout, 6-minute walk test, St. George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnoea scale, modified Borg scale and International Physical Activity Questionnaire. Consenting ever-COVID volunteers completed 129Xe MRI and pulmonary function tests only. RESULTS Seventy-six post-COVID and nine never-COVID participants were evaluated. Ventilation defect per cent (VDP) was abnormal and significantly greater in ever-COVID as compared with never-COVID participants (p<0.001) and significantly greater in ever-hospitalised compared with never-hospitalised participants who had COVID-19 (p=0.048), in whom diffusing capacity of the lung for carbon-monoxide (p=0.009) and 6-minute walk distance (6MWD) (p=0.005) were also significantly different. 129Xe MRI VDP was also related to the 6MWD (p=0.02) and post-exertional SpO2 (p=0.002). Participants with abnormal VDP (≥4.3%) had significantly worse 6MWD (p=0.003) and post-exertional SpO2 (p=0.03). CONCLUSION 129Xe MRI VDP was significantly worse in ever-hospitalised as compared with never-hospitalised participants and was related to 6MWD and exertional SpO2 but not SGRQ or mMRC scores. TRIAL REGISTRATION NUMBER NCT05014516.
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Affiliation(s)
- Harkiran K Kooner
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Alexander M Matheson
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Carmen Venegas
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nisarg Radadia
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terence Ho
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Norman B Konyer
- Imaging Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Giles E Santyr
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell S Albert
- Department of Chemistry, Lakehead University, Thunder Bay, Ontario, Canada.,Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
| | - Alexei Ouriadov
- Department of Physics and Astronomy, Western University, London, Ontario, Canada
| | - Mohamed Abdelrazek
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Svenningsen
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Ontario, Canada .,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
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55
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Lehmann A, Gysan M, Bernitzky D, Bal C, Prosch H, Zehetmayer S, Milos RI, Vonbank K, Pohl W, Idzko M, Gompelmann D. Comparison of pulmonary function test, diffusion capacity, blood gas analysis and CT scan in patients with and without persistent respiratory symptoms following COVID-19. BMC Pulm Med 2022; 22:196. [PMID: 35578190 PMCID: PMC9109200 DOI: 10.1186/s12890-022-01987-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Long-lasting symptoms following SARS-CoV2-infection have been described in several studies. However, there is only limited knowledge about the ongoing pathophysiology and the association with pathological findings in medical examinations. Methods In this post hoc analysis of a prospective trial, 135 patients following COVID-19 were enrolled and grouped with respect to the presence or absence of respiratory ongoing symptoms following COVID-19. Pulmonary function test (PFT), diffusion capacity measurement (TLCO SB and TLCO/VA), blood gas analysis (BGA), laboratory tests and high-resolution computed tomography (HRCT) of patients with persistent respiratory symptoms were compared to those of asymptomatic patients. Results In this analysis, 71% (96/135) of all patients (mean age 49 years; range 20–91 years) reported long-lasting symptoms after a median (IQR) of 85 days (60–116) following COVID-19 whereby 57.8% (78/135) complained about persistent pulmonary symptoms. Pathological findings in blood test, PFT, TLCO, BGA and/or HRCT were found in 71.8% and 64.1% of patients with and without long-lasting respiratory symptoms respectively. Patients with persistent respiratory symptoms were significantly younger and presented a significant lower FVC (%), TLC (L), and TLCO SB compared to asymptomatic patients (p < 0.05). The multiple logistic regression results in a significant effect of age (p = 0.004) and TLCO SB (p = 0.042). Conclusion Following COVID-19, a large proportion of patients experience ongoing symptoms, whereby the respiratory symptoms are the predominant complaints. Compared to asymptomatic patients, patients with ongoing symptoms were younger and presented a significant lower FVC, TLC and TLCO SB. The multiple logistic regression demonstrated only a significant association between the TLCO SB as the only PFT parameter and the perceived symptoms.
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Affiliation(s)
- Antje Lehmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Maximilian Gysan
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Dominik Bernitzky
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Christina Bal
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sonja Zehetmayer
- Institute for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Karin Vonbank
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Pohl
- Department of Pulmonology, Krankenhaus Hietzing, Vienna, Austria
| | - Marco Idzko
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Daniela Gompelmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria.
