1
|
Bidhendi-Yarandi R, Biglarian A, Karlstad JL, Moe CF, Bakhshi E, Khodaei-Ardakani MR, Behboudi-Gandevani S. Prevalence of depression, anxiety, stress, and suicide tendency among individual with long-COVID and determinants: A systematic review and meta-analysis. PLoS One 2025; 20:e0312351. [PMID: 39874315 PMCID: PMC11774403 DOI: 10.1371/journal.pone.0312351] [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: 06/28/2024] [Accepted: 10/04/2024] [Indexed: 01/30/2025] Open
Abstract
BACKGROUND While mental health alterations during active COVID-19 infection have been documented, the prevalence of long-term mental health consequences remains unclear. This study aimed to determine the prevalence of mental health symptoms-depression, anxiety, stress, and suicidal tendencies-and to identify their trends and associated risk factors in individuals with long-COVID. METHODS We conducted a systematic literature search of databases including PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, Web of Science, and PsycINFO up to August 2024, targeting observational studies published in English. Study quality was assessed using structured standard tools. The primary outcome was the pooled prevalence of depression, anxiety, stress, and suicidal tendencies in individuals with long-COVID. Secondary outcomes included trends in these mental health problems over time and identification of associated determinants. RESULTS A total of 94 eligible studies were included in the analysis. The pooled prevalence estimates, regardless of follow up times duration, were as follows: depression, 25% (95%CI:22-28%; PI:1-59%); anxiety (adjusted via trim and fill method), 23%(95%CI:21-25%;PI:2-35%); composite outcomes of depression and/or anxiety, 25% (95%CI:23-27%;PI:2-51%); stress, 26%(95%CI:13-39%;PI:1-69%); and suicidality, 19%(95%CI:15-22%;PI:13-25%). The results of meta-regression analyses revealed a statistically significant trend showing a gradual decrease in the prevalence of the composite outcome of anxiety and/or depression over time (RD = -0.004,P = 0.022). Meta-regression results indicated that being female and younger age were significantly associated with a higher prevalence of mental health symptoms. Study design and study setting did not contribute to heterogeneity. CONCLUSION One-fourth of individual with long-COVID experience mental health symptoms, including depression, anxiety, and stress, which remain prevalent even two years post-infection despite a slight decreasing trend. Factors such as female gender and younger age were linked to higher rates of anxiety and depression. These findings indicate the need for ongoing mental health screening and early interventions to mitigate long-term psychological distress in long-COVID patients.
Collapse
Affiliation(s)
- Razieh Bidhendi-Yarandi
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Biostatistics and Epidemiology, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- Department of Biostatistics and Epidemiology, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | | - Enayatollah Bakhshi
- Department of Biostatistics and Epidemiology, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | |
Collapse
|
2
|
Qian J, Zhang G, Wu H, Sha L. Impact of the COVID-19 infection on children with allergic diseases in China. Pediatr Res 2025; 97:360-364. [PMID: 38937639 DOI: 10.1038/s41390-024-03365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The COVID-19 pandemic has prompted investigations into the association between this novel virus and allergic diseases, particularly asthma in children. However, the nature of this relationship remains poorly established. OBJECTIVE This study aims to determine the clinical characteristics of children with allergic diseases who have contracted COVID-19. METHODS A retrospective study was conducted at the Children's Hospital Affiliated to the Capital Institute of Pediatrics from January to March 2023. A total of 568 children aged 0-17 years diagnosed with asthma and COVID-19 infection were included. A comparative analysis of clinical characteristics was conducted between asthma and non-asthma groups. RESULTS Asthmatic children with COVID-19 infection showed significantly higher frequencies of cough, wheezing, expectoration, and long-term symptoms compared to those without asthma (P < 0.05). Subgroups with poor therapy compliance exhibited elevated proportions of cough, chest tightness, and wheezing compared to good therapy compliance (P < 0.05). Multivariate logistic regression identified poor therapy compliance as a risk factor for long COVID in asthmatic children. CONCLUSION Children with asthma secondary to COVID-19 infection were more prone to developing coughs, expectoration, and wheezing. Poor therapy compliance emerged as a significant risk factor for long COVID-19 in these individuals. IMPACT Asthmatic children with COVID-19 infection showed significantly higher frequencies of cough, wheezing, expectoration. Poor therapy compliance was the risk factor for long COVID in asthmatic children. This article supplements the effects of different therapeutic drugs on the condition of children with asthma after infection with COVID-19 as well as the possible risk factors for the long COVID. The results of our study have important implications for public health policy makers and healthcare professionals. To understand the impact of COVID-19 on children with asthma will help guide appropriate management strategies and ensure access to necessary healthcare resources.
