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Goldstein DS, Mina Y, Walitt B, Sullivan P, Enose-Akahata Y, Jacobson S, Nguyen ML, Sidenko S, Wiebold A, Smith B, Gelsomino J, Isonaka R, Moore S, Nath A. Persistent Autonomic and Immunologic Abnormalities in Neurologic Post-Acute Sequelae of SARS-CoV2 Infection. Neurology 2024; 103:e209742. [PMID: 39173103 PMCID: PMC11343584 DOI: 10.1212/wnl.0000000000209742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/21/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES After acute coronavirus disease-2019 (COVID-19), people often experience fatigue, "brain fog," or other central neurologic symptoms (neuro-post-acute SARS-CoV2, or "Neuro-PASC"). In this observational study we evaluated whether abnormalities noted on initial evaluation persist after at least another year. METHODS Neuro-PASC research participants who had undergone comprehensive inpatient testing at the NIH Clinical Center returned after at least 1 year for follow-up assessments including symptoms rating scales, MRI, lumbar puncture for tests of the CSF, physiologic recordings during the Valsalva maneuver and head-up tilting (with serial plasma catechols and cardiac Doppler ultrasound during the tilting), blood volume measurement, skin biopsies to examine sympathetic innervation, and blood sampling for neuroendocrine and immunologic measures. RESULTS 7 patients with Neuro-PASC (6 women, age range 42-63 years) underwent follow-up testing. 71% of initially abnormal test results remained abnormal at follow-up, including the pattern of CSF and serum oligoclonal bands, CSF indices of central catecholamine deficiency, baroreflex-cardiovagal dysfunction, the occurrence of tilt-evoked sudden hypotension, white matter hyperintensities on MRI, and adaptive responses in CSF. DISCUSSION In Neuro-PASC most of the autonomic and immunologic abnormalities found initially are still present after more than a year.
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Affiliation(s)
- David S Goldstein
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Yair Mina
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Brian Walitt
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Patti Sullivan
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Yoshimi Enose-Akahata
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Steven Jacobson
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - My-Le Nguyen
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Stanislav Sidenko
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Amanda Wiebold
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Bryan Smith
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Janna Gelsomino
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Risa Isonaka
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Sarah Moore
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Avindra Nath
- From the Autonomic Medicine Section (D.S.G., P.S., J.G., R.I., S.M.), and Infections of the Nervous System Section (Y.M., A.W., B.S.) Clinical Neurosciences Program (CNP), Division of Intramural Research (DIR), National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, MD; Sackler Faculty of Medicine (Y.M.), Tel Aviv University, Israel; Office of the Clinical Director (B.W., A.N.), and Viral Immunology Section (Y.E.-A., S.J.), DIR, NINDS; and Echocardiography Laboratory (M.-L.N., S.S.), DIR, National Heart, Lung, and Blood Institute, Bethesda, MD
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Kulkarni S, Jenkins D, Dhar A, Mir F. Treating Lows: Management of Orthostatic Hypotension. J Cardiovasc Pharmacol 2024; 84:303-315. [PMID: 39027973 PMCID: PMC11368167 DOI: 10.1097/fjc.0000000000001597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/24/2024] [Indexed: 07/20/2024]
Abstract
ABSTRACT Orthostatic hypotension is a prevalent clinical condition, caused by heterogenous etiologies and associated with significant morbidity and mortality. Management is particularly challenging in patients with uncontrolled hypertension. A thorough assessment is needed to draw an appropriate management plan. The treatment aims to improve postural symptoms while minimizing side effects and reducing iatrogenic exacerbation of supine hypertension. A personalized management plan including rationalizing medications, patient education, identification, and avoidance of triggers, as well as nonpharmacological therapies such as compression devices, dietary modifications, and postural aids, make the first steps. Among pharmacological therapies, midodrine and fludrocortisone are the most prescribed and best studied; pyridostigmine, atomoxetine, and droxidopa are considered next. Yohimbine remains an investigational agent. A multidisciplinary team may be required in some patients with multiple comorbidities and polypharmacy. However, there is a lack of robust efficacy and safety evidence for all therapies. Building robust real-world and stratified clinical trials based on underlying pathophysiology may pave the way for further drug development and better clinical strategies and in this challenging unmet medical need.
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Affiliation(s)
- Spoorthy Kulkarni
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Clinical Pharmacology and Therapeutics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Danny Jenkins
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Lewisham and Greenwich NHS Foundation Trust, London, United Kingdom; and
| | - Arko Dhar
- University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Fraz Mir
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Clinical Pharmacology and Therapeutics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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3
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Bustamante C, Pinilla Bonilla LB, Restrepo JC. Neurological symphony: post-acute COVID-19 syndrome, an innovative pathophysiological exploration from neuraltherapeutic medicine. Front Integr Neurosci 2024; 18:1417856. [PMID: 39070159 PMCID: PMC11275269 DOI: 10.3389/fnint.2024.1417856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024] Open
Abstract
The SARS-CoV-2 pandemic has affected 771 million people and caused 6.9 million confirmed deaths as of November 2023. Beyond the adversity, a crucial and less-explored chapter unfolds: adaptive sequelae. These have altered social, mental, and emotional conditions, leaving an imprint on biological systems. While some cases fully resolve the pathological process post-acute infection, others persist with symptoms, posing a challenge that underscores the need to comprehend pathophysiology from innovative perspectives. The article delves into “Long COVID” or Post-Acute COVID-19 Syndrome (PACS), where symptoms persist for ≥4 weeks irrespective of initial severity. Risk factors include a history of severe illness, in-hospital management, and intensive care. This article also explores theories, derived from various experimental models, that have demonstrated the involvement of the nervous system in coordination with the psychoneuroimmunoendocrine axes in the expression of inflammation. It is posited that PACS involves processes of peripheral and central sensitization (corticalization), facilitating dishomeostasis and the chronicity of the inflammatory process. In this context, various therapeutic strategies grounded in modulating the inflammatory reflex are reviewed, primarily through the infiltration of local anesthetics via linear and non-linear approaches. Neural therapeutic use is considered to stimulate the regulatory inflammatory circuits coordinated by the neuroimmune-endocrine system.
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Affiliation(s)
- Carlos Bustamante
- Institute for Advanced Integrative Medicine, Medellin, Colombia
- Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - Laura Bibiana Pinilla Bonilla
- Institute for Advanced Integrative Medicine, Medellin, Colombia
- Research and Innovation Center, Integrated Subnetwork of Health Services of South, Bogotá, Colombia
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Szczepanska-Sadowska E, Czarzasta K, Bogacki-Rychlik W, Kowara M. The Interaction of Vasopressin with Hormones of the Hypothalamo-Pituitary-Adrenal Axis: The Significance for Therapeutic Strategies in Cardiovascular and Metabolic Diseases. Int J Mol Sci 2024; 25:7394. [PMID: 39000501 PMCID: PMC11242374 DOI: 10.3390/ijms25137394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
A large body of evidence indicates that vasopressin (AVP) and steroid hormones are frequently secreted together and closely cooperate in the regulation of blood pressure, metabolism, water-electrolyte balance, and behavior, thereby securing survival and the comfort of life. Vasopressin cooperates with hormones of the hypothalamo-pituitary-adrenal axis (HPA) at several levels through regulation of the release of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and multiple steroid hormones, as well as through interactions with steroids in the target organs. These interactions are facilitated by positive and negative feedback between specific components of the HPA. Altogether, AVP and the HPA cooperate closely as a coordinated functional AVP-HPA system. It has been shown that cooperation between AVP and steroid hormones may be affected by cellular stress combined with hypoxia, and by metabolic, cardiovascular, and respiratory disorders; neurogenic stress; and inflammation. Growing evidence indicates that central and peripheral interactions between AVP and steroid hormones are reprogrammed in cardiovascular and metabolic diseases and that these rearrangements exert either beneficial or harmful effects. The present review highlights specific mechanisms of the interactions between AVP and steroids at cellular and systemic levels and analyses the consequences of the inappropriate cooperation of various components of the AVP-HPA system for the pathogenesis of cardiovascular and metabolic diseases.
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Affiliation(s)
- Ewa Szczepanska-Sadowska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
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Rinaldi L, Rigo S, Pani M, Bisoglio A, Khalaf K, Minonzio M, Shiffer D, Romeo MA, Verzeletti P, Ciccarelli M, Bordoni MG, Stranges S, Riboli E, Furlan R, Barbic F. Long-COVID autonomic syndrome in working age and work ability impairment. Sci Rep 2024; 14:11835. [PMID: 38782998 PMCID: PMC11116376 DOI: 10.1038/s41598-024-61455-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Long-COVID19 has been recently associated with long-sick leave and unemployment. The autonomic nervous system functioning may be also affected by SARS-CoV-2, leading to a chronic autonomic syndrome. This latter remains widely unrecognized in clinical practice. In the present study, we assessed the occurrence of Long-COVID19 Autonomic Syndrome in a group of active workers as well as the relationships between their autonomic dysfunction and work ability. This prospective observational study was conducted during the 2nd wave of the pandemic in Italy. Forty-five patients (53.6 ± 8.4 years; 32 M) hospitalized for COVID19, were consecutively enrolled at the time of their hospital discharge (T0) and followed-up for 6 months. Autonomic symptoms and work ability were assessed by COMPASS31 and Work Ability Index questionnaires at T0, one (T1), three and six (T6) months after hospital discharge and compared to those retrospectively collected for a period preceding SARS-CoV-2 infection. Clinical examination and standing test were also performed at T1 and T6. One in three working-age people developed a new autonomic syndrome that was still evident 6 months after the acute infection resolution. This was associated with a significant reduction in the work ability. Recognition of Long-COVID19 Autonomic Syndrome may promote early intervention to facilitate return to work and prevent unemployment.
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Affiliation(s)
- Luca Rinaldi
- Occupational Medicine, IRCCS Salvatore Maugeri, University of Pavia, Pavia, Italy
| | - Stefano Rigo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Margherita Pani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Andrea Bisoglio
- Department of Neurosurgery, University Vita e Salute S. Raffaele, Milan, Italy
| | - Kareem Khalaf
- Department of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Maura Minonzio
- IRCCS Humanitas Research Hospital, Internal Medicine, 20089, Rozzano, Italy
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Internal Medicine, 20089, Rozzano, Italy
| | - Maria Angela Romeo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Michele Ciccarelli
- IRCCS Humanitas Research Hospital, Internal Medicine, 20089, Rozzano, Italy
| | | | - Saverio Stranges
- Departments of Epidemiology and Biostatistics, Family Medicine and Medicine, Western University, London, ON, Canada
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elio Riboli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- School of Public Health, Imperial College London, London, UK
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Internal Medicine, 20089, Rozzano, Italy
| | - Franca Barbic
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- IRCCS Humanitas Research Hospital, Internal Medicine, 20089, Rozzano, Italy.
- Departments of Epidemiology and Biostatistics, Family Medicine and Medicine, Western University, London, ON, Canada.
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Meenakshisundaram C, Moustafa A, Ranabothu M, Maraey A, Grubb B. Impact of COVID-19 infection on baseline autonomic symptoms in patients with preexisting postural tachycardia syndrome and orthostatic intolerance: A retrospective study. Am J Med Sci 2024; 367:323-327. [PMID: 38340983 DOI: 10.1016/j.amjms.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Postural orthostatic tachycardia syndrome (POTS) and dysautonomia following a SARS-CoV-2 infection have been recently reported. The underlying mechanism of dysautonomia is not well understood. The impact of this viral illness on the underlying autonomic symptoms has not been studied in patients with a pre-existing POTS diagnosis. Our study aims to report the impact of a COVID-19 infection on patients with preexisting POTS, both during the acute phase of the disease and post-recovery. METHODS Institutional Review Board (IRB) approval was obtained to access charts of the study subjects. All patients with known POTS disease who acquired COVID-19 infection between April 2020 and May 2021 were included. The end point of the study was worsening POTS related symptoms including orthostatic dizziness, palpitation, fatigue and syncope/ presyncope post COVID-19 infection that required escalation of therapy. Basic demographics, details of POTS diagnosis, medications, Additional information regarding COVID 19 infection, duration of illness, need for hospitalization, worsening of POTS symptoms, need for ED visits, the type of persisting symptoms and vaccination status were obtained from the retrospective chart review. RESULTS A total of 41 patients were studied. The alpha-variant was the most common causing SARS-CoV-2 infection. 27% (11 patients) of them had tested positive for COVID- 19 infection more than once. About 38 (92.7%) of them reported having worsening of their baseline POTS symptoms during the active infection phase. About 28 patients (68%) experienced worsening of their dysautonomia symptoms for at least 1-6 months post infection. Nearly 30 patients (73.2%) required additional therapy for their symptom control and improvement. CONCLUSIONS Patients with pre-existing POTS, most experienced a worsening of their baseline autonomic symptoms after suffering the COVID-19 infection which required additional pharmacotherapy for their symptom improvement.