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Schilling C, Meyer-Lindenberg A, Schweiger JI. [Cognitive disorders and sleep disturbances in long COVID]. DER NERVENARZT 2022; 93:779-787. [PMID: 35576015 PMCID: PMC9109661 DOI: 10.1007/s00115-022-01297-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/07/2023]
Abstract
Hintergrund In den letzten 2 Jahren der COVID-19(„coronavirus disease 2019“)-Pandemie ist das Wissen um Langzeitfolgen der Erkrankung, das sog. „Long-COVID“, rapide gewachsen. Es bleiben jedoch noch viele Fragen offen, v. a. was die Ursachen überdauernder Beschwerden und ihre Prognose betrifft. Kognitive Störungen und Schlafstörungen gehören zu den häufig beklagten Beschwerden. Beide gehen mit starkem Leidensdruck und deutlicher Alltagsbeeinträchtigung einher. Ziel der Arbeit Wie ist die Datenlage zum Auftreten kognitiver Störungen und Schlafstörungen bei Long-COVID? Welches sind Einflussfaktoren und was ist bekannt zum Verlauf und zu möglichen zugrunde liegenden Mechanismen? Welche Therapieoptionen gibt es? Material und Methode In einem narrativen Review werden die wichtigsten Befunde zu kognitiven Störungen und Schlafstörungen bei Long-COVID dargestellt. Es wird ein Überblick gegeben über die Kohortenstudien mit Daten zu Prävalenz und Einflussfaktoren beider Symptomkomplexe. Es werden derzeitige Kenntnisse und Hypothesen zu pathophysiologischen Mechanismen dargestellt und ein Ausblick auf Behandlungsansätze gegeben. Ergebnisse Etwa ein Fünftel der Betroffenen berichtet mehr als 3 Monate nach einer SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion über kognitive Einschränkungen, etwa ein Drittel über Schlafstörungen, wobei es neben insomnischen auch zu hypersomnische Beschwerden kommt. Kognitive Störungen und Schlafstörungen treten bei Betroffenen aller Schweregrade auf. Es gibt Hinweise auf eine Besserung kognitiver Defizite im Verlauf, allerdings sind weitere Längsschnittstudien notwendig. Diskussion Neben der Prognose sind die zugrunde liegenden Krankheitsmechanismen noch unzureichend verstanden. Zudem besteht großer Forschungsbedarf zur Wirksamkeit und zu spezifischen Wirkfaktoren therapeutischer Interventionen.
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Affiliation(s)
- Claudia Schilling
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland.
| | - Andreas Meyer-Lindenberg
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Janina Isabel Schweiger
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
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Romero-Ortuno R, Jennings G, Xue F, Duggan E, Gormley J, Monaghan A. Predictors of Submaximal Exercise Test Attainment in Adults Reporting Long COVID Symptoms. J Clin Med 2022; 11:2376. [PMID: 35566502 PMCID: PMC9099491 DOI: 10.3390/jcm11092376] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 02/08/2023] Open
Abstract
Adults with long COVID often report intolerance to exercise. Cardiopulmonary exercise testing (CPET) has been used in many settings to measure exercise ability but has been conducted in a few long COVID cohorts. We conducted CPET in a sample of adults reporting long COVID symptoms using a submaximal cycle ergometer protocol. We studied pre-exercise predictors of achieving 85% of the age-predicted maximum heart rate (85%HRmax) using logistic regression. Eighty participants were included (mean age 46 years, range 25−78, 71% women). Forty participants (50%) did not reach 85%HRmax. On average, non-achievers reached 84% of their predicted 85%HRmax. No adverse events occurred. Participants who did not achieve 85%HRmax were older (p < 0.001), had more recent COVID-19 illness (p = 0.012) with higher frequency of hospitalization (p = 0.025), and had been more affected by dizziness (p = 0.041) and joint pain (p = 0.028). In the logistic regression model including age, body mass index, time since COVID-19, COVID-19-related hospitalization, dizziness, joint pain, pre-existing cardiopulmonary disease, and use of beta blockers, independent predictors of achieving 85%HRmax were younger age (p = 0.001) and longer time since COVID-19 (p = 0.008). Our cross-sectional findings suggest that exercise tolerance in adults with long COVID has potential to improve over time. Longitudinal research should assess the extent to which this may occur and its mechanisms. ClinicalTrials.gov identifier: NCT05027724 (TROPIC Study).
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Affiliation(s)
- Roman Romero-Ortuno
- School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland; (G.J.); (F.X.); (E.D.); (J.G.); (A.M.)