Collapse
Affiliation(s)
- Jing Qian
- Department of Respiratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Guoqing Zhang
- Department of Respiratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Huahong Wu
- Department of Growth and Development, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Li Sha
- Department of Allergy, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China.
| |
Collapse
|
3
|
Alharbi A, Almogbel F, Rabbani U, Memish ZA. Long COVID-19 and Coexistence of Fatigue and Depression: A Cross-sectional Study from Saudi Arabia. J Epidemiol Glob Health 2024; 14:1602-1608. [PMID: 39400651 DOI: 10.1007/s44197-024-00312-7] [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: 06/03/2024] [Accepted: 09/30/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Coronavirus disease 2019 (COVID-19) is associated with various manifestations even after infection resolution. This study aimed to assess the prevalence of post-COVID-19 fatigue and its predictors. METHODS We conducted a nationwide cross-sectional study among Polymerase Chain Reaction test confirmed COVID-19 cases in Saudi Arabia from July 2021 to February 2022. We collected data through telephonic interviews covering socio-demographics, comorbidities, body mass index, smoking, illness severity, and COVID-19 vaccination status. We assessed fatigue using Fatigue Severity Scale while depression was assessed using Patient Health Questionnaire-2. Logistic regression was employed to analyze the relationship between post-COVID-19 fatigue and depression. RESULTS The analysis included 361 participants with a mean age of 37 ± 10.5 years, among whom 43% were female. Approximately 10% had comorbidities, and 21% were current smokers. Nearly two-thirds (68%) of the participants reported mild illness. The prevalence of perceived fatigue was 22.7%, while fatigue measured by the Fatigue Severity Scale was 14.4%. The multivariable logistic regression model revealed that COVID-19 severity and depression were significant predictors of post-COVID-19 fatigue; adjusted odds ratio 1.87 (95% CI: 1.10 to 3.18) and 14.3 (95% CI: 4.55 to 45.0), respectively. CONCLUSION Our findings suggest a higher prevalence of perceived fatigue compared to that measured by the Fatigue Severity Scale, underscoring the importance of using a valid assessment tool for fatigue among COVID-19 patients to ensure proper management. The significant association between post-COVID-19 fatigue and depression highlights the need for psychological assessment of COVID-19 patients to enhance their post-infection quality of life.
Collapse
Affiliation(s)
| | - Faisal Almogbel
- Family Medicine Academy, Qassim Health Cluster, Qassim, Saudi Arabia
| | - Unaib Rabbani
- Family Medicine Academy, Qassim Health Cluster, Qassim, Saudi Arabia
| | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
4
|
Ye XL, Zhang Y, Dai XH, Gan J, Liu Y, Liao AM, Zhao LZ, Xie C, Zuo J, Wang P, Ai LL, Zhang YF, Huang Y, Zhang J, Shi QM, Zheng JF, Tan WL, Hu XB. Post‑recovery symptoms of infected cases after Omicron pandemic: a quick online cross-sectional study based on C19-YRSm in China. BMC Public Health 2024; 24:2833. [PMID: 39407171 PMCID: PMC11481264 DOI: 10.1186/s12889-024-20282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 10/03/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND The post COVID-19 health condition of Chinese residents infected with Omicron is not clear after the change of epidemic prevention policies. This study aimed to clarify the epidemiology and associated factors about health status of rehabilitation patients. METHODS A quick questionnaire study based on C19-YRSm was conducted in mainland China through internet from May 1, 2023, to May 7, 2023. Chinese native speakers infected with Omicron variant agreed to participate were included. Persisting symptom and living habits were simultaneously inquired. Logistic regression analysis was used to identify the associated factors. RESULTS In this study 753 individuals were included. Of whom 57.90% were males, 89.38% did not seek medical service, 99.47% recovered within less than 120 days. Breathlessness (47.68%), cognitive impairment (44.89%), Anxiety/mood changes (33.20%), pain/discomfort (32.94%), fatigue or tiredness not improved by rest (32.27%) and post-exertional malaise (30.01%) were the top reported key symptoms. Less than 10% respondents reported functional limitations. The prevalence of fever was reported greater than that of other symptoms, with dry eyes at 14.87%, appetite change at 14.34%, and hair loss at 12.22%. Middle age (OR: 2.353, 95%CI: 1.171 ~ 4.729), underlying diseases (OR: 2.293, 95%CI: 1.216 ~ 4.324), severe key symptom (OR: 6.168, 95%CI: 1.376 ~ 27.642) and at least one other symptom (OR: 1.847, 95%CI: 1.225 ~ 2.718)during the recovery were the risk factors of poor overall health after infection (current overall health score <8; 74.10%), while daily exercise in recovery period (OR: 0.457, 95%CI: 0.229 ~ 0.913), a low-fat diet (OR: 0.600, 95%CI: 0.401 ~ 0.898) and the recovery time from 2 to 4 months (OR: 0.639, 95%CI: 0.445 ~ 0.918) were the protective factors. CONCLUSION This is the first time to use the C19-YRSm scale to evaluate the health status in China. The study revealed prevalence of persistent symptoms within 120 days after Omicron onset.