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Affiliation(s)
| | | | - Meghana Ranabothu
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Ahmed Maraey
- Division of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Blair Grubb
- Division of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
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Adli N, Bala M, Bougmiza MI, Al-Kuwari MG, Al-Khenji AH, Selim N. Post-COVID-19 syndrome, who at risk and why: an insight from Qatar 2022. Front Public Health 2024; 12:1368568. [PMID: 38680936 PMCID: PMC11048960 DOI: 10.3389/fpubh.2024.1368568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/04/2024] [Indexed: 05/01/2024] Open
Abstract
Background Despite the recovery from the COVID-19 pandemic, many people experience post-COVID-19 syndrome, which negatively impacts their health and function. This condition has become a significant public health problem that requires immediate attention. Objective To study the prevalence, clinical characteristics, and predictors of post-COVID-19 Syndrome in Qatar during 2022. Methods An analytic cross-sectional study was conducted among COVID-19 confirmed cases from January 2022 to July 2022 in Qatar. A simple random sample was employed to include (n = 588) participants from the list of cases and invited to participate in a telephone survey. The World Health Organization's standard case definition for PCS was adopted. Results Out of 368, the prevalence of post-COVID-19 syndrome was 43.2% (n = 159). Most PCS cases were females (67.9%; n = 108), married (73.6%; n = 117), and university and higher educational level (83.6%; n = 133). However, 78.7% (n = 125) reported poor to moderate levels of social support. Only 30.2% (n = 48) of PCS patients had a history of chronic diseases, and 5.7% (n = 9) required hospital admission during acute illness. Among PCS cases, the most commonly reported symptoms were fatigue (75.5%), followed by anxiety (49.1%), forgetfulness (46.5%), mood alteration (45.3%), and general weakness (39.6%). The logistic regression revealed that female gender (AOR: 2.58 95%CI: 1.58-4.225, p < 0.0001), university and high educational level (AOR: 2.2, 95%CI: 1.256-3.98, p < 0.006), poor level of social support (AOR: 2.45; 95%CI: 1.55-4.13; p < 0.002), were significant predictors for PCS. Conclusion Post-COVID-19 syndrome may go under-recognized. More efforts are needed to raise awareness and mobilize the resources to respond to this ongoing public health problem.
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Affiliation(s)
- Nada Adli
- Specialist of Community and Preventive Medicine, Department of Community and Preventive Medicine, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohamed Bala
- Specialist of Community and Preventive Medicine, Department of Wellness Program, Primary Health Care Corporation (PHCC), Doha, Qatar
| | - Mohamed Iheb Bougmiza
- Community and Preventive Medicine Department, Primary Health Care Corporation (PHCC), Doha, Qatar
- Community Medicine Department, Faculty of Medicine, Sousse University, Sousse, Tunisia
| | - Mohamed Ghaith Al-Kuwari
- Senior Consultant of Community and Preventive Medicine, Primary Health Care Corporation (PHCC), Doha, Qatar
- College of Medicine, Doha, Qatar
| | - Abdul Hameed Al-Khenji
- Senior Consultant of Community and Preventive Medicine, Primary Health Care Corporation (PHCC), Doha, Qatar
| | - Nagah Selim
- Community and Preventive Medicine Department, Primary Health Care Corporation (PHCC), Doha, Qatar
- Public Health and Preventive Medicine, Cairo University, Cairo, Egypt
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Giunta S, Giordani C, De Luca M, Olivieri F. Long-COVID-19 autonomic dysfunction: An integrated view in the framework of inflammaging. Mech Ageing Dev 2024; 218:111915. [PMID: 38354789 DOI: 10.1016/j.mad.2024.111915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
The recently identified syndrome known as Long COVID (LC) is characterized by a constellation of debilitating conditions that impair both physical and cognitive functions, thus reducing the quality of life and increasing the risk of developing the most common age-related diseases. These conditions are linked to the presence of symptoms of autonomic dysfunction, in association with low cortisol levels, suggestive of reduced hypothalamic-pituitary-adrenal (HPA) axis activity, and with increased pro-inflammatory condition. Alterations of dopamine and serotonin neurotransmitter levels were also recently observed in LC. Interestingly, at least some of the proposed mechanisms of LC development overlap with mechanisms of Autonomic Nervous System (ANS) imbalance, previously detailed in the framework of the aging process. ANS imbalance is characterized by a proinflammatory sympathetic overdrive, and a concomitant decreased anti-inflammatory vagal parasympathetic activity, associated with reduced anti-inflammatory effects of the HPA axis and cholinergic anti-inflammatory pathway (CAP). These neuro-immune-endocrine system imbalanced activities fuel the vicious circle of chronic inflammation, i.e. inflammaging. Here, we refine our original hypothesis that ANS dysfunction fuels inflammaging and propose that biomarkers of ANS imbalance could also be considered biomarkers of inflammaging, recognized as the main risk factor for developing age-related diseases and the sequelae of viral infections, i.e. LC.
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Affiliation(s)
- Sergio Giunta
- Casa di Cura Prof. Nobili (Gruppo Garofalo (GHC) Castiglione dei Pepoli -Bologna), Italy
| | - Chiara Giordani
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy.
| | - Maria De Luca
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Fabiola Olivieri
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, Ancona, Italy
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9
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Goldstein DS. Post-COVID dysautonomias: what we know and (mainly) what we don't know. Nat Rev Neurol 2024; 20:99-113. [PMID: 38212633 DOI: 10.1038/s41582-023-00917-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
Following on from the COVID-19 pandemic is another worldwide public health challenge that is referred to variously as long COVID, post-COVID syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC). PASC comes in many forms and affects all body organs. This heterogeneous presentation suggests involvement of the autonomic nervous system (ANS), which has numerous roles in the maintenance of homeostasis and coordination of responses to various stressors. Thus far, studies of ANS dysregulation in people with PASC have been largely observational and descriptive, based on symptom inventories or objective but indirect measures of cardiovascular function, and have paid little attention to the adrenomedullary, hormonal and enteric nervous components of the ANS. Such investigations do not consider the syndromic nature of autonomic dysfunction. This Review provides an update on the literature relating to ANS abnormalities in people with post-COVID syndrome and presents a theoretical perspective on how the ANS might participate in common features of PASC.
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Affiliation(s)
- David S Goldstein
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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10
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de Cássia Collaço R, Lammens M, Blevins C, Rodgers K, Gurau A, Yamauchi S, Kim C, Forrester J, Liu E, Ha J, Mei Y, Boehm C, Wohler E, Sobreira N, Rowe PC, Valle D, Brock MV, Bosmans F. Anxiety and dysautonomia symptoms in patients with a Na V1.7 mutation and the potential benefits of low-dose short-acting guanfacine. Clin Auton Res 2024; 34:191-201. [PMID: 38064009 DOI: 10.1007/s10286-023-01004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/15/2023] [Indexed: 03/17/2024]
Abstract
PURPOSE Guanfacine is an α2A-adrenergic receptor agonist, FDA-approved to treat attention-deficit hyperactivity disorder and high blood pressure, typically as an extended-release formulation up to 7 mg/day. In our dysautonomia clinic, we observed that off-label use of short-acting guanfacine at 1 mg/day facilitated symptom relief in two families with multiple members presenting with severe generalized anxiety. We also noted anecdotal improvements in associated dysautonomia symptoms such as hyperhidrosis, cognitive impairment, and palpitations. We postulated that a genetic deficit existed in these patients that might augment guanfacine susceptibility. METHODS We used whole-exome sequencing to identify mutations in patients with shared generalized anxiety and dysautonomia symptoms. Guanfacine-induced changes in the function of voltage-gated Na+ channels were investigated using voltage-clamp electrophysiology. RESULTS Whole-exome sequencing uncovered the p.I739V mutation in SCN9A in the proband of two nonrelated families. Moreover, guanfacine inhibited ionic currents evoked by wild-type and mutant NaV1.7 encoded by SCN9A, as well as other NaV channel subtypes to a varying degree. CONCLUSION Our study provides further evidence for a possible pathophysiological role of NaV1.7 in anxiety and dysautonomia. Combined with off-target effects on NaV channel function, daily administration of 1 mg short-acting guanfacine may be sufficient to normalize NaV channel mutation-induced changes in sympathetic activity, perhaps aided by partial inhibition of NaV1.7 or other channel subtypes. In a broader context, expanding genetic and functional data about ion channel aberrations may enable the prospect of stratifying patients in which mutation-induced increased sympathetic tone normalization by guanfacine can support treatment strategies for anxiety and dysautonomia symptoms.
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Affiliation(s)
- Rita de Cássia Collaço
- Molecular Physiology and Neurophysics Group, Department of Basic and Applied Medical Sciences, University of Ghent, Ghent, Belgium
| | - Maxime Lammens
- Molecular Physiology and Neurophysics Group, Department of Basic and Applied Medical Sciences, University of Ghent, Ghent, Belgium
| | - Carley Blevins
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kristen Rodgers
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrei Gurau
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Suguru Yamauchi
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christine Kim
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jeannine Forrester
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Edward Liu
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jinny Ha
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yuping Mei
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Corrine Boehm
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Wohler
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter C Rowe
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David Valle
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Malcolm V Brock
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Frank Bosmans
- Molecular Physiology and Neurophysics Group, Department of Basic and Applied Medical Sciences, University of Ghent, Ghent, Belgium.
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11
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Goldstein DS. Linking the Extended Autonomic System with the Homeostat Theory: New Perspectives about Dysautonomias. J Pers Med 2024; 14:123. [PMID: 38276245 PMCID: PMC10817591 DOI: 10.3390/jpm14010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/14/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
Dysautonomias are conditions in which altered functions of one or more components of the autonomic nervous system (ANS) adversely affect health. This essay is about how elucidating mechanisms of dysautonomias may rationalize personalized treatments. Emphasized here are two relatively new ideas-the "extended" autonomic system (EAS) and the "homeostat" theory as applied to the pathophysiology and potential treatments of dysautonomias. The recently promulgated concept of the EAS updates Langley's ANS to include neuroendocrine, immune/inflammatory, and central components. The homeostat theory builds on Cannon's theory of homeostasis by proposing the existence of comparators (e.g., a thermostat, glucostat, carbistat, barostat) that receive information about regulated variables (e.g., core temperature, blood glucose, blood gases, delivery of blood to the brain). Homeostats sense discrepancies between the information and response algorithms. The presentation links the EAS with the homeostat theory to understand pathophysiological mechanisms of dysautonomias. Feed-forward anticipatory processes shift input-output curves and maintain plateau levels of regulated variables within different bounds of values-"allostasis". Sustained allostatic processes increase long-term wear-and-tear on effectors and organs-allostatic load. They decreaseing thresholds for destabilizing and potentially fatal positive feedback loops. The homeostat theory enables mathematical models that define stress, allostasis, and allostatic load. The present discussion applies the EAS and homeostat concepts to specific examples of pediatric, adolescent/adult, and geriatric dysautonomias-familial dysautonomia, chronic orthostatic intolerance, and Lewy body diseases. Computer modeling has the potential to take into account the complexity and dynamics of allostatic processes and may yield testable predictions about individualized treatments and outcomes.
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Affiliation(s)
- David S Goldstein
- Autonomic Medicine Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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12
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BROCK MALCOLMV, BOSMANS FRANK. A MULTI-HIT MODEL OF LONG COVID PATHOPHYSIOLOGY: THE INTERACTION BETWEEN IMMUNE TRIGGERS AND NERVOUS SYSTEM SIGNALING. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2024; 134:149-164. [PMID: 39135572 PMCID: PMC11316875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Early in the pandemic, clinicians recognized an overlap between Long COVID symptoms and dysautonomia, suggesting autonomic nervous system (ANS) dysfunction. Our clinical experience at Johns Hopkins with primary dysautonomia suggested heritability of sympathetic dysfunction, manifesting primarily as hyperhidrosis and as other dysautonomia symptoms. Whole exome sequencing revealed mutations in genes regulating electrical signaling in the nervous system, thus providing a genetic basis for the sympathetic overdrive observed. We hypothesize that dysautonomia in Long COVID requires two molecular hits: a genetic vulnerability to prime the ANS and a SARS-CoV-2 infection, as an immune trigger, to further disrupt ANS function resulting in increased sympathetic activity. Indeed, Long COVID patients show signs of chronic inflammation and autoimmunity. We have translated this two-hit concept to the clinic using ion channel inhibitors to target genetic susceptibility and immunomodulators to treat inflammation. This multi-hit hypothesis shows promise for managing Long COVID and merits further study.