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Zanetta C, Rocca MA, Filippi M. Impact of immunotherapies on COVID-19 outcomes in multiple sclerosis patients. Expert Rev Clin Immunol 2022; 18:495-512. [PMID: 35395927 DOI: 10.1080/1744666x.2022.2064845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION SARS-CoV-2 pandemic has led the scientific community to maximize efforts to prevent infections and disease severity in patients with multiple sclerosis (pwMS). We analyze the impact of immunotherapies on COVID-19 outcomes in pwMS, providing our interpretation of data. AREAS COVERED Infections, hospitalizations, intensive care unit admissions and death rates in COVID-19 pwMS are comparable to general population. Severity of disability, MS clinical phenotype, age and comorbidities, along with the use of intravenous methylprednisolone and anti-CD20 treatments, are risk factors for COVID-19 severity. Disease modifying treatments (DMTs) can be safely started and continued during the pandemic. Benefit-risk evaluation is mandatory when managing second-line therapies, to balance risk of worse COVID-19 outcomes and MS reactivation. COVID-19 vaccination is safe in MS and its efficacy could be reduced in fingolimod and ocrelizumab-treated patients. EXPERT OPINION Rate of (re)-infection and outcomes with SARS-CoV-2 variants in pwMS and antiviral properties of DMTs need to be further explored. Data on COVID-19 in pregnant MS women, children and elderly pwMS are limited. Evidence on long-term effects of infection is needed. Impact of emerging DMTs on COVID-19 should be investigated. More data and longer follow-up are needed to characterize long-term efficacy and safety profile of vaccinations in pwMS.
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Affiliation(s)
| | - Maria A Rocca
- Neurology Unit.,Neuroimaging Research Unit, Division of Neuroscience.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neurology Unit.,Neurorehabilitation Unit.,Neuroimaging Research Unit, Division of Neuroscience.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Global Trends and Research Hotspots in Long COVID: A Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063742. [PMID: 35329428 PMCID: PMC8955790 DOI: 10.3390/ijerph19063742] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/18/2022]
Abstract
Long COVID is a condition distinguished by long-term sequelae that occur or persist after the convalescence period of COVID-19. During the COVID-19 pandemic, more and more people who tested positive for SARS-CoV-2 experienced long COVID, which attracted the attention of researchers. This study aims to assess the pattern of long COVID research literature, analyze the research topics, and provide insights on long COVID. In this study, we extracted 784 publications from Scopus in the field of long COVID. According to bibliometric analysis, it is found that: developed countries in Europe and America were in leading positions in terms of paper productivity and citations. The International Journal of Environmental Research and Public Health and the Journal of Clinical Medicine were leading journals in the perspective of publications count, and Nature Medicine had the highest number of citations. Author Greenhalgh T has the highest number of papers and citations. The main research topics were: pathophysiology, symptoms, treatment, and epidemiology. The causes of long COVID may be related to organ injury, inflammation, maladaptation of the angiotensin-converting enzyme 2 (ACE2) pathway, and mental factors. The symptoms are varied, including physical and psychological symptoms. Treatment options vary from person to person. Most patients developed at least one long-term symptom. Finally, we presented some possible research opportunities.
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Monaghan A, Jennings G, Xue F, Byrne L, Duggan E, Romero-Ortuno R. Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome. Front Physiol 2022; 13:833650. [PMID: 35309052 PMCID: PMC8931464 DOI: 10.3389/fphys.2022.833650] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/31/2022] [Indexed: 12/28/2022] Open
Abstract
In this observational cross-sectional study, we investigated predictors of orthostatic intolerance (OI) in adults reporting long COVID symptoms. Participants underwent a 3-min active stand (AS) with Finapres® NOVA, followed by a 10-min unmedicated 70° head-up tilt test. Eighty-five participants were included (mean age 46 years, range 25–78; 74% women), of which 56 (66%) reported OI during AS (OIAS). OIAS seemed associated with female sex, more fatigue and depressive symptoms, and greater inability to perform activities of daily living (ADL), as well as a higher heart rate (HR) at the lowest systolic blood pressure (SBP) point before the first minute post-stand (mean HRnadir: 88 vs. 75 bpm, P = 0.004). In a regression model also including age, sex, fatigue, depression, ADL inability, and peak HR after the nadir SBP, HRnadir was the only OIAS predictor (OR = 1.09, 95% CI: 1.01–1.18, P = 0.027). Twenty-two (26%) participants had initial (iOH) and 5 (6%) classical (cOHAS) orthostatic hypotension, but neither correlated with OIAS. Seventy-one participants proceeded to tilt, of which 28 (39%) had OI during tilt (OItilt). Of the 53 who had a 10-min tilt, 7 (13%) had an HR increase >30 bpm without cOHtilt (2 to HR > 120 bpm), but six did not report OItilt. In conclusion, OIAS was associated with a higher initial HR on AS, which after 1 min equalised with the non-OIAS group. Despite these initial orthostatic HR differences, POTS was infrequent (2%). ClinicalTrials.gov Identifier: NCT05027724 (retrospectively registered on August 30, 2021).