Collapse
Affiliation(s)
- Xiao-Lei Ye
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China.
| | - Ying Zhang
- The First Affiliated Hospital of Xi 'an Jiaotong University in Shaanxi Province, Xi 'an, 710000, P. R. China
| | - Xin-Hua Dai
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China
| | - Jun Gan
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China
| | - Yue Liu
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China
| | - Ai-Miao Liao
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China
| | - Li-Zhi Zhao
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China
| | - Chao Xie
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China
| | - Jing Zuo
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China
| | - Ping Wang
- Baiyin Central Hospital, Baiyin, 730900, P. R. China
| | - Le-Le Ai
- Nanjing Bioengineering (Gene)Technology Center for Medicines, Zhongshan East Road, 293, Nanjing, 210002, P. R. China
| | - Yi-Fan Zhang
- Department of Stomatology, the 940th Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army, Lanzhou, 730030, P. R. China
| | - Yan Huang
- The Third People's Hospital of Chengdu (Affiliated Hospital of Southwest Jiaotong University), Chengdu, 610000, P. R. China
| | - Juan Zhang
- The Lanzhou Enci Stomatological Hospital, Lanzhou, 730030, P. R. China
| | - Qing-Ming Shi
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China.
| | - Jun-Feng Zheng
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China.
| | - Wei-Long Tan
- Nanjing Bioengineering (Gene)Technology Center for Medicines, Zhongshan East Road, 293, Nanjing, 210002, P. R. China.
| | - Xiao-Bing Hu
- Center for Disease Control and Prevention in Western Theater Command, Lanzhou, 730030, P. R. China.
| |
Collapse
|
5
|
Hamad AH, Taher DH, Naif AA, Omar IF, Manookian A, Saber AF, Ahmed SK, Hussein S. Assessment of Anxiety, Stress, and Depression Among COVID-19 Survivors After 40 Months in the Kurdistan Region of Iraq: An Online Cross-Sectional Study. Cureus 2024; 16:e63739. [PMID: 39100015 PMCID: PMC11295783 DOI: 10.7759/cureus.63739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND AND AIMS COVID-19 survivors often experience significant and pervasive psychological distress. This study aimed to investigate the prevalence and demographic factors affecting anxiety, stress, and depression levels among COVID-19 survivors in the Kurdistan region of Iraq. METHOD This online cross-sectional study was conducted from August 1, 2023 to December 17, 2023, in the Kurdistan region of Iraq, including Erbil, Sulaymaniyah, and Duhok. Purposive sampling was used to collect data using an online survey. The survey included demographic information and the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX), with frequency and percentage used for categorical variables and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess associations between demographic factors and mental health outcomes. A p-value of less than 0.05 was considered statistically significant. RESULTS A total of 783 participants were enrolled in the study. The mean score for anxiety was 11.62 ± 4.71, indicating moderate levels. For depression, the mean score was 11.54 ± 5.21, indicating mild levels, and for stress, the mean score was 14.0 ± 5.78, indicating normal levels. Younger individuals (15-27) showed higher stress (Estimate: 18.96, P=0.001) and anxiety (Estimate: 2.79, P=0.001) levels compared to older age groups. Males reported significantly lower stress (Estimate: -1.01, P=0.001), anxiety (Estimate: -1.29, P=0.001), and depression (Estimate: -0.72, P=0.001) than females. Participants with a diploma had lower anxiety (Estimate: 0.65, P=0.004) and stress (Estimate: 0.77, P=0.002) levels compared to those with only elementary education. CONCLUSIONS The study found moderate levels of anxiety among COVID-19 survivors, with mild depression and normal stress levels. To address these issues, it is recommended that policymakers develop targeted mental health interventions. Healthcare providers should focus on early identification and treatment, providing personalized counseling and support to enhance coping mechanisms and overall psychological well-being. By implementing these measures, mental health outcomes for COVID-19 survivors in Iraq can be significantly improved.