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13
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Knoop I, Jones ASK, Gall N, Chilcot J, Pascoe W, Moss-Morris R. Validation of symptom measures in patients under investigation for postural orthostatic tachycardia syndrome (POTS): The Orthostatic Grading Scale (OGS) and the Symptom Screen for Small-fiber Polyneuropathy (SSS). Auton Neurosci 2023; 250:103130. [PMID: 37976608 DOI: 10.1016/j.autneu.2023.103130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Postural Orthostatic Tachycardia Syndrome (POTS) presents with a range of poorly delineated symptoms across several domains. There is an urgent need for standardized symptom reporting in POTS, but a lack of validated symptom burden instruments. Our aim was to evaluate the psychometric properties of two symptom burden measures: the Orthostatic Grading Scale (OGS) and the Symptom Screen for Small-Fiber Polyneuropathy (SSS), in patients under investigation for suspected POTS. DESIGN Psychometric validation study. METHODS Confirmatory factor analysis (CFA) tested the factor structure of the SSS and OGS completed by 149 patients under investigation for POTS. Scale reliability and validity were assessed. The uni-dimensionality of the SSS was assessed through principal component analysis (PCA). RESULTS CFA of the OGS revealed that a 1-factor structure had adequate fit. CFA of the SSS revealed that a 5-factor structure had generally appropriate fit supporting the originally proposed 5 factors (1: Gastrointestinal, 2: Somatosensory, 3: Miscellaneous, 4: Microvascular, and 5: Urological). In addition, the SSS demonstrated sufficient uni-dimensionality in the PCA, warranting use of a single total score. Omega coefficients of both measures indicated satisfactory internal reliability (0.668-0.931). Correlations with related constructs (distress (K10 score), r = 0.317-0.404, p < 0.001) and heart rate indices (with the OGS, r = 0.211-0.294, p < 0.05) suggested sound convergent and divergent validity. CONCLUSIONS Initial evidence suggests that the OGS and SSS have good psychometric properties for use in populations with suspected and confirmed POTS.
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Affiliation(s)
- Iris Knoop
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Annie S K Jones
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Nicholas Gall
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Joseph Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - William Pascoe
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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14
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Bradbury J, Wilkinson S, Schloss J. Nutritional Support During Long COVID: A Systematic Scoping Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:695-704. [PMID: 37102680 DOI: 10.1089/jicm.2022.0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Introduction: Long COVID is a term that encompasses a range of signs, symptoms, and sequalae that continue or develop after an acute COVID-19 infection. The lack of early recognition of the condition contributed to delays in identifying factors that may contribute toward its development and prevention. The aim of this study was to scope the available literature to identify potential nutritional interventions to support people with symptoms associated with long COVID. Methods: This study was designed as a systematic scoping review of the literature (registration PROSPERO CRD42022306051). Studies with participants aged 18 years or older, with long COVID and who underwent a nutritional intervention were included in the review. Results: A total of 285 citations were initially identified, with five papers eligible for inclusion: two were pilot studies of nutritional supplements in the community, and three were nutritional interventions as part of inpatient or outpatient multidisciplinary rehabilitation programs. There were two broad categories of interventions: those that focused on compositions of nutrients (including micronutrients such as vitamin and mineral supplements) and those that were incorporated as part of multidisciplinary rehabilitation programs. Nutrients included in more than one study were multiple B group vitamins, vitamin C, vitamin D, and acetyl-l-carnitine. Discussion: Two studies trialed nutritional supplements for long COVID in community samples. Although these initial reports were positive, they are based on poorly designed studies and therefore cannot provide conclusive evidence. Nutritional rehabilitation was an important aspect of recovery from severe inflammation, malnutrition, and sarcopenia in hospital rehabilitation programs. Current gaps in the literature include a potential role for anti-inflammatory nutrients such as the omega 3 fatty acids, which are currently undergoing clinical trials, glutathione-boosting treatments such as N-acetylcysteine, alpha-lipoic acid, or liposomal glutathione in long COVID, and a possible adjunctive role for anti-inflammatory dietary interventions. This review provides preliminary evidence that nutritional interventions may be an important part of a rehabilitation program for people with severe long COVID symptomatology, including severe inflammation, malnutrition, and sarcopenia. For those in the general population with long COVID symptoms, the role of specific nutrients has not yet been studied well enough to recommend any particular nutrient or dietary intervention as a treatment or adjunctive treatment. Clinical trials of single nutrients are currently being conducted, and future systematic reviews could focus on single nutrient or dietary interventions to identify their nuanced mechanisms of action. Further clinical studies incorporating complex nutritional interventions are also warranted to strengthen the evidence base for using nutrition as a useful adjunctive treatment for people living with long COVID.
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Affiliation(s)
- Joanne Bradbury
- Health Sciences, Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Sarah Wilkinson
- Health Sciences, Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
- National Centre for Natural Medicine (NCNM), Faculty of Health, Southern Cross University, Lismore, NSW, Australia
| | - Janet Schloss
- National Centre for Natural Medicine (NCNM), Faculty of Health, Southern Cross University, Lismore, NSW, Australia
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Virrantaus H, Liira H, Posharina T, Sulg A, Mäntylä T, Kanerva M, Laakso S, Sainio M, Malmivaara A, Vuokko A, Varonen M, Venäläinen M, Arokoski J. Prognosis of patients with long COVID symptoms: a protocol for a longitudinal cohort study at a primary care referred outpatient clinic in Helsinki, Finland. BMJ Open 2023; 13:e072935. [PMID: 37848295 PMCID: PMC10582861 DOI: 10.1136/bmjopen-2023-072935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION After COVID-19, many continue to experience persistent debilitating symptoms, that is, long COVID. Its most prevalent symptoms are chest pain, difficulties with breathing, painful muscles, ageusia or anosmia, tingling extremities and general tiredness. This paper describes the protocol of the Long COVID Cohort Study to assess the prognosis and prognostic determinants of patients with long COVID by implementing patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs) and clinical examinations during a 1-year follow-up. METHODS AND ANALYSIS This is a prospective, single-site cohort study consisting of administering questionnaires and clinical examinations to adult patients referred to the Clinic for Long-Term Effects of COVID-19 at Helsinki University Hospital (Hospital district of Helsinki and Uusimaa). The referrals are from all healthcare units within HUS and other hospital districts during years 2021-2023. All admitted patients have had laboratory-confirmed COVID-19. The targeted study sample size is 500 participants. The questionnaires are administered at 0, 3, 6 and 12 months. The main outcome variables are the changes in self-reported functional abilities and quality of life. In addition, we will evaluate functional abilities at baseline using neurocognitive evaluation, a 6MWT and a measurement of hand grip strength. The Long COVID Cohort Study will form a quality register for the clinic and characterise the first systematic collection of PROMs, PREMs, questionnaire and clinical examinations related to long COVID in Finland. The Study belongs to a study consortium Long COVID-HORIZON-HLTH-2021-DISEASE-04 that aims to reveal the biomechanisms of long COVID. ETHICS AND DISSEMINATION This study has been approved by the Helsinki University Hospital research ethics committee board, ID HUS/1493/2021 on 6 March 2021. All study participants sign written informed consent for participation. The study findings will be reported for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05699512; Pre-results.
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Affiliation(s)
- Hélène Virrantaus
- Outpatient Clinic for Long-Term Effects of COVID-19, Helsinki University Central Hospital, Helsinki, Finland
| | - Helena Liira
- Outpatient Clinic for Long-Term Effects of COVID-19, Helsinki University Central Hospital, Helsinki, Finland
| | - Tatiana Posharina
- Outpatient Clinic for Long-Term Effects of COVID-19, Helsinki University Central Hospital, Helsinki, Finland
| | - Aleksandra Sulg
- Outpatient Clinic for Long-Term Effects of COVID-19, Helsinki University Central Hospital, Helsinki, Finland
| | - Teemu Mäntylä
- Outpatient Clinic for Long-Term Effects of COVID-19, Helsinki University Central Hospital, Helsinki, Finland
- Brain Centre, Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Mari Kanerva
- Department of Hospital Hygiene and Infection Control, TYKS Turku University Hospital, Turku, Finland
| | - Sini Laakso
- Clinical Neurosciences, Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Sainio
- Outpatient Clinic for Functional Disorders, Helsinki University Central Hospital, Helsinki, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Aki Vuokko
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mikko Varonen
- Outpatient Clinic for Long-Term Effects of COVID-19, Helsinki University Central Hospital, Helsinki, Finland
| | - Mikko Venäläinen
- Department of Medical Physics, University of Turku, Turku, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Central Hospital, Helsinki, Finland
- Department of Surgery, Helsingin yliopisto, Helsinki, Finland
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16
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Wei ZYD, Liang K, Shetty AK. Complications of COVID-19 on the Central Nervous System: Mechanisms and Potential Treatment for Easing Long COVID. Aging Dis 2023; 14:1492-1510. [PMID: 37163427 PMCID: PMC10529748 DOI: 10.14336/ad.2023.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/12/2023] [Indexed: 05/12/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invades human cells by binding to the angiotensin-converting-enzyme-2 (ACE-2) using a spike protein and leads to Coronavirus disease-2019 (COVID-19). COVID-19 primarily causes a respiratory infection that can lead to severe systemic inflammation. It is also common for some patients to develop significant neurological and psychiatric symptoms. The spread of SARS-CoV-2 to the CNS likely occurs through several pathways. Once spread in the CNS, many acute symptoms emerge, and such infections could also transpire into severe neurological complications, including encephalitis or ischemic stroke. After recovery from the acute infection, a significant percentage of patients develop "long COVID," a condition in which several symptoms of COVID-19 persist for prolonged periods. This review aims to discuss acute and chronic neurological problems after SARS-CoV-2 infection. The potential mechanisms by which SARS-CoV-2 enters the CNS and causes neuroinflammation, neuropathological changes observed in post-mortem brains of COVID-19 patients, and cognitive and mood problems in COVID-19 survivors are discussed in the initial part. The later part of the review deliberates the causes of long COVID, approaches for noninvasive tracking of neuroinflammation in long COVID patients, and the potential therapeutic strategies that could ease enduring CNS symptoms observed in long COVID.
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Affiliation(s)
- Zhuang-Yao D Wei
- Institute for Regenerative Medicine, Department of Cell Biology and Genetics, Texas A&M University Health Science Center School of Medicine, College Station, TX, USA
| | - Ketty Liang
- Sam Houston State University College of Osteopathic Medicine, Conroe, TX, USA
| | - Ashok K Shetty
- Institute for Regenerative Medicine, Department of Cell Biology and Genetics, Texas A&M University Health Science Center School of Medicine, College Station, TX, USA
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Chen TB, Chang CM, Yang CC, Tsai IJ, Wei CY, Yang HW, Yang CP. Neuroimmunological Effect of Vitamin D on Neuropsychiatric Long COVID Syndrome: A Review. Nutrients 2023; 15:3802. [PMID: 37686834 PMCID: PMC10490318 DOI: 10.3390/nu15173802] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 2019 (COVID-19). COVID-19 is now recognized as a multiorgan disease with a broad spectrum of manifestations. A substantial proportion of individuals who have recovered from COVID-19 are experiencing persistent, prolonged, and often incapacitating sequelae, collectively referred to as long COVID. To date, definitive diagnostic criteria for long COVID diagnosis remain elusive. An emerging public health threat is neuropsychiatric long COVID, encompassing a broad range of manifestations, such as sleep disturbance, anxiety, depression, brain fog, and fatigue. Although the precise mechanisms underlying the neuropsychiatric complications of long COVID are presently not fully elucidated, neural cytolytic effects, neuroinflammation, cerebral microvascular compromise, breakdown of the blood-brain barrier (BBB), thrombosis, hypoxia, neurotransmitter dysregulation, and provoked neurodegeneration are pathophysiologically linked to long-term neuropsychiatric consequences, in addition to systemic hyperinflammation and maladaptation of the renin-angiotensin-aldosterone system. Vitamin D, a fat-soluble secosteroid, is a potent immunomodulatory hormone with potential beneficial effects on anti-inflammatory responses, neuroprotection, monoamine neurotransmission, BBB integrity, vasculometabolic functions, gut microbiota, and telomere stability in different phases of SARS-CoV-2 infection, acting through both genomic and nongenomic pathways. Here, we provide an up-to-date review of the potential mechanisms and pathophysiology of neuropsychiatric long COVID syndrome and the plausible neurological contributions of vitamin D in mitigating the effects of long COVID.