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Affiliation(s)
- Ann Monaghan
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Glenn Jennings
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Feng Xue
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lisa Byrne
- Falls and Syncope Unit, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Eoin Duggan
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Falls and Syncope Unit, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
- *Correspondence: Roman Romero-Ortuno,
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The cognitive and psychiatric subacute impairment in severe Covid-19. Sci Rep 2022; 12:3563. [PMID: 35241761 PMCID: PMC8894467 DOI: 10.1038/s41598-022-07559-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/21/2022] [Indexed: 02/08/2023] Open
Abstract
Neurologic impairment persisting months after acute severe SARS-CoV-2 infection has been described because of several pathogenic mechanisms, including persistent systemic inflammation. The objective of this study is to analyze the selective involvement of the different cognitive domains and the existence of related biomarkers. Cross-sectional multicentric study of patients who survived severe infection with SARS-CoV-2 consecutively recruited between 90 and 120 days after hospital discharge. All patients underwent an exhaustive study of cognitive functions as well as plasma determination of pro-inflammatory, neurotrophic factors and light-chain neurofilaments. A principal component analysis extracted the main independent characteristics of the syndrome. 152 patients were recruited. The results of our study preferential involvement of episodic and working memory, executive functions, and attention and relatively less affectation of other cortical functions. In addition, anxiety and depression pictures are constant in our cohort. Several plasma chemokines concentrations were elevated compared with both, a non-SARS-Cov2 infected cohort of neurological outpatients or a control healthy general population. Severe Covid-19 patients can develop an amnesic and dysexecutive syndrome with neuropsychiatric manifestations. We do not know if the deficits detected can persist in the long term and if this can trigger or accelerate the onset of neurodegenerative diseases.
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A Novel Methodology for the Synchronous Collection and Multimodal Visualization of Continuous Neurocardiovascular and Neuromuscular Physiological Data in Adults with Long COVID. SENSORS 2022; 22:s22051758. [PMID: 35270905 PMCID: PMC8914998 DOI: 10.3390/s22051758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
Background: Reports suggest that adults with post-COVID-19 syndrome or long COVID may be affected by orthostatic intolerance syndromes, with autonomic nervous system dysfunction as a possible causal factor of neurocardiovascular instability (NCVI). Long COVID can also manifest as prolonged fatigue, which may be linked to neuromuscular function impairment (NMFI). The current clinical assessment for NCVI monitors neurocardiovascular performance upon the application of orthostatic stressors such as an active (i.e., self-induced) stand or a passive (tilt table) standing test. Lower limb muscle contractions may be important in orthostatic recovery via the skeletal muscle pump. In this study, adults with long COVID were assessed with a protocol that, in addition to the standard NCVI tests, incorporated simultaneous lower limb muscle monitoring for NMFI assessment. Methods: To conduct such an investigation, a wide range of continuous non-invasive biomedical sensing technologies were employed, including digital artery photoplethysmography for the extraction of cardiovascular signals, near-infrared spectroscopy for the extraction of regional tissue oxygenation in brain and muscle, and electromyography for assessment of timed muscle contractions in the lower limbs. Results: With the proposed methodology described and exemplified in this paper, we were able to collect relevant physiological data for the assessment of neurocardiovascular and neuromuscular functioning. We were also able to integrate signals from a variety of instruments in a synchronized fashion and visualize the interactions between different physiological signals during the combined NCVI/NMFI assessment. Multiple counts of evidence were collected, which can capture the dynamics between skeletal muscle contractions and neurocardiovascular responses. Conclusions: The proposed methodology can offer an overview of the functioning of the neurocardiovascular and neuromuscular systems in a combined NCVI/NMFI setup and is capable of conducting comparative studies with signals from multiple participants at any given time in the assessment. This could help clinicians and researchers generate and test hypotheses based on the multimodal inspection of raw data in long COVID and other cohorts.