Collapse
Affiliation(s)
- Abdulqader H Hamad
- Department of Psychiatric and Mental Health Nursing, College of Nursing, Hawler Medical University, Erbil, IRQ
| | - Diyar H Taher
- Department of Psychiatric and Mental Health, College of Medicine, Hawler Medical University, Erbil, IRQ
| | - Ahmed A Naif
- Department of Psychiatric and Mental Health Nursing, College of Nursing, Hawler Medical University, Erbil, IRQ
| | - Iman F Omar
- Department of Nursing, College of Nursing, Koya Technical Institute, Erbil, IRQ
| | - Arpi Manookian
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IRN
| | - Abdulmalik F Saber
- Department of Psychiatric and Mental Health Nursing, College of Nursing, Hawler Medical University, Erbil, IRQ
| | - Sirwan K Ahmed
- Department of Nursing, College of Nursing, University of Raparin, Sulaymaniyah, IRQ
| | - Safin Hussein
- Department of Biology, University of Raparin, Sulaymaniyah, IRQ
| |
Collapse
|
6
|
Alhammad AM, Aldardeer NF, Alqahtani A, Aljawadi MH, Alnefaie B, Alonazi R, Almuqbil M, Alsaadon A, Alqahtani RM, Alballaa R, Alshehri B, Alarifi MI, Alosaimi FD. Mental health status among COVID-19 patients survivors of critical illness in Saudi Arabia: A 6-month follow-up questionnaire study. World J Clin Cases 2024; 12:2560-2567. [PMID: 38817225 PMCID: PMC11135434 DOI: 10.12998/wjcc.v12.i15.2560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/11/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Psychological assessment after intensive care unit (ICU) discharge is increasingly used to assess patients' cognitive and psychological well-being. However, few studies have examined those who recovered from coronavirus disease 2019 (COVID-19). There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19. AIM To evaluate anxiety and depression among patients who had severe COVID-19. METHODS This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for > 24 h for COVID-19. Eligible patients were contacted via telephone. The patient's anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale (HADS). The primary outcome was the mean HADS score. The secondary outcomes were risk factors of anxiety and/or depression. RESULTS Patients who were admitted to the ICU because of COVID-19 were screened (n = 518). Of these, 48 completed the questionnaires. The mean age was 56.3 ± 17.2 years. Thirty patients (62.5%) were male. The main comorbidities were endocrine (n = 24, 50%) and cardiovascular (n = 21, 43.8%) diseases. The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4 (SD ± 8.5). A HADS score of > 7 for anxiety and depression was detected in 15 patients (30%) and 18 patients (36%), respectively. Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression [odds ratio (OR) 39.06, 95% confidence interval: 1.309-1165.8; P < 0.05]. CONCLUSION Six months after ICU discharge, 30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression. To compare the psychological status of patients following an ICU admission (with vs without COVID-19), further studies are warranted.
Collapse
Affiliation(s)
- Abdullah M Alhammad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia
| | - Namareq F Aldardeer
- Department of Pharmacy Services, King Faisal Specialist Hospital and Research Centre, Jeddah 21499, Saudi Arabia
| | - Abdulaziz Alqahtani
- Corporate Department of Pharmacy Services, King Saud University Medical City, Riyadh 12372, Saudi Arabia
| | - Mohammad H Aljawadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia
| | - Bushra Alnefaie
- College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia
| | - Raghad Alonazi
- College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia
| | - Abdulrahman Alsaadon
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Rakan M Alqahtani
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Rashid Alballaa
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Bader Alshehri
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Mohammed I Alarifi
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Fahad D Alosaimi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| |
Collapse
|
7
|
Imtiaz S, Batubara EM, Abuelgasim MH, Alabad MM, Alyousef LM, Alqahtani NH, Sabbagh AY, Alharbi FA, Ibrahim AS. Long-term outcome of pulmonary involvement in patients with coronavirus disease 2019: The role of high-resolution computed tomography and functional status - A prospective single-center observational study. Ann Thorac Med 2024; 19:147-154. [PMID: 38766376 PMCID: PMC11100471 DOI: 10.4103/atm.atm_191_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Since its first outbreak, coronavirus disease 2019 (COVID-19) has led to a great deal of published literature highlighting the short-term determinants of morbidity and mortality. Recently, several studies have reported radiological and functional sequelae from 3 months to 1 year among hospitalized