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Affiliation(s)
- Ting-Bin Chen
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Ching-Mao Chang
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
- Institute of Traditional Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Cheng-Chia Yang
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan;
| | - I-Ju Tsai
- Department of Medical Research, Kuang Tien General Hospital, Taichung 433, Taiwan;
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua 50544, Taiwan
| | - Hao-Wen Yang
- Department of Family Medicine, Kuang Tien General Hospital, Taichung 433, Taiwan
| | - Chun-Pai Yang
- Department of Medical Research, Kuang Tien General Hospital, Taichung 433, Taiwan;
- Department of Neurology, Kuang Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, HungKuang University, Taichung 433, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
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18
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Wang X, Yin X, Liu P, Wang A, Mu W, Xu J, Lu W, Chen Z, Zhou Y, Xu S, Wang Y. The effect of Baduanjin Qigong combined with five-elements music on anxiety and quality of sleep in asymptomatic patients with COVID-19 infection: A randomised controlled trial. Heliyon 2023; 9:e18962. [PMID: 37636423 PMCID: PMC10447985 DOI: 10.1016/j.heliyon.2023.e18962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
Background Infections of Coronavirus Disease-2019 (COVID-19) and the subsequent quarantine can culminate in anxious mood and sleep disturbances. The objective of this clinical trial was to investigate the effect of traditional Qigong with music therapy on relieving anxiety and improving the quality of sleep in Chinese adults with COVID-19 infection. Methods A total of 200 asymptomatic COVID-19 infected patients were randomly assigned into two groups during their quarantine period in Chongming Island, Shanghai. The patients in the treatment group daily received Baduanjin Qigong, five-elements music therapy and routine care, while the patients in the control group only took the routine care. The primary outcome was anxiety levels measured by the 7-item Generalized Anxiety Disorder scale (GAD-7). Secondary outcomes included the quality of sleep measured by the Jenkins Sleep Scale (JSS), the degree of depression measured by the Patient Health Questionnaire (PHQ-9), as well as the self-efficacy in the Perceived Health Competence Scale (PHCS). An online questionnaire was given to all participants on the day of arrival to determine the baseline for all outcomes and then given again on the day of discharge. A one-way analysis of covariance was used to analyze the differences between the two groups after intervention. Results At the end of the intervention, 177 (88.5%) patients finished the questionnaire. Patients in the treatment group had clearly decreased GAD-7 scores (MD = 2.7, 95% CI = 2.3, 3.2) after the daily exercise and music. Patients in the control group had little changes in the GAD-7 (MD = -0.2, 95%CI = -0.7, 0.3, P = 0.07), as well as the PHQ-9 (MD = 0.1, 95%CI = -0.5, 0.6, P = 0.66) after the routine care, when compared to their baseline scores. There were statistical between-group differences in GAD-7 (MD = 2.9, 95% CI = 2.2, 3.6, P < 0.001)and in the PHQ-9 scores (MD = 3.6, 95% CI = 2.9, 4.4, P < 0.001) at the post-treatment. Compared with the control group, patients had significantly lower scores on the JSS (MD = 2.7, 95% CI = 2.0, 3.3, P < 0.001), and higher scores on the PHCS (MD = -5.0, 95% CI = -6.1, -3.9, P < 0.001) after receiving Qigong and the music therapy. Conclusion Traditional Baduanjin Qigong and five-elements music therapy help to relieve anxiety and depression, and improve the sleep quality in patients with COVID-19 infection. Trial registration Chinese Clinical Trial Registry ChiCTR2200059800.
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Affiliation(s)
- Xian Wang
- The Department of Nursing, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Xuan Yin
- The Department of Acupuncture and Moxibustion, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Ping Liu
- The Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Anzi Wang
- The Department of Nursing, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Wenfang Mu
- The Department of Nursing, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Jun Xu
- The Department of Nursing, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Weiyan Lu
- The Department of Nursing, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Zhuping Chen
- The Department of Nursing, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Yan Zhou
- The Department of Nursing, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Shifen Xu
- The Department of Acupuncture and Moxibustion, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Yan Wang
- The Department of Nursing, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200071, China
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19
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Latchman PL, Yang Q, Morgenthaler D, Kong L, Sebagisha J, Melendez L, Green CA, Bernard S, Mugno R, De Meersman R. Autonomic modulation, spontaneous baroreflex sensitivity and fatigue in young men after COVID-19. Physiol Res 2023; 72:329-336. [PMID: 37449746 PMCID: PMC10669003 DOI: 10.33549/physiolres.935051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/16/2023] [Indexed: 08/26/2023] Open
Abstract
Impaired autonomic modulation and baroreflex sensitivity (BRS) have been reported during and after COVID-19. Both impairments are associated with negative cardiovascular outcomes. If these impairments were to exist undetected in young men after COVID-19, they could lead to negative cardiovascular outcomes. Fatigue is associated with autonomic dysfunction during and after COVID-19. It is unclear if fatigue can be used as an indicator of impaired autonomic modulation and BRS after COVID-19. This study aims to compare parasympathetic modulation, sympathetic modulation, and BRS between young men who had COVID-19 versus controls and to determine if fatigue is associated with impaired autonomic modulation and BRS. Parasympathetic modulation as the high-frequency power of R-R intervals (lnHFR-R), sympathetic modulation as the low-frequency power of systolic blood pressure variability (LFSBP), and BRS as the -index were measured by power spectral density analysis. These variables were compared between 20 young men who had COVID-19 and 24 controls. Independent t-tests and Mann-Whitney U tests indicated no significant difference between the COVID-19 and the control group in: lnHFR-R, P=0.20; LFSBP, P=0.11, and -index, P=0.20. Fatigue was not associated with impaired autonomic modulation or BRS. There is no difference in autonomic modulations or BRS between young men who had COVID-19 compared to controls. Fatigue did not seem to be associated with impaired autonomic modulation or impaired BRS in young men after COVID-19. Findings suggest that young men might not be at increased cardiovascular risk from COVID-19-related dysautonomia and impaired BRS.
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Affiliation(s)
- P L Latchman
- Southern Connecticut State University, New Haven, Connecticut, U.S.A.
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20
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Komaroff AL, Lipkin WI. ME/CFS and Long COVID share similar symptoms and biological abnormalities: road map to the literature. Front Med (Lausanne) 2023; 10:1187163. [PMID: 37342500 PMCID: PMC10278546 DOI: 10.3389/fmed.2023.1187163] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Some patients remain unwell for months after "recovering" from acute COVID-19. They develop persistent fatigue, cognitive problems, headaches, disrupted sleep, myalgias and arthralgias, post-exertional malaise, orthostatic intolerance and other symptoms that greatly interfere with their ability to function and that can leave some people housebound and disabled. The illness (Long COVID) is similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as well as to persisting illnesses that can follow a wide variety of other infectious agents and following major traumatic injury. Together, these illnesses are projected to cost the U.S. trillions of dollars. In this review, we first compare the symptoms of ME/CFS and Long COVID, noting the considerable similarities and the few differences. We then compare in extensive detail the underlying pathophysiology of these two conditions, focusing on abnormalities of the central and autonomic nervous system, lungs, heart, vasculature, immune system, gut microbiome, energy metabolism and redox balance. This comparison highlights how strong the evidence is for each abnormality, in each illness, and helps to set priorities for future investigation. The review provides a current road map to the extensive literature on the underlying biology of both illnesses.
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Affiliation(s)
- Anthony L. Komaroff
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - W. Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, United States
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21
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Suh HW, Kwon CY, Lee B. Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies. Healthcare (Basel) 2023; 11:healthcare11081095. [PMID: 37107929 PMCID: PMC10137929 DOI: 10.3390/healthcare11081095] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) sequelae (or long COVID) has become a clinically significant concern. Several studies have reported the relationship between heart rate variability (HRV) parameters and COVID-19. This review investigates the long-term association between COVID-19 and HRV parameters. Four electronic databases were searched up to 29 July 2022. We included observational studies comparing HRV parameters (measurement durations: 1 min or more) in participants with and without a history of COVID-19. We used assessment tools developed by the National Heart, Lung, and Blood Institute group to evaluate the methodological quality of included studies. Eleven cross-sectional studies compared HRV parameters in individuals who recovered from acute COVID-19 infection to controls (n = 2197). Most studies reported standard deviation of normal-to-normal intervals (SDNN) and root mean square of the successive differences. The methodological quality of the included studies was not optimal. The included studies generally found decreased SDNN and parasympathetic activity in post-COVID-19 individuals. Compared to controls, decreases in SDNN were observed in individuals who recovered from COVID-19 or had long COVID. Most of the included studies emphasized parasympathetic inhibition in post-COVID-19 conditions. Due to the methodological limitations of measuring HRV parameters, the findings should be further validated by robust prospective longitudinal studies.
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Affiliation(s)
- Hyo-Weon Suh
- Health Policy Research Team, Division of Healthcare Research, National Evidence-Based Healthcare Collaborating Agency, 400 Neungdong-ro, Gwangjin-gu, Seoul 04933, Republic of Korea
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dong-Eui University, Busan 47227, Republic of Korea
| | - Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Republic of Korea
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22
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Tretter F, Peters EMJ, Sturmberg J, Bennett J, Voit E, Dietrich JW, Smith G, Weckwerth W, Grossman Z, Wolkenhauer O, Marcum JA. Perspectives of (/memorandum for) systems thinking on COVID-19 pandemic and pathology. J Eval Clin Pract 2023; 29:415-429. [PMID: 36168893 PMCID: PMC9538129 DOI: 10.1111/jep.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
Is data-driven analysis sufficient for understanding the COVID-19 pandemic and for justifying public health regulations? In this paper, we argue that such analysis is insufficient. Rather what is needed is the identification and implementation of over-arching hypothesis-related and/or theory-based rationales to conduct effective SARS-CoV2/COVID-19 (Corona) research. To that end, we analyse and compare several published recommendations for conceptual and methodological frameworks in medical research (e.g., public health, preventive medicine and health promotion) to current research approaches in medical Corona research. Although there were several efforts published in the literature to develop integrative conceptual frameworks before the COVID-19 pandemic, such as social ecology for public health issues and systems thinking in health care, only a few attempts to utilize these concepts can be found in medical Corona research. For this reason, we propose nested and integrative systemic modelling approaches to understand Corona pandemic and Corona pathology. We conclude that institutional efforts for knowledge integration and systemic thinking, but also for integrated science, are urgently needed to avoid or mitigate future pandemics and to resolve infection pathology.
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Affiliation(s)
- Felix Tretter
- Bertalanffy Center for the Study of Systems ScienceViennaAustria
| | - Eva M. J. Peters
- Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and PsychotherapyJustus‐Liebig‐UniversityGiessenHesseGermany
- Internal Medicine and DermatologyUniversitätsmedizin‐CharitéBerlinGermany
| | - Joachim Sturmberg
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- International Society for Systems and Complexity Sciences for HealthPrincetonNew JerseyUSA
| | - Jeanette Bennett
- Department of Psychological Science, StressWAVES Biobehavioral Research LabUniversity of North CarolinaCharlotteNorth CarolinaUSA
| | - Eberhard Voit
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine ISt. Josef Hospital, Ruhr PhilosophyBochumGermany
- Diabetes Centre Bochum/HattingenKlinik BlankensteinHattingenGermany
- Centre for Rare Endocrine Diseases (ZSE), Ruhr Centre for Rare Diseases (CeSER)BochumGermany
- Centre for Diabetes Technology, Catholic Hospitals BochumRuhr University BochumBochumGermany
| | - Gary Smith
- International Society for the Systems SciencesPontypoolUK
| | - Wolfram Weckwerth
- Vienna Metabolomics Center (VIME) and Molecular Systems Biology (MOSYS)University of ViennaViennaAustria
| | - Zvi Grossman
- Department of Physiology and Pharmacology, Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Olaf Wolkenhauer
- Department of Systems Biology & BioinformaticsUniversity of RostockRostockGermany
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23
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Hassan L, Ahsan Z, Bint E Riaz H. An Unusual Case of Blackout in a COVID-19 Patient: COVID-19 Brain Fog. Cureus 2023; 15:e36273. [PMID: 37073192 PMCID: PMC10105897 DOI: 10.7759/cureus.36273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
This case report highlights a unique case of brain fog in a COVID-19 patient suggesting COVID-19's neurotropic nature. COVID-19 is associated with a long-COVID syndrome that presents with cognitive decline and fatigue. Recent studies show the emergence of a novel syndrome known as post-acute COVID syndrome or long COVID, which constitutes a variety of symptoms that continue for four weeks following the onset of a COVID-19 diagnosis. Numerous post-COVID patients experience both short and long-lasting symptoms affecting several organs, including the brain, which includes being unconscious, bradyphrenia, or amnesia. This long COVID status comprises of "brain fog", which, coupled with neuro-cognitive effects, has a significant role in prolonging the recovery phase. The pathogenesis of brain fog is currently unknown. One of the leading causes might be the involvement of neuroinflammation due to mast cells stimulated by pathogenic and stress stimuli. This in turn, triggers the release of mediators that activate microglia, causing inflammation in the hypothalamus. Its ability to invade the nervous system through trans-neural or hematogenous mechanisms is possibly the chief cause behind the presenting symptoms. This case report highlights a unique case of brain fog in a COVID-19 patient suggesting COVID-19's neurotropic nature and how it may lead to neurologic complications such as meningitis, encephalitis, and Guillain-Barré syndrome.