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Ameratunga R, Woon ST, Lea E, Steele R, Lehnert K, Leung E, Brooks AES. The (apparent) antibody paradox in COVID-19. Expert Rev Clin Immunol 2022; 18:335-345. [PMID: 35184669 PMCID: PMC8935454 DOI: 10.1080/1744666x.2022.2044797] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Rohan Ameratunga
- Department of Clinical immunology, Auckland Hospital, Park Rd, Grafton 1010, Auckland New Zealand
- Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton 1010, Auckland, New Zealand
- Department of Molecular Medicine and Pathology, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland
| | - See-Tarn Woon
- Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton 1010, Auckland, New Zealand
- Department of Molecular Medicine and Pathology, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland
| | - Edward Lea
- Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton 1010, Auckland, New Zealand
| | - Richard Steele
- Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton 1010, Auckland, New Zealand
- Department of Respiratory Medicine, Wellington Hospital, Wellington, New Zealand
| | - Klaus Lehnert
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, School of Biological Sciences, University of Auckland, Symonds St, Auckland, New Zealand Wilkins Centre, University of Auckland
| | - Euphemia Leung
- Auckland Cancer Society Research Centre, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anna E. S. Brooks
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, School of Biological Sciences, University of Auckland, Symonds St, Auckland, New Zealand Wilkins Centre, University of Auckland
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64
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Yelin D, Moschopoulos CD, Margalit I, Gkrania-Klotsas E, Landi F, Stahl JP, Yahav D. ESCMID rapid guidelines for assessment and management of long COVID. Clin Microbiol Infect 2022; 28:955-972. [PMID: 35182760 PMCID: PMC8849856 DOI: 10.1016/j.cmi.2022.02.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/06/2023]
Abstract
Scope The aim of these guidelines is to provide evidence-based recommendations for the assessment and management of individuals with persistent symptoms after acute COVID-19 infection and to provide a definition for this entity, termed ‘long COVID’. Methods We performed a search of the literature on studies addressing epidemiology, symptoms, assessment, and treatment of long COVID. The recommendations were grouped by these headings and by organ systems for assessment and treatment. An expert opinion definition of long COVID is provided. Symptoms were reviewed by a search of the available literature. For assessment recommendations, we aimed to perform a diagnostic meta-analysis, but no studies provided relevant results. For treatment recommendations we performed a systematic review of the literature in accordance with the PRISMA statement. We aimed to evaluate patient-related outcomes, including quality of life, return to baseline physical activity, and return to work. Quality assessment of studies included in the systematic review is provided according to study design. Recommendations Evidence was insufficient to provide any recommendation other than conditional guidance. The panel recommends considering routine blood tests, chest imaging, and pulmonary functions tests for patients with persistent respiratory symptoms at 3 months. Other tests should be performed mainly to exclude other conditions according to symptoms. For management, no evidence-based recommendations could be provided. Physical and respiratory rehabilitation should be considered. On the basis of limited evidence, the panel suggests designing high-quality prospective clinical studies/trials, including a control group, to further evaluate the assessment and management of individuals with persistent symptoms of COVID-19.
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Affiliation(s)
- Dana Yelin
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Charalampos D Moschopoulos
- Fourth Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ili Margalit
- COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | - Francesco Landi
- Geriatric Internal Medicine Department, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Jean-Paul Stahl
- Infectious Diseases Department, University and Hospital Grenoble Alpes, Grenoble Cedex, France
| | - Dafna Yahav
- Fourth Department of Internal Medicine, Medical School of Athens, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
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65
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Abstract
PURPOSE OF REVIEW We reviewed current evidence on the impact of coronavirus disease 2019 (COVID-19) pandemic on sleep of different populations. RECENT FINDINGS Several studies demonstrated that sleep deprivation may cause immune system dysregulation, which deteriorates the course of COVID-19. The increased prevalence of sleep disorders among COVID-19 patients has been associated with more severe disease and worse clinical outcomes. Healthcare workers who were subjected to atypical workload and more nightshifts developed sleep disorders which associated with work-related errors and COVID-19 infection susceptibility. In general population, circadian misalignment and excessive stressors impaired sleep quality. Sleep dysfunction has been recorded due to the pandemic. It is essential to implement interventions in order to alleviate pandemic-related sleep disorders. Telemedicine, cognitive behavioral therapy, and sleep hygiene practices appear to be helpful. Psychotropic medication should be cautiously administered, while other pharmacological agents, such as melatonin, have shown promising results.