COVID-19 survivors; however, long-term (more than 1 year) respiratory consequences in this population remain to be evaluated. OBJECTIVE To assess the long-term radiological and pulmonary function outcomes of patients with COVID-19 2 years after resolution of the initial infection. METHODS Hospitalized COVID-19 patients with moderate to severe disease who survived acute illness were included in this prospective and partially retrospective study. Clinical assessment, laboratory tests, high-resolution computed tomography scans, and pulmonary function tests (PFTs) were performed at baseline, followed by radiological and lung function assessments at 6 and 24 months. RESULTS Among 106 enrolled participants (mean age 62 ± 13.5 years; males: 61), 44 (41.5%) and 27 (25.4%) underwent radiological assessment at 6 and 24 months, respectively. Overall, 22.6% (24) of patients had residual radiological abnormalities. Overt fibrosis was observed in 12.2% of patients. Computed tomography disease severity and extent diminished significantly at 6 (13 ± 6, P < 0.001) and 24 months (11 ± 6, P < 0.001) from baseline. PFTs were performed in 65 (61.3%), 22 (20.7%), and 34 (32%) patients at baseline, 6 and 24 months, respectively. Impaired diffusion capacity (median diffusion capacity for carbon monoxide: 60%, interquartile range [IQR]: 51-80), restrictive lung defect (mean total lung capacity: 73.4% ± 18% predicted), and reduced exercise tolerance (median 6-min walk distance: 360 m, IQR: 210-400) were the predominant features at baseline. With the exception of exercise tolerance, a statistically significant improvement was observed in lung function parameters at the extended follow-up (2 years). CONCLUSIONS Hospitalized COVID-19 survivors are at increased risk of developing long-term pulmonary complications, including lung fibrosis. A protocol-based approach to the management of post-COVID-19 patients is mandatory to improve future outcomes.
Collapse
Affiliation(s)
- Sadia Imtiaz
- Department of Medicine, Division of Respiratory Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Enas M Batubara
- Division of Respiratory Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed H Abuelgasim
- Division of Respiratory Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mahdi M Alabad
- Division of Respiratory Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Nayef H Alqahtani
- Department of Radio-Diagnostics and Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Alaa Y Sabbagh
- Department of Radio-Diagnostics and Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fawaz A Alharbi
- Division of Respiratory Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed S Ibrahim
- Division of Respiratory Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
Gutiérrez-García AG, Contreras CM. Olfactory Epithelium Infection by SARS-CoV-2: Possible Neuroinflammatory Consequences of COVID-19. Complex Psychiatry 2024; 10:59-70. [PMID: 39545135 PMCID: PMC11560153 DOI: 10.1159/000540982] [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: 11/07/2023] [Accepted: 07/25/2024] [Indexed: 11/17/2024] Open
Abstract
Background The loss of smell is a typical diagnostic symptom of coronavirus disease 2019 (COVID-19). This sensorial deprivation may be expressed as quantitative (anosmia or hyposmia) or qualitative (dysosmia) alterations as a consequence of anatomical disturbances of the nasal epithelium structure. The olfactory system sends direct neuronal connections to brain structures that are involved in emotional processing, including deep temporal nuclei. This anatomical and functional feature may be related to the occurrence of emotional disorders among COVID-19 patients. Summary We identify a possible sequence of events, from typical olfactory dysfunction that is associated with COVID-19 and caused by olfactory epithelium damage to disturbances in the quality of life and emotional state of infected patients that is attributable to possible neuroinflammatory processes. Sensorial deprivation causes deleterious actions on mood, negatively affecting quality of life. Olfactory dysfunction that is associated with COVID-19 occurs concurrently with psychological distress, symptoms of anxiety, and depressive disorders and impinges on self-perceived quality of life. Key Messages Changes in mood are certainly associated with multiple factors, including the environment and isolation, but the observation that the virus may penetrate the central nervous system through the olfactory bulb and the connection between the olfactory system and prefrontal and orbitofrontal cortices and the amygdala-hippocampus do not allow one to discard neural factors that are involved in the pathophysiology of emotional symptoms in post-COVID-19 patients. Behavioral symptoms of COVID-19 involve local olfactory actions and the participation of central neuronal systems.