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24
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Cabral-Marques O, Moll G, Catar R, Preuß B, Bankamp L, Pecher AC, Henes J, Klein R, Kamalanathan AS, Akbarzadeh R, van Oostveen W, Hohberger B, Endres M, Koolmoes B, Levarht N, Postma R, van Duinen V, van Zonneveld AJ, de Vries-Bouwstra J, Fehres C, Tran F, do Vale FYN, da Silva Souza KB, Filgueiras IS, Schimke LF, Baiocchi GC, de Miranda GC, da Fonseca DLM, Freire PP, Hackel AM, Grasshoff H, Stähle A, Müller A, Dechend R, Yu X, Petersen F, Sotzny F, Sakmar TP, Ochs HD, Schulze-Forster K, Heidecke H, Scheibenbogen C, Shoenfeld Y, Riemekasten G. Autoantibodies targeting G protein-coupled receptors: An evolving history in autoimmunity. Report of the 4th international symposium. Autoimmun Rev 2023; 22:103310. [PMID: 36906052 DOI: 10.1016/j.autrev.2023.103310] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
G protein-coupled receptors (GPCR) are involved in various physiological and pathophysiological processes. Functional autoantibodies targeting GPCRs have been associated with multiple disease manifestations in this context. Here we summarize and discuss the relevant findings and concepts presented in the biennial International Meeting on autoantibodies targeting GPCRs (the 4th Symposium), held in Lübeck, Germany, 15-16 September 2022. The symposium focused on the current knowledge of these autoantibodies' role in various diseases, such as cardiovascular, renal, infectious (COVID-19), and autoimmune diseases (e.g., systemic sclerosis and systemic lupus erythematosus). Beyond their association with disease phenotypes, intense research related to the mechanistic action of these autoantibodies on immune regulation and pathogenesis has been developed, underscoring the role of autoantibodies targeting GPCRs on disease outcomes and etiopathogenesis. The observation repeatedly highlighted that autoantibodies targeting GPCRs could also be present in healthy individuals, suggesting that anti-GPCR autoantibodies play a physiologic role in modeling the course of diseases. Since numerous therapies targeting GPCRs have been developed, including small molecules and monoclonal antibodies designed for treating cancer, infections, metabolic disorders, or inflammatory conditions, anti-GPCR autoantibodies themselves can serve as therapeutic targets to reduce patients' morbidity and mortality, representing a new area for the development of novel therapeutic interventions.
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Affiliation(s)
- Otávio Cabral-Marques
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil; Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil; Department of Pharmacy and Postgraduate Program of Health and Science, Federal University of Rio Grande do Norte, Natal, Brazil; Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of Sao Paulo (USP), Sao Paulo, Brazil.
| | - Guido Moll
- Department of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany; BIH Center for Regenerative Therapies (BCRT) and Berlin-Brandenburg School for Regenerative Therapies (BSRT), all Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Rusan Catar
- Department of Nephrology and Internal Intensive Care Medicine, Charité University Hospital, Berlin, Germany
| | - Beate Preuß
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Lukas Bankamp
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Ann-Christin Pecher
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Joerg Henes
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - Reinhild Klein
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
| | - A S Kamalanathan
- Centre for BioSeparation Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Reza Akbarzadeh
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Wieke van Oostveen
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Bettina Hohberger
- Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany.; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Cluster of Excellence, Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Stroke Research Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Bryan Koolmoes
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Nivine Levarht
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Rudmer Postma
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Vincent van Duinen
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Anton Jan van Zonneveld
- LUMC, Department of Internal Medicine (Nephrology), Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden, the Netherlands
| | - Jeska de Vries-Bouwstra
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Cynthia Fehres
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, the Netherlands
| | - Florian Tran
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Fernando Yuri Nery do Vale
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Igor Salerno Filgueiras
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Lena F Schimke
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gabriela Crispim Baiocchi
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Gustavo Cabral de Miranda
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Dennyson Leandro Mathias da Fonseca
- Interunit Postgraduate Program on Bioinformatics, Institute of Mathematics and Statistics (IME), University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Paula Paccielli Freire
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Alexander M Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Stähle
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Antje Müller
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Ralf Dechend
- Experimental and Clinical Research Center, A collaboration of Max Delbruck Center for Molecular Medicine and Charité Universitätsmedizin, and HELIOS Clinic, Department of Cardiology and Nephrology, Berlin 13125, Germany
| | - Xinhua Yu
- Priority Area Chronic Lung Diseases, Research Center Borstel (RCB), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Frank Petersen
- Priority Area Chronic Lung Diseases, Research Center Borstel (RCB), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Franziska Sotzny
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - Thomas P Sakmar
- Laboratory of Chemical Biology and Signal Transduction, The Rockefeller University, New York, NY, USA
| | - Hans D Ochs
- University of Washington School of Medicine and Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Carmen Scheibenbogen
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.
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25
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El-Rhermoul FZ, Fedorowski A, Eardley P, Taraborrelli P, Panagopoulos D, Sutton R, Lim PB, Dani M. Autoimmunity in Long Covid and POTS. OXFORD OPEN IMMUNOLOGY 2023; 4:iqad002. [PMID: 37255928 PMCID: PMC10224806 DOI: 10.1093/oxfimm/iqad002] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/23/2023] [Accepted: 03/08/2023] [Indexed: 11/10/2023] Open
Abstract
Orthostatic intolerance and other autonomic dysfunction syndromes are emerging as distinct symptom clusters in Long Covid. Often accompanying these are common, multi-system constitutional features such as fatigue, malaise and skin rashes which can signify generalized immune dysregulation. At the same time, multiple autoantibodies are identified in both Covid-related autonomic disorders and non-Covid autonomic disorders, implying a possible underlying autoimmune pathology. The lack of specificity of these findings precludes direct interpretations of cause and association, but their prevalence with its supporting evidence is compelling.
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Affiliation(s)
- Fatema-Zahra El-Rhermoul
- Department of Allergy and Clinical Immunology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital and Karolinska Institute, Stockholm 171 77, Sweden
| | - Philip Eardley
- Imperial Syncope Unit, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | | | | | - Richard Sutton
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Phang Boon Lim
- Imperial Syncope Unit, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Melanie Dani
- Imperial Syncope Unit, Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London, London W12 0BZ, UK
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26
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Cremaschi RC, Bahi CAS, Paola AAVD, Arakaki JSO, Ferreira PRA, Bellei NCJ, Borges V, Coelho FMS. Neurological symptoms and comorbidity profile of hospitalized patients with COVID-19. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:146-154. [PMID: 36948200 PMCID: PMC10033191 DOI: 10.1055/s-0043-1761433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND The neurological manifestations in COVID-19 adversely impact acute illness and post-disease quality of life. Limited data exist regarding the association of neurological symptoms and comorbid individuals. OBJECTIVE To assess neurological symptoms in hospitalized patients with acute COVID-19 and multicomorbidities. METHODS Between June 2020 and July 2020, inpatients aged 18 or older, with laboratory-confirmed COVID-19, admitted to the Hospital São Paulo (Federal University of São Paulo), a tertiary referral center for high complexity cases, were questioned about neurological symptoms. The Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire was used. The data were analyzed as a whole and whether subjective olfactory dysfunction was present or not. RESULTS The mean age of the sample was 55 ± 15.12 years, and 58 patients were male. The neurological symptoms were mostly xerostomia (71%), ageusia/hypogeusia (50%), orthostatic intolerance (49%), anosmia/hyposmia (44%), myalgia (31%), dizziness (24%), xerophthalmia (20%), impaired consciousness (18%), and headache (16%). Furthermore, 91% of the patients had a premorbidity. The 44 patients with subjective olfactory dysfunction were more likely to have hypertension, diabetes, weakness, shortness of breath, ageusia/hypogeusia, dizziness, orthostatic intolerance, and xerophthalmia. The COMPASS-31 score was higher than that of previously published controls (14.85 ± 12.06 vs. 8.9 ± 8.7). The frequency of orthostatic intolerance was 49% in sample and 63.6% in those with subjective olfactory dysfunction (2.9-fold higher risk compared to those without). CONCLUSION A total of 80% of inpatients with multimorbidity and acute COVID-19 had neurological symptoms. Chemical sense and autonomic symptoms stood out. Orthostatic intolerance occurred in around two-thirds of the patients with anosmia/hyposmia. Hypertension and diabetes were common, mainly in those with anosmia/hyposmia.
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Affiliation(s)
| | | | | | | | | | | | - Vanderci Borges
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - Fernando Morgadinho Santos Coelho
- Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil
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Mahmoud A, Kania B, Geris S, Akroush W, Manickam R, Azzam MHK. The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection. Radiol Case Rep 2023; 18:715-718. [PMCID: PMC9742062 DOI: 10.1016/j.radcr.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
The carotid sinus-arterial baroreflex is essential in maintaining blood pressure (BP) regulation. Afferent baroreflex failure (ABF) can present with labile changes in BP within seconds and can be secondary to neck surgery or radiation. We present here the first case, to our knowledge, of ABF precipitated by thyroidectomy, in a patient with active COVID-19 pneumonia, causing difficult control of severely labile BP in a critical care unit. Contributing factors included her critical illness state with upregulation of IL-6 leading to pituitary-adrenal axis alteration, her thyroidectomy further exacerbating autonomic dysfunction, as well as downregulation of ACE2 via COVID-19 infection. Management was achieved with a combination of midodrine and clonidine catered to specific BP thresholds. Additional research with a multidisciplinary approach is warranted to fully optimize the treatment of ABF in patients with neck surgery and or inflammatory conditions such as COVID-19.
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Affiliation(s)
- Anas Mahmoud
- Department of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USA
| | - Brooke Kania
- Department of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USA,Corresponding author
| | - Shady Geris
- Department of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USA
| | - Wadah Akroush
- Department of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USA
| | - Rajapriya Manickam
- Department of Critical Care, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USA
| | - Moh'd Hazem K Azzam
- Department of Critical Care, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USA
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Converging Evidence of Similar Symptomatology of ME/CFS and PASC Indicating Multisystemic Dyshomeostasis. Biomedicines 2023; 11:biomedicines11010180. [PMID: 36672687 PMCID: PMC9855891 DOI: 10.3390/biomedicines11010180] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
The purpose of this article is to review the evidence of similar symptomatology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and post-acute sequelae of SARS-CoV-2 infection (PASC). Reanalysis of data from a study by Jason comparing symptom reports from two groups of ME/CFS and PASC patients shows a notably similar symptomatology. Symptom scores of the PASC group and the ME/CFS group correlated 0.902 (p < 0.0001) across items. The hypothesis is presented that ME/CFS and PASC are caused by a chronic state of multisystemic disequilibrium including endocrinological, immunological, and/or metabolic changes. The hypothesis holds that a changed set point persistently pushes the organism towards a pathological dysfunctional state which fails to reset. To use an analogy of a thermostat, if the ‘off switch’ of a thermostat intermittently stops working, for periods the house would become warmer and warmer without limit. The hypothesis draws on recent investigations of the Central Homeostasis Network showing multiple interconnections between the autonomic system, central nervous system, and brain stem. The hypothesis helps to explain the shared symptomatology of ME/CFS and PASC and the unpredictable, intermittent, and fluctuating pattern of symptoms of ME/CFS and PASC. The current theoretical approach remains speculative and requires in-depth investigation before any definite conclusions can be drawn.