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66
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Kim Y, Kim SE, Kim T, Yun KW, Lee SH, Lee E, Seo JW, Jung YH, Chong YP. Preliminary Guidelines for the Clinical Evaluation and Management of Long COVID. Infect Chemother 2022; 54:566-597. [PMID: 36196612 PMCID: PMC9533168 DOI: 10.3947/ic.2022.0141] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Long-lasting coronavirus disease 2019 (COVID-19) symptoms beyond 12 weeks, the so-called ‘long COVID’ have been increasingly reported worldwide. Long COVID can be manifested in various forms, and there is an increasing demand for proper assessment and management. However, it is challenging when trying to determine the best-practice standards of care based on the current evidence because there is no internationally agreed clinical definition or clear treatment pathway. Therefore, the present guidelines have been drafted to provide advice on diagnosis and management based on the latest updated available evidence and the consensus of expert opinion. So far, no standard test and drug treatment can be strongly recommended for patients with long COVID because of a lack of evidence. The present guidelines provide advice based on 12 key questions, including appropriate interventions for long COVID that can be used in clinical practice. Continuous careful observation and studies related to long COVID are needed for the long-term impact of COVID-19 and proper management for long COVID to be determined.
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Affiliation(s)
- Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Seong Eun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tark Kim
- Divison of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun-Won Seo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Young Hee Jung
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Harenwall S, Heywood-Everett S, Henderson R, Godsell S, Jordan S, Moore A, Philpot U, Shepherd K, Smith J, Bland AR. Post-Covid-19 Syndrome: Improvements in Health-Related Quality of Life Following Psychology-Led Interdisciplinary Virtual Rehabilitation. J Prim Care Community Health 2021; 12:21501319211067674. [PMID: 34939506 PMCID: PMC8721676 DOI: 10.1177/21501319211067674] [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] [Indexed: 01/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is increasingly recognized as having significant long-term impact on physical and mental health. The Primary Care Wellbeing Service (PCWBS) in Bradford District Care NHS Foundation Trust (BDCFT) is a psychology-led specialist interdisciplinary team of health professionals specializing in persistent physical symptoms (PPS) and Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME) with an emphasis on holistic integrated care. The PCWBS quickly recognized the risk of the long-term effects of COVID-19, particularly for social, health and care staff, and developed a 7-week virtual rehabilitation course which was piloted in October 2020. The “Recovering from COVID” course takes a whole system, biopsychosocial approach to understanding COVID-19 and post-viral fatigue (PVF) and is delivered by an interdisciplinary team consisting of a clinical psychologist, physiotherapist, occupational therapist, dietitian, speech and language therapist, assistant psychologist, and a personal support navigator with support from a team administrator. The course focuses on understanding PVF, sleep optimization, nutrition, swallowing, activity management, energy conservation, stress management, breathing optimization, managing setbacks, and signposting to appropriate resources and services. Since the pilot, PCWBS has delivered 7 courses to support over 200 people suffering from post-COVID-19 syndrome. One hundred and forty-nine individuals that enrolled on the “Recovering from COVID” course completed the EQ-5D-5L to assess Health-related quality of life (HRQoL) across 5 dimensions, including problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Subsequently, 76 individuals completed these measures at the end of the rehabilitation course showing that patient ratings were significantly improved. In response to the NIHR recommendation for rapid evaluation of different service models for supporting people with post-COVID-19 syndrome, this data offers hope that rehabilitation is effective in reversing some of the problems faced by people living with the long-term effects of COVID-19.
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Affiliation(s)
- Sari Harenwall
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | | | | | - Sherri Godsell
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Sarah Jordan
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Angela Moore
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ursula Philpot
- Bradford District Care NHS Foundation Trust, Bradford, UK.,Leeds Beckett University, Leeds, UK
| | - Kirsty Shepherd
- Bradford District Care NHS Foundation Trust, Bradford, UK.,University of Bradford, Bradford, UK
| | - Joanne Smith
- Bradford District Care NHS Foundation Trust, Bradford, UK
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