Collapse
Affiliation(s)
- Ana G. Gutiérrez-García
- Laboratorio de Neurofarmacología, Instituto de Neuroetología, Universidad Veracruzana, Xalapa, Mexico
| | - Carlos M. Contreras
- Unidad Periférica-Xalapa, Instituto de Investigaciones Biomédicas, National Autonomous University of Mexico (UNAM), Xalapa, Mexico
| |
Collapse
|
9
|
Adly HM, Saleh SAK, Garout MA, Abdulkhaliq AA, Khafagy AA, Saati AA, AlJahdali IA, Alandiyjany MN, Al-Tawfiq JA. Post COVID-19 Symptoms Among Infected Vaccinated Individuals: A Cross-Sectional Study in Saudi Arabia. J Epidemiol Glob Health 2023; 13:740-750. [PMID: 37665505 PMCID: PMC10686930 DOI: 10.1007/s44197-023-00146-9] [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: 06/04/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Multiple studies investigated the endurance and occurrence of symptoms three months after SARS-CoV-2 infection. This study examines the possible effects of COVID-19 vaccination on the persistence of post-recovery symptoms. PATIENTS AND METHODS A cross-sectional survey was conducted in Saudi Arabia to evaluate 14 prevalent long COVID-19 symptoms among vaccinated individuals. Patients self-reported their acute COVID-19 experience, demographic information, chronic conditions, vaccine history, and persistent symptoms. RESULTS Of the 484 patients, four respondents were excluded from the study as they had not received the vaccine, and 111 (23.1%) were vaccinated but did not get infected and were also excluded. The remaining 369 (76.9%) reported COVID-19 and a vaccination and thus they were included in the study. The occurrence of post-COVID-19 symptoms was reported in 59 (16.1%) for ≤ 3 months, 202 (54.8%) experienced persistent symptoms 3-6 months, and 108 (29.1%) reported symptoms lasting > 6 months. In relation to age group, persistent symptoms 3-6 months after recovery was more common in those > 50 years and symptoms lasting > 6 months were more common in 30-50 years of age (p < 0.001). Persistence of symptoms for 3-6 months was more common in those who were infected prior to vaccination compared to those who were infected after vaccination (P < 0.001). Of the included patients, 323 (87.5%) rated their health as good, 41 (11.1%) considered it fair, and 5 (1.4%) described their well-being as poor or terrible. CONCLUSION The study provides information of persistent symptoms in vaccinated individuals who had recovered from COVID-19 and highlights the need for targeted interventions to alleviate post-COVID-19 symptoms. The study is limited by its reliance on self-reported data and potential selection bias. Future research is needed to understand the mechanisms underlying persistent symptoms in vaccinated individuals and to identify effective interventions for long COVID.
Collapse
Affiliation(s)
- Heba M Adly
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Saleh A K Saleh
- Biochemisty Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Oncology Diagnostic Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammed A Garout
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Altaf A Abdulkhaliq
- Biochemisty Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah A Khafagy
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah A Saati
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imad A AlJahdali
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Maher N Alandiyjany
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, 21955, Makkah, Saudi Arabia
- Quality and Development Affair, Batterjee Medical College, 21442, Jeddah, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Infectious Diseases Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
10
|
Al Jahdhami I, Arshad H, Omar H, Bennji SM, Al Nomani K, Al Ghafri M, Al Syabi M, Al Hinai S, Al Mawali A. Persistence of Symptoms Following Hospitalization for COVID-19 in Oman:
A Bidirectional Observational Study. Oman Med J 2023; 38:e570. [PMID: 38283209 PMCID: PMC10822130 DOI: 10.5001/omj.2023.120] [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: 03/31/2023] [Accepted: 07/02/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives This study sought to assess the prevalence of persistent COVID-19-related symptoms in patients with mild, severe, and critical disease. Methods We conducted a bidirectional cohort observational study that included all adult patients ≥ 18 years, admitted to Armed Forces Hospital, Muscat between July 2020 and June 2022, with COVID-19 infection and discharged alive. Patients were requested to attend outpatient clinic at weeks six and 12 post-discharge, where they filled out a questionnaire and underwent a chest X-ray. Additionally, blood tests were performed if necessary. Healthcare workers with mild infections were also requested to fill out a questionnaire about their initial symptoms, persistent symptoms, and comorbidities. Results The study included 468 patients, comprising 261 hospitalized patients and 207 healthcare workers. On follow-up, 39.7% of patients presented with residual symptoms, such as cough, breathlessness, and joint pain. These symptoms were more common in patients with medical comorbidities, particularly hypertension, diabetes, and dyslipidemia. Notably, these symptoms were also observed in patients with mild disease. Post-COVID-19 pulmonary fibrosis was observed in 21 patients, mainly among those admitted to the intensive care unit or requiring prolonged hospitalization. Conclusions This study highlights the persistence of symptoms and the prevalence of post-COVID-19 syndrome at two months post-discharge, especially among patients with severe and critical disease during the acute phase. Various predictors of post-COVID-19 syndrome were identified, including female gender, older age, presence of comorbidities, disease severity, and hypertension. Therefore, patients in these categories require thorough evaluation and long-term follow-up to manage residual symptoms.