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Öztürk Y, Yıldız MB, Bolaç R. Evaluation of Pupillometric Parameters in Patients with COVID-19. Ocul Immunol Inflamm 2023; 31:39-43. [PMID: 34637671 DOI: 10.1080/09273948.2021.1980811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate the pupillary diameter and pupillary light response in patients who have recovered from the COVID-19. METHODS Thirty two eyes of 32 patients with a history of COVID-19 in the last two months and 32 eyes of 32 age and sex-matched healthy controls were included in this prospective study. All patients had neurological symptoms. Dynamic and static pupillometry measurements were performed with the Sirius (CSO, Italy) corneal topography device. RESULTS Patients with COVID-19 had higher mean scotopic, mesopic, and photopic pupil diameters compared to the controls (p = .01, p = .04, p = .02, respectively). In dynamic pupillometry analysis, 0th, 2th, 8th and 16th second pupil diameter measurements were higher in COVID-19 patients (p = .02, p = .04, p = .04, p = .04, respectively). There were no differences in the average speed of pupillary dilatation (p > .05). CONCLUSION Our findings suggest that the pupillary response, an indicator of autonomic nervous system activity, may be affected in COVID-19 patients with neurological symptoms.
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Affiliation(s)
- Yücel Öztürk
- Haydarpaşa Numune Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Merve Beyza Yıldız
- Haydarpaşa Numune Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Rüveyde Bolaç
- Haydarpaşa Numune Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
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30
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Therapeutic target and clinical impact of day-to-day blood pressure variability in hypertensive patients with covid-19. Hypertens Res 2023; 46:165-174. [PMID: 36280737 PMCID: PMC9589643 DOI: 10.1038/s41440-022-01077-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
Blood pressure variability (BPV) is essential in hypertensive patients and is frequently associated with organ damage. As of today, hypertension is still the most common comorbidity in COVID-19, but the impact of BPV and the therapeutic target of BPV on outcomes in COVID-19 patients with hypertension remain unclear. Therefore, this study investigated the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status, and efficacy of antihypertensives in suppressing hypertensive covid-19 patient BPV. This cohort retrospective study enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the severity of COVID-19, the presence of hypertension, and their BPV status. During hospitalization, mean arterial pressure (MAP) was measured at 6 a.m. and 6 p.m., and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. In addition, we compared the hypertensive status, COVID-19 severity, in-hospital mortality, and antihypertensive agents between the BPV groups. The mean age was 53.85 ± 18.84 years old. Hypertension was significantly associated with high BPV with prevalence ratio (PR) = 1.38 (95% CI = 1.13-1.70; p = 0.003) or severe COVID-19 (PR = 1.39; 95% CI = 1.09-1.76; p = 0.005). In laboratory findings, high BPV group had lower Albumin, higher WBC, serum Cr, CRP, and creatinine to albumin ratio. High BPV status also significantly increased risk of mortality (HR = 2.30; 95% CI = 1.73-3.86; p < 0.001). Patients with a combination of severe COVID-19 status, hypertension, and high BPV status had the highest risk of in-hospital mortality (HR = 3.51; 95% CI = 2.32-4.97; p < 0.001) compared to other combination status groups. In COVID-19 patients with hypertension, combination therapy with calcium channel blockers (CCB) as well as CCB monotherapy significantly develop low BPV (PR = 2.002; 95 CI% = 1.33-3.07; p = 0.004) and low mortality (HR = 0.17; 95% CI = 0.05-0.56; p = 0.004). Hypertensive status and severe COVID-19 were significantly associated with high BPV, and these factors increased in-hospital mortality. CCBs might be antihypertensive agents that potentially effectively suppressing BPV and mortality in COVID-19 patients.
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Muacevic A, Adler JR, Breve F, Magnusson PM, Varrassi G. Exploring the Implications of New-Onset Diabetes in COVID-19: A Narrative Review. Cureus 2023; 15:e33319. [PMID: 36741600 PMCID: PMC9894635 DOI: 10.7759/cureus.33319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Abstract
Post-viral new-onset diabetes has been an important feature of the COVID-19 pandemic. It is not always clear if new-onset diabetes is the unmasking of a previously undiagnosed condition, the acceleration of prediabetes, or new-onset diabetes that would not have otherwise occurred. Even asymptomatic cases of COVID-19 have been associated with new-onset diabetes. Diabetes that emerges during acute COVID-19 infection tends to have an atypical presentation, characterized by hyperglycemia and potentially life-threatening diabetic ketoacidosis. It is not always clear if new-onset diabetes is type 1 or type 2 diabetes mellitus. Many cases of COVID-associated diabetes appear to be type 1 diabetes, which is actually an autoimmune disorder. The clinical course varies temporally and with respect to outcomes; in some cases, diabetes resolves completely or improves incrementally after recovery from COVID-19. Disruptions in macrophagy caused by COVID-19 infection along with an exaggerated inflammatory response that can occur in COVID-19 also play a role. Those who survive COVID-19 remain at a 40% elevated risk for diabetes in the first year, even if their case of COVID-19 was not particularly severe. A subsequent post-pandemic wave of new diabetes patients may be expected.
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32
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Kamchatnov PR, Cheremin RA, Skipetrova LA, Chugunov AV. Neurological Signs of Postcovid Syndrome. NEUROSCIENCE AND BEHAVIORAL PHYSIOLOGY 2022; 52:968-975. [PMID: 36589208 PMCID: PMC9789305 DOI: 10.1007/s11055-022-01324-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 06/17/2023]
Abstract
The challenge of postcovid syndrome (PCS) is of great interest due to its wide distribution and variety of clinical signs. The main neurological signs of PCS are discussed. Data on the presumptive mechanisms forming PCS are presented. The potential for using the drug Mexidol to treat patients with PCS is addressed.
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Affiliation(s)
- P. R. Kamchatnov
- Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia
| | - R. A. Cheremin
- Speech Pathology and Neurorehabilitation Center, Moscow Health Department, Moscow, Russia
| | - L. A. Skipetrova
- Speech Pathology and Neurorehabilitation Center, Moscow Health Department, Moscow, Russia
| | - A. V. Chugunov
- Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia
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33
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Orfei MD, Porcari DE, D’Arcangelo S, Maggi F, Russignaga D, Ricciardi E. A New Look on Long-COVID Effects: The Functional Brain Fog Syndrome. J Clin Med 2022; 11:5529. [PMID: 36233392 PMCID: PMC9573330 DOI: 10.3390/jcm11195529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Epidemiological data and etiopathogenesis of brain fog are very heterogeneous in the literature, preventing adequate diagnosis and treatment. Our study aimed to explore the relationship between brain fog, neuropsychiatric and cognitive symptoms in the general population. A sample of 441 subjects underwent a web-based survey, including the PANAS, the DASS-21, the IES-R, the Beck Cognitive Insight Scale, and a questionnaire investigating demographic information, brain fog, subjective cognitive impairments (Scc) and sleep disorders. ANOVA, ANCOVA, correlation and multiple stepwise regression analyses were performed. In our sample, 33% of participants were defined as Healthy Subjects (HS; no brain fog, no Scc), 27% as Probable Brain Fog (PBF; brain fog or Scc), and 40% as Functional Brain Fog (FBF; brain fog plus Scc). PBF and FBF showed higher levels of neuropsychiatric symptoms than HS, and FBF showed the worst psychological outcome. Moreover, worse cognitive symptoms were related to the female gender, greater neuropsychiatric symptoms, sleep disorders, and rumination/indecision. Being a woman and more severe neuropsychiatric symptoms were predictors of FBF severity. Our data pointed out a high prevalence and various levels of severity and impairments of brain fog, suggesting a classificatory proposal and a multifaceted etiopathogenic model, thus facilitating adequate diagnostic and therapeutic approaches.
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Affiliation(s)
- Maria Donata Orfei
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Desirée Estela Porcari
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Sonia D’Arcangelo
- Intesa Sanpaolo Innovation Center SpA Neuroscience Lab, Via Inghilterra 3, 10138 Turin, Italy
| | - Francesca Maggi
- Intesa Sanpaolo Innovation Center SpA Neuroscience Lab, Via Inghilterra 3, 10138 Turin, Italy
| | - Dario Russignaga
- Intesa Sanpaolo S.p.A., HSE Office, Via Lorenteggio 266, 20152 Milan, Italy
| | - Emiliano Ricciardi
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
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Sukocheva OA, Maksoud R, Beeraka NM, Madhunapantula SV, Sinelnikov M, Nikolenko VN, Neganova ME, Klochkov SG, Amjad Kamal M, Staines DR, Marshall-Gradisnik S. Analysis of post COVID-19 condition and its overlap with myalgic encephalomyelitis/chronic fatigue syndrome. J Adv Res 2022; 40:179-196. [PMID: 36100326 PMCID: PMC8619886 DOI: 10.1016/j.jare.2021.11.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/02/2021] [Accepted: 11/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) triggers the development of numerous pathologies and infection-linked complications and exacerbates existing pathologies in nearly all body systems. Aside from the primarily targeted respiratory organs, adverse SARS-CoV-2 effects were observed in nervous, cardiovascular, gastrointestinal/metabolic, immune, and other systems in COVID-19 survivors. Long-term effects of this viral infection have been recently observed and represent distressing sequelae recognised by the World Health Organisation (WHO) as a distinct clinical entity defined as post-COVID-19 condition. Considering the pandemic is still ongoing, more time is required to confirm post COVID-19 condition diagnosis in the COVID-19 infected cohorts, although many reported post COVID-19 symptoms overlap with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). AIMS OF REVIEW In this study, COVID-19 clinical presentation and associated post-infection sequelae (post-COVID-19 condition) were reviewed and compared with ME/CFS symptomatology. KEY SCIENTIFIC CONCEPTS OF REVIEW The onset, progression, and symptom profile of post COVID-19 condition patients have considerable overlap with ME/CFS. Considering the large scope and range of pro-inflammatory effects of this virus, it is reasonable to expect development of post COVID-19 clinical complications in a proportion of the affected population. There are reports of a later debilitating syndrome onset three months post COVID-19 infection (often described as long-COVID-19), marked by the presence of fatigue, headache, cognitive dysfunction, post-exertional malaise, orthostatic intolerance, and dyspnoea. Acute inflammation, oxidative stress, and increased levels of interleukin-6 (IL-6) and tumor necrosis factor α (TNFα), have been reported in SARS-CoV-2 infected patients. Longitudinal monitoring of post COVID-19 patients is warranted to understand the long-term effects of SARS-CoV-2 infection and the pathomechanism of post COVID-19 condition.
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Affiliation(s)
- Olga A Sukocheva
- College of Nursing and Health Sciences, Flinders University of South Australia, Bedford Park 5042, SA, Australia; The National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
| | - Rebekah Maksoud
- The National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Consortium Health International for Myalgic Encephalomyelitis, National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD, Australia
| | - Narasimha M Beeraka
- Department of Biochemistry, Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), JSS Academy of Higher Education & Research (JSS AHER), Mysore, India
| | - SabbaRao V Madhunapantula
- Department of Biochemistry, Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), JSS Academy of Higher Education & Research (JSS AHER), Mysore, India; Special Interest Group in Cancer Biology and Cancer Stem Cells (SIG-CBCSC), JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysore, India
| | - Mikhail Sinelnikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Mohovaya 11c10, Moscow, Russia
| | - Vladimir N Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Mohovaya 11c10, Moscow, Russia
| | - Margarita E Neganova
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Sergey G Klochkov
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Mohammad Amjad Kamal
- King Fahd Medical Research Center, King Abdulaziz University, P. O. Box 80216, Jeddah 21589, Saudi Arabia; Enzymoics, 7 Peterlee Place, Novel Global Community Educational Foundation, Hebersham, NSW 2770, Australia
| | - Donald R Staines
- The National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Consortium Health International for Myalgic Encephalomyelitis, National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD, Australia
| | - Sonya Marshall-Gradisnik
- The National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Consortium Health International for Myalgic Encephalomyelitis, National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD, Australia
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Ceccarini G, Gilio D, Magno S, Pelosini C, Leverone M, Miceli C, Barison A, Fabiani I, Emdin M, Santini F. Post-acute cardiac complications following SARS-CoV-2 infection in partial lipodystrophy due to LMNA gene p.R349W mutation. J Endocrinol Invest 2022; 45:1569-1575. [PMID: 35384599 PMCID: PMC8984660 DOI: 10.1007/s40618-022-01795-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE SARS-CoV-2 infection may cause varying degrees of cardiac injury and the presence of underlying cardiovascular morbidities contributes to the frequency and severity of occurrence of this complication. Lipodystrophy syndromes are frequently characterized by severe metabolic derangements that represent relevant cardiovascular risk factors. Besides causing lipodystrophy, mutations in the lamin A/C (LMNA) gene can lead to a wide spectrum of tissue-specific disorders including cardiac involvement. METHODS AND RESULTS We herein examine the case of two patients affected by atypical progeroid syndrome and partial lipodystrophy due to a heterozygous missense LMNA mutation c.1045 C > T (p.R349W) who presented initially with mild COVID-19 and developed severe cardiovascular complications within few weeks of SARS-CoV-2 infection. Before being infected with SARS-CoV-2, our patients had cardiovascular morbidities (mild mitral regurgitation in one patient, ischemic heart disease with bifascicular block in the other patient) in adjunct to cardiovascular risk factors, but the SARS-CoV-2 infection contributed to quickly and significantly decompensate their balance. CONCLUSION These findings warn that patients affected by LMNA p.R349W mutation and likely other LMNA mutations associated with cardiovascular morbidity should be considered at extremely elevated risk of post-acute cardiological manifestations and should therefore undergo a vigilant follow-up after SARS-CoV-2 infection. Both patients developed COVID-19 before the specific vaccination was available to them and this unfortunate situation should remark the importance of vaccination coverage against SARS-CoV-2 infection for all patients affected by lipodystrophy, especially those with underlying comorbidities.
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Affiliation(s)
- G Ceccarini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital, Pisa, Italy.
| | - D Gilio
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital, Pisa, Italy
| | - S Magno
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital, Pisa, Italy
| | - C Pelosini
- Chemistry and Endocrinology Laboratory, University Hospital, Pisa, Italy
| | - M Leverone
- Cardiology Unit, Ospedale degli Infermi, Biella, Italy
| | - C Miceli
- Cardiology Unit, Presidio Ospedaliero di Cittadella, Padova, Italy
| | - A Barison
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - I Fabiani
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - F Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital, Pisa, Italy
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36
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COVID-19 Vaccination Might Induce Postural Orthostatic Tachycardia Syndrome: A Case Report. Vaccines (Basel) 2022; 10:vaccines10070991. [PMID: 35891154 PMCID: PMC9323926 DOI: 10.3390/vaccines10070991] [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: 05/23/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 01/09/2023] Open
Abstract
We report a case of new-onset postural orthostatic tachycardia syndrome in a healthy 46-year-old female after a single dose of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine. There have been three prior reports of new-onset postural orthostatic tachycardia syndrome after COVID-19 vaccination. Predominant symptoms noted included fatigue, brain fog, headache, sinus tachycardia, and dizziness. Management includes noninvasive therapies, behavioral approaches, and pharmacologic regimens. Here, the patient presented with fatigue, palpitations, dizziness, and presyncope, with symptoms beginning 7 days after vaccination. Presenting vitals included temperature within normal limits, inappropriate tachycardia, up to 120 beats per minute, blood pressure of 128/87 mm of mercury, and 100% saturation in room air. Her management included lifestyle changes, dietary supplements, and ivabradine. Further studies are needed to evaluate prevalence, etiology, and optimal management.
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Carmona-Torre F, Mínguez-Olaondo A, López-Bravo A, Tijero B, Grozeva V, Walcker M, Azkune-Galparsoro H, López de Munain A, Alcaide AB, Quiroga J, Del Pozo JL, Gómez-Esteban JC. Dysautonomia in COVID-19 Patients: A Narrative Review on Clinical Course, Diagnostic and Therapeutic Strategies. Front Neurol 2022; 13:886609. [PMID: 35720084 PMCID: PMC9198643 DOI: 10.3389/fneur.2022.886609] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/28/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction On March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. Objective To conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. Results Autonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. Conclusion Symptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease.
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Affiliation(s)
- Francisco Carmona-Torre
- Infectious Disease Service, University Clinic of Navarra, Pamplona, Spain.,COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ane Mínguez-Olaondo
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Alba López-Bravo
- Neurology Department, Hospital Reina Sofía de Tudela-OSASUNBIDEA, Tudela, Spain.,Aragon Institute for Health Research (IIS-A), Zaragoza, Spain
| | - Beatriz Tijero
- Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Neurodegenerative Diseases Group Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Neurology Department, Cruces University Hospital-OSAKIDETZA, Barakaldo, Spain
| | | | - Michaela Walcker
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain
| | - Harkaitz Azkune-Galparsoro
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Infectious Disease Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Adolfo López de Munain
- Neurology Department, Donostia University Hospital-OSAKIDETZA, San Sebastián, Spain.,ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neuroscience Area, Biodonostia Research Institute, San Sebastián, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Belen Alcaide
- COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Pulmonary Department, University Clinic of Navarra, Pamplona, Spain
| | - Jorge Quiroga
- COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Internal Medicine Department, University Clinic of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Institute Carlos III, Madrid, Spain
| | - Jose Luis Del Pozo
- Infectious Disease Service, University Clinic of Navarra, Pamplona, Spain.,COVID-19 Department, University Clinic of Navarra, Pamplona, Spain.,Immune and Infectious Inflammatory Diseases Research, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Juan Carlos Gómez-Esteban
- ATHENEA Neuroclinics, Policlínica Gipuzkoa Grupo Quironsalud, Donostia, Spain.,Neurology Department, Faculty of Medicine, University of Deusto, Bilbao, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Neurodegenerative Diseases Group Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Neurology Department, Cruces University Hospital-OSAKIDETZA, Barakaldo, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
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Long COVID and the Autonomic Nervous System: The Journey from Dysautonomia to Therapeutic Neuro-Modulation through the Retrospective Analysis of 152 Patients. NEUROSCI 2022. [DOI: 10.3390/neurosci3020021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction. The severity and prevalence of Post-Acute COVID-19 Sequela (PACS) or long-COVID syndrome (long COVID) should not be a surprise. Long-COVID symptoms may be explained by oxidative stress and parasympathetic and sympathetic (P&S) dysfunction. This is a retrospective, hypothesis generating, outcomes study. Methods. From two suburban practices in northeastern United States, 152 long COVID patients were exposed to the following practices: (1) first, they were P&S tested (P&S Monitor 4.0; Physio PS, Inc., Atlanta, GA, USA) prior to being infected with COVID-19 due to other causes of autonomic dysfunction; (2) received a pre-COVID-19 follow-up P&S test after autonomic therapy; (3) then, they were infected with COVID-19; (4) P&S tested within three months of surviving the COVID-19 infection with long-COVID symptoms; and, finally, (5) post-COVID-19, follow-up P&S tested, again, after autonomic therapy. All the patients completed autonomic questionnaires with each test. This cohort included 88 females (57.8%), with an average age of 47.0 years (ranging from 14 to 79 years), and an average BMI of 26.9 #/in2. Results. More pre-COVID-19 patients presented with sympathetic withdrawal than parasympathetic excess. Post-COVID-19, these patients presented with this ratio reversed and, on average, 49.9% more autonomic symptoms than they did pre-COVID-19. Discussion. Both parasympathetic excess and sympathetic withdrawal are separate and treatable autonomic dysfunctions and autonomic treatment significantly reduces the prevalence of autonomic symptoms. Conclusion. SARS-CoV-2, via its oxidative stress, can lead to P&S dysfunction, which, in turn, affects the control and coordination of all systems throughout the whole body and may explain all of the symptoms of long-COVID syndrome. Autonomic therapy leads to positive outcomes and patient quality of life may be restored.
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Khazaal S, Harb J, Rima M, Annweiler C, Wu Y, Cao Z, Abi Khattar Z, Legros C, Kovacic H, Fajloun Z, Sabatier JM. The Pathophysiology of Long COVID throughout the Renin-Angiotensin System. Molecules 2022; 27:2903. [PMID: 35566253 PMCID: PMC9101946 DOI: 10.3390/molecules27092903] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has expanded across the world since its discovery in Wuhan (China) and has had a significant impact on people's lives and health. Long COVID is a term coined by the World Health Organization (WHO) to describe a variety of persistent symptoms after acute SARS-CoV-2 infection. Long COVID has been demonstrated to affect various SARS-CoV-2-infected persons, independently of the acute disease severity. The symptoms of long COVID, like acute COVID-19, consist in the set of damage to various organs and systems such as the respiratory, cardiovascular, neurological, endocrine, urinary, and immune systems. Fatigue, dyspnea, cardiac abnormalities, cognitive and attention impairments, sleep disturbances, post-traumatic stress disorder, muscle pain, concentration problems, and headache were all reported as symptoms of long COVID. At the molecular level, the renin-angiotensin system (RAS) is heavily involved in the pathogenesis of this illness, much as it is in the acute phase of the viral infection. In this review, we summarize the impact of long COVID on several organs and tissues, with a special focus on the significance of the RAS in the disease pathogenesis. Long COVID risk factors and potential therapy approaches are also explored.
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Affiliation(s)
- Shaymaa Khazaal
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, Tripoli P.O. Box 45061, Lebanon;
| | - Julien Harb
- Faculty of Medicine and Medical Sciences, University of Balamand, Dekouene Campus, Sin El Fil P.O. Box 55251, Lebanon;
| | - Mohamad Rima
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and Its Applications, EDST, Lebanese University, Tripoli P.O. Box 45061, Lebanon;
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital & Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, University of Angers, 44312 Angers, France;
| | - Yingliang Wu
- State Key Laboratory of Virology, Modern Virology Research Center, College of Life Sciences, Wuhan University, Wuhan 430072, China; (Y.W.); (Z.C.)
| | - Zhijian Cao
- State Key Laboratory of Virology, Modern Virology Research Center, College of Life Sciences, Wuhan University, Wuhan 430072, China; (Y.W.); (Z.C.)
| | - Ziad Abi Khattar
- Laboratory of Georesources, Geosciences and Environment (L2GE), Microbiology/Tox-Ecotoxicology Team, Faculty of Sciences 2, Lebanese University, Campus Fanar, Jdeidet El-Matn, Beirut P.O. Box 90656, Lebanon;
| | - Christian Legros
- INSERM, CNRS, MITOVASC, Team 2 CarMe, SFR ICAT, University of Angers, 49000, France;
| | - Hervé Kovacic
- Institut de Neurophysiopathologie (INP), Aix-Marseille Université CNRS, 13385 Marseille, France;
| | - Ziad Fajloun
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, Tripoli P.O. Box 45061, Lebanon;
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and Its Applications, EDST, Lebanese University, Tripoli P.O. Box 45061, Lebanon;
| | - Jean-Marc Sabatier
- Institut de Neurophysiopathologie (INP), Aix-Marseille Université CNRS, 13385 Marseille, France;
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Kluczna A, Mularska E, Dzierżanowski T. Orthostatic hypotonia as a probably late sequela of SARS-CoV-2 infection in a patient provided with palliative home care: a case report. Eur J Med Res 2022; 27:60. [PMID: 35488314 PMCID: PMC9051496 DOI: 10.1186/s40001-022-00685-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/10/2022] [Indexed: 01/21/2023] Open
Abstract
Background The SARS-CoV-2 pandemic has become a challenge for the entire healthcare system. Treatment for COVID-19 includes casual and symptomatic management in the acute phase of the disease and focuses on the treating early complications of the disease. Long-term health consequences of the infection have not yet been fully identified. A special group of patients with comorbidities, including neoplastic disease for whom the interpretation and management of symptoms is a major challenge. Case presentation In this case report, we present a 73-year-old woman with recently diagnosed gastric adenocarcinoma in whom we diagnosed orthostatic hypotonia in the aftermath of SARS-CoV-2 infection. We administered thiethylperazine maleate 6.5 mg daily. Additionally, we advised the patient to slowly lift from the recumbent position, raise the headboard, take meals in small portions, and increase fluid intake. These pharmacological and nonpharmacological measures resulted in sustained relief of dizziness and nausea. Conclusions The occurrence of orthostatic hypotonia seems a possible late sequela of SARS-CoV-2 infection, and simple measures appeared sufficient to achieve sustained symptom control.