Collapse
Affiliation(s)
| | - Husna Arshad
- Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - Hiba Omar
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sami M. Bennji
- Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | | | | | | | | | - Adhra Al Mawali
- Department of Quality Assurance and Planning, German University of Technology, Muscat, Oman
| |
Collapse
|
11
|
Rodriguez-Morales AJ, Lopez-Echeverri MC, Perez-Raga MF, Quintero-Romero V, Valencia-Gallego V, Galindo-Herrera N, López-Alzate S, Sánchez-Vinasco JD, Gutiérrez-Vargas JJ, Mayta-Tristan P, Husni R, Moghnieh R, Stephan J, Faour W, Tawil S, Barakat H, Chaaban T, Megarbane A, Rizk Y, Sakr R, Escalera-Antezana JP, Alvarado-Arnez LE, Bonilla-Aldana DK, Camacho-Moreno G, Mendoza H, Rodriguez-Sabogal IA, Millán-Oñate J, Lopardo G, Barbosa AN, Cimerman S, Chaves TDSS, Orduna T, Lloveras S, Rodriguez-Morales AG, Thormann M, Zambrano PG, Perez C, Sandoval N, Zambrano L, Alvarez-Moreno CA, Chacon-Cruz E, Villamil-Gomez WE, Benites-Zapata V, Savio-Larriera E, Cardona-Ospina JA, Risquez A, Forero-Peña DA, Henao-Martínez AF, Sah R, Barboza JJ, León-Figueroa DA, Acosta-España JD, Carrero-Gonzalez CM, Al-Tawfiq JA, Rabaan AA, Leblebicioglu H, Gonzales-Zamora JA, Ulloa-Gutiérrez R. The global challenges of the long COVID-19 in adults and children. Travel Med Infect Dis 2023; 54:102606. [PMID: 37295581 PMCID: PMC10247301 DOI: 10.1016/j.tmaid.2023.102606] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira, 660003, Risaralda, Colombia; Faculty of Health Sciences, Universidad Científica del Sur, Lima, 15067, Peru; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon.
| | - María Camila Lopez-Echeverri
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Maria Fernanda Perez-Raga
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Valentina Quintero-Romero
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Valentina Valencia-Gallego
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Nicolas Galindo-Herrera
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Santiago López-Alzate
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Juan Diego Sánchez-Vinasco
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Juan José Gutiérrez-Vargas
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia
| | - Percy Mayta-Tristan
- Faculty of Health Sciences, Universidad Científica del Sur, Lima, 15067, Peru
| | - Rola Husni
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Rima Moghnieh
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Joseph Stephan
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Wissam Faour
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Samah Tawil
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Hanane Barakat
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Toufic Chaaban
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Andre Megarbane
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Youssef Rizk
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Rania Sakr
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| | - Juan Pablo Escalera-Antezana
- Direction of First Level, Municipal Secretary of Health, Municipal Autonomous Government of Cochabamba, Cochabamba, Bolivia
| | | | | | - German Camacho-Moreno
- Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, DC, Colombia; Division of Infectious Diseases, HOMI, Hospital Pediátrico La Misericordia, Bogotá, DC, Colombia; Fundación Hospital Infantil Universitario de San José, Bogotá, DC, Colombia
| | - Henry Mendoza
- Hemera Unidad de Infectología IPS SAS, Bogota, Colombia
| | | | - Jose Millán-Oñate
- Clinica Imbanaco Grupo Quironsalud, Cali, Colombia; Universidad Santiago de Cali, Cali, Colombia; Clinica de Occidente, Cali, Colombia; Clinica Sebastián de Belalcazar, Valle del Cauca, Colombia
| | - Gustavo Lopardo
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina
| | - Alexandre Naime Barbosa
- Infectious Diseases Department, Botucatu Medical School, UNESP, Brazilian Society for Infectious Diseases, São Paulo, SP, Brazil
| | - Sergio Cimerman
- Institute of Infectious Diseases Emilio Ribas, São Paulo, Brazil
| | - Tânia do Socorro Souza Chaves
- Evandro Chagas Institute, Health of Ministry of Brazil, Belém, Pará, Brazil; Faculdade de Medicina da Universidade Federal do Pará, Brazil
| | - Tomas Orduna
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina; Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | - Susana Lloveras
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina; Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | - Andrea G Rodriguez-Morales
- Unidad Procedimientos, Policlínico Neurología, Centro de Referencia de Salud Dr. Salvador Allende Gossens, Santiago de Chile, Chile
| | - Monica Thormann
- Hospital Salvador Bienvenido Gautier, Santo Domingo, Dominican Republic
| | | | - Clevy Perez
- Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Lysien Zambrano
- Institute for Research in Medical Sciences and Right to Health (ICIMEDES), National Autonomous University of Honduras (UNAH), Tegucigalpa, Honduras
| | - Carlos A Alvarez-Moreno
- National Clinical Coordinator COVID-19-WHO Studies, Colombia; Clinica Universitaria Colombia, Clinica Colsanitas and Facultad de Medicina, Universidad Nacional de Colombia, Colombia
| | | | - Wilmer E Villamil-Gomez
- Centro de Investigación en Ciencias de la Vida, Universidad Simón Bolívar, Barranquilla, Colombia; Grupo de Expertos Clínicos Secretaria de Salud de Barranquilla, Barranquilla, Colombia
| | - Vicente Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Jaime A Cardona-Ospina
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, 660003, Colombia; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, 94704, USA
| | - Alejandro Risquez
- Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - David A Forero-Peña
- Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela; Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Andrés F Henao-Martínez
- Division of Infectious Diseases, School of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Ranjit Sah
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal; Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Maharashtra, India
| | | | | | - Jaime David Acosta-España
- Institute of Microbiology, Friedrich Schiller University Jena, Beutenbergstraße 13, 07745, Jena, Germany; Postgraduate Program in Infectious Diseases, School of Medicine, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | | | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, 34465, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 47405, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia; Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610, Pakistan
| | - Hakan Leblebicioglu
- Department of Infectious Diseases, VM Medicalpark Samsun Hospital, Samsun, Turkey
| | - Jose A Gonzales-Zamora
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Rolando Ulloa-Gutiérrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica; Cátedra de Pediatría, Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| |
Collapse
|
12
|
AlBahrani S, AlBarrak A, AlGubaisi N, Alkurdi H, Alburaiki D, AlGhamdi A, AlOthaiqy M, Tayeb S, Tayeb N, Abdraboh S, Khairi A, Alshareef L, AlHarbi A, AlRabeeah S, Alqahtani AS, Alqahtani JS, Hakami FH, Al-Maqati TN, Alkhrashi SA, Almershad MM, AlAbbadi A, Hakami MH, Faqihi O, Altawfiq KJA, Jebakumar AZ, Al-Tawfiq JA. Self-reported long COVID-19 symptoms are rare among vaccinated healthcare workers. J Infect Public Health 2023; 16:1276-1280. [PMID: 37315430 DOI: 10.1016/j.jiph.2023.05.037] [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: 03/01/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION COVID-19 pandemic adversely affected healthcare workers (HCWs). Here, we evaluate the occurence of long-COVID-19 symtoms among HCWs. METHODS This is a questionnaire-based study of HCWs who had COVID-19 in two medical centers in Saudi Arabia and were mostly vaccinated. RESULTS The study included 243 HCWs with a mean age (+ SD) of 36.1 (+ 7.6) years. Of them, 223 (91.8%) had three doses of COVID-19 vaccine, 12 (4.9%) had four doses, and 5 (2.1%) had two doses. The most common symptoms at the start of the illness were cough (180, 74.1%), shortness of breath (124, 51%), muscle ache (117, 48.1%), headache (113, 46.5%), sore throat (111, 45.7%), diarrhea (109, 44.9%) and loss of taste (108, 44.4%). Symptoms lasted for< one week in 117 (48.1%),> one week and< 1 month in 89 (36.6%),> 2 months and< 3 months in 9 (3.7%), and> 3 months in 15 (6.2%). The main symptoms present> 3 months were hair loss (8, 3.3%), cough (5, 2.1%), and diarrhea (5, 2.1%). A binomial regression analysis showed no relationship between persistence of symptoms for> 3 months and other demographic or clinical symptoms characteristics. CONCLUSION The study showed a low rate of the occurence of long-COVID> 3 months during the Omicron-wave among mostly vaccinated HCWs with no significant comorbidities. Furhter studies are needed to examine the effect of different vaccines on long-COVID-19 among HCWs.
Collapse
Affiliation(s)
- Salma AlBahrani
- Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Ali AlBarrak
- Infectious disease division, Internal Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Nawal AlGubaisi
- Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Hamoud Alkurdi