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Affiliation(s)
- Agnieszka Kluczna
- Medical Department, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland. .,Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, Oczki 3, 02-007, Warsaw, Poland.
| | - Elżbieta Mularska
- Observational and Infectious Disease Ward, Clinical Specialist Hospital in Chorzow, Zjednoczenia 10, 41-500, Chorzów, Poland
| | - Tomasz Dzierżanowski
- Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, Oczki 3, 02-007, Warsaw, Poland
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41
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López-Sampalo A, Bernal-López MR, Gómez-Huelgas R. [Persistent COVID-19 syndrome. A narrative review]. Rev Clin Esp 2022; 222:241-250. [PMID: 34803180 PMCID: PMC8590955 DOI: 10.1016/j.rce.2021.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/12/2021] [Indexed: 01/09/2023]
Abstract
As the coronavirus-2019 disease (COVID-19) pandemic, caused by the infection with severe acute respiratory syndrome (SARS-CoV-2) coronavirus type 2, has progressed, persistent COVID-19 syndrome is an increasingly recognized problem on which a significant volume of medical literature is developing. Symptoms may be persistent or appear, after an asymptomatic period, weeks or months after the initial infection. The clinical picture is as markedly heterogeneous and multisystemic as in the acute phase, so multidisciplinary management is required. In addition, their appearance is not related to the severity of the initial infection, so they can affect both mild patients, even asymptomatic, and seriously ill patients who have required hospitalization. Although it can affect people of any age, it is more common in middle-aged women. The sequelae can generate a high impact on the quality of life, and in the work and social environment. The objective of this paper is to review persistent COVID-19 syndrome, to know its clinical manifestations and the strategies for the management and follow-up of these patients.
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Affiliation(s)
- A López-Sampalo
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
| | - M R Bernal-López
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, España
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42
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López-Sampalo A, Bernal-López MR, Gómez-Huelgas R. Persistent COVID-19 syndrome. A narrative review. Rev Clin Esp 2022; 222:241-250. [PMID: 35260380 PMCID: PMC8882405 DOI: 10.1016/j.rceng.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
As the coronavirus-2019 disease (COVID-19) pandemic, caused by the infection with severe acute respiratory syndrome (SARS-CoV-2) coronavirus type 2, has progressed, persistent COVID-19 syndrome is an increasingly recognized problem on which a significant volume of medical literature is developing. Symptoms may be persistent or appear, after an asymptomatic period, weeks or months after the initial infection. The clinical picture is as markedly heterogeneous and multisystemic as in the acute phase, so multidisciplinary management is required. In addition, their appearance is not related to the severity of the initial infection, so they can affect both mild patients, even asymptomatic, and seriously ill patients who have required hospitalization. Although it can affect people of any age, it is more common in middle-aged women. The sequelae can generate a high impact on the quality of life, and in the work and social environment. The objective of this paper is to review persistent COVID-19 syndrome, to know its clinical manifestations and the strategies for the management and follow-up of these patients.
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Affiliation(s)
- A López-Sampalo
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - M R Bernal-López
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Boskabadi SJ, Sharifpour A, Zakariaei Z, Banimostafavi ES, Soleymani M. Diabetic ketoacidosis mimicking COVID-19 in an adolescent. Clin Case Rep 2022; 10:e05662. [PMID: 35387285 PMCID: PMC8978777 DOI: 10.1002/ccr3.5662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/24/2022] Open
Abstract
Diabetic ketoacidosis (DKA) may be associated with nonspecific symptoms such as dyspnea, tachycardia, anorexia, and vomiting that are similar to COVID-19. We describe an adolescent who was referred to the emergency department with the above symptoms and died after being discharged, regardless of the differential diagnosis and laboratory findings.
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Affiliation(s)
- Seyed Javad Boskabadi
- Department of Clinical PharmacyFaculty of PharmacyMazandaran University of Medical SciencesSariIran
| | - Ali Sharifpour
- Pulmonary and Critical Care DivisionImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
- Communicable Diseases InstituteToxoplasmosis Research CenterIranian National Registry Center for Lophomoniasis and ToxoplasmosisMazandaran University of Medical SciencesSariIran
| | - Zakaria Zakariaei
- Communicable Diseases InstituteToxoplasmosis Research CenterIranian National Registry Center for Lophomoniasis and ToxoplasmosisMazandaran University of Medical SciencesSariIran
- Toxicology and Forensic Medicine DivisionToxoplasmosis Research CenterImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Elham Sadat Banimostafavi
- Communicable Diseases InstituteToxoplasmosis Research CenterIranian National Registry Center for Lophomoniasis and ToxoplasmosisMazandaran University of Medical SciencesSariIran
- Department of RadiologyImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Mostafa Soleymani
- Communicable Diseases InstituteToxoplasmosis Research CenterIranian National Registry Center for Lophomoniasis and ToxoplasmosisMazandaran University of Medical SciencesSariIran
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Morrow AK, Malone LA, Kokorelis C, Petracek LS, Eastin EF, Lobner KL, Neuendorff L, Rowe PC. Long-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS. CURRENT PEDIATRICS REPORTS 2022; 10:31-44. [PMID: 35287333 PMCID: PMC8906524 DOI: 10.1007/s40124-022-00261-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
Purpose of Review To discuss emerging understandings of adolescent long COVID or post-COVID-19 conditions, including proposed clinical definitions, common symptoms, epidemiology, overlaps with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and orthostatic intolerance, and preliminary guidance on management. Recent Findings The recent World Health Organization clinical case definition of post-COVID-19 condition requires a history of probable or confirmed SARS-CoV-2 infection, with symptoms starting within 3 months of the onset of COVID-19. Symptoms must last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms of the post-COVID-19 condition include, but are not limited to, fatigue, shortness of breath, and cognitive dysfunction. These symptoms generally have an impact on everyday functioning. The incidence of prolonged symptoms following SARS-CoV-2 infection has proven challenging to define, but it is now clear that those with relatively mild initial infections, without severe initial respiratory disease or end-organ injury, can still develop chronic impairments, with symptoms that overlap with conditions like ME/CFS (profound fatigue, unrefreshing sleep, post-exertional malaise, cognitive dysfunction, and orthostatic intolerance). Summary We do not yet have a clear understanding of the mechanisms by which individuals develop post-COVID-19 conditions. There may be several distinct types of long COVID that require different treatments. At this point, there is no single pharmacologic agent to effectively treat all symptoms. Because some presentations of post-COVID-19 conditions mimic disorders such as ME/CFS, treatment guidelines for this and related conditions can be helpful for managing post-COVID-19 symptoms. Supplementary Information The online version contains supplementary material available at 10.1007/s40124-022-00261-4.
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Affiliation(s)
- Amanda K Morrow
- Kennedy Krieger Institute, Baltimore, MD USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Laura A Malone
- Kennedy Krieger Institute, Baltimore, MD USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Christina Kokorelis
- Kennedy Krieger Institute, Baltimore, MD USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Lindsay S Petracek
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, 200 N Wolfe St, Room 2077, Baltimore, MD USA
| | - Ella F Eastin
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, 200 N Wolfe St, Room 2077, Baltimore, MD USA
| | | | - Luise Neuendorff
- Division of Cardiology, Department of Internal Medicine, University of Toronto, Toronto, Canada
| | - Peter C Rowe
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, 200 N Wolfe St, Room 2077, Baltimore, MD USA
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45
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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] [Key Words] [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
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Abstract
Purpose Autonomic dysfunction in patients with viral infections has been described before. In this study, we aimed to evaluate autonomic functions in patients with the coronavirus infectious disease 2019 (COVİD-19). Methods In this cross-sectional study, we compared 112 patients who had recovered from COVID-19 and 106 healthy controls. Symptoms of autonomic dysfunction were assessed with the SCOPA-AUT scale. Results Pupillomotor, urinary and sudomotor subscores of SCOPA-AUT scale were significantly higher in the COVID-19 patient group (p = 0.03, p = 0,006, p = 0.0001, respectively). There were no significant difference in terms of gastrointestinal, cardiovascular, sexual subscores and total SCOPA-AUT scores between the patient and control groups. The presence of fatigue symptom in the acute phase of COVID-19 increased the total SCOPA-AUT score by 2.2 points (p = 0.04) whereas the presence of smell loss (OR = 5.82, p = 0.01) and dyspnea (OR = 5.8, p = 0.03) were significant risk factors for pupillomotor dysfunction. The urinary, cardiovascular, sexual subscores and the total score of SCOPA-AUT scale were positively correlated with the age of the patient group. Conclusion Our study suggests that many patients might have prolonged symptoms of autonomic dysfunction after the acute phase of COVID-19 that might worsen the clinical recovery.
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47
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Nagai M, Förster CY. Day-to-day blood pressure variability in COVID-19: A biomarker of disrupted central autonomic network. J Clin Hypertens (Greenwich) 2022; 24:234-236. [PMID: 35129297 PMCID: PMC8924999 DOI: 10.1111/jch.14438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/20/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Michiaki Nagai
- Department of CardiologyHiroshima City Asa HospitalHiroshimaJapan
| | - Carola Yvette Förster
- Department of AnesthesiologyIntensive CareEmergency and Pain MedicineWürzburgGermany
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48
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Jost K, Rodriguez B, Söll N, Hoepner R, Z'Graggen WJ. Tolerability of COVID-19 mRNA vaccines in patients with postural tachycardia syndrome: a cross-sectional study. F1000Res 2022; 11:215. [PMID: 37822957 PMCID: PMC10562791 DOI: 10.12688/f1000research.109373.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 10/13/2023] Open
Abstract
Background: Postural tachycardia syndrome (POTS) is a form of autonomic dysregulation. There is increasing evidence that the etiology may be immune-mediated in a subgroup of patients. Patients with POTS often experience an exacerbation of their symptoms associated with (viral) infections and often fear the same symptom aggravation after vaccination. In this report we describe the tolerability of messenger ribonucleic acid (mRNA) vaccines against coronavirus disease 19 (COVID-19) and the consequences of a COVID-19 infection on POTS symptoms in our cohort of patients with neuropathic POTS. Methods: We conducted a standardized, checklist-based interview with 23 patients and recorded the acute side effects of mRNA vaccination, acute symptoms of COVID-19 infection as well as the effects of vaccination and COVID-19 infection on POTS symptoms. Results: Of all included patients, 20 patients received two mRNA vaccines without having had a previous COVID-19 infection, and five patients in total had suffered a COVID-19 infection. Of these, three had COVID-19 without and two after being vaccinated. No increased frequency of side effects after both doses of mRNA vaccines was observed. Six patients reported a mild and short-term aggravation of their POTS symptoms beyond the duration of acute vaccine side effects. All five patients who suffered a COVID-19 infection subsequently reported a pronounced and persistent exacerbation of POTS symptoms. Conclusions: Our observations suggest that mRNA vaccines are not associated with a higher frequency of acute side effects in patients with POTS. Symptom exacerbation as a consequence of mRNA vaccination seems to be less frequent and of shorter duration compared to patients who suffered a COVID-19 infection.
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Affiliation(s)
- Karin Jost
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Bern, 3010, Switzerland
| | - Belén Rodriguez
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, Bern, 3010, Switzerland
| | - Nicole Söll
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, Bern, 3010, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Bern, 3010, Switzerland
| | - Werner J. Z'Graggen
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Bern, 3010, Switzerland
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, Bern, 3010, Switzerland
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49
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Nagai M, Kato M, Keigo D. Anxiety and hypertension in the COVID-19 era: how is the central autonomic network linked? Hypertens Res 2022; 45:922-923. [PMID: 35181765 PMCID: PMC8855028 DOI: 10.1038/s41440-022-00864-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
| | - Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Dote Keigo
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
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50
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Jones OY, Yeralan S. Is Long COVID a State of Systemic Pericyte Disarray? J Clin Med 2022; 11:jcm11030572. [PMID: 35160024 PMCID: PMC8836446 DOI: 10.3390/jcm11030572] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 01/03/2023] Open
Abstract
The most challenging aspect of Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) or Long COVID remains for the discordance between the viral damage from acute infection in the recent past and susceptibility of Long COVID without clear evidence of post infectious inflammation or autoimmune reactions. In this communication we propose that disarray of pericytes plays a central role in emerge of Long COVID. We assume pericytes are agents with “Triple-A” qualities, i.e., analyze-adapt and advance, necessary for sustainability of host homeostasis. Based on this view, we further suggest Long COVID may provide a model system to integrate system theory and complex adaptive systems to explore a new class of maladies those are currently not well defined and with no remedies.
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Affiliation(s)
- Olcay Y. Jones
- Pediatric Rheumatology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Correspondence: (O.Y.J.); (S.Y.)
| | - Sencer Yeralan
- School of IT and Engineering, ADA University, Baku AZ1008, Azerbaijan
- Correspondence: (O.Y.J.); (S.Y.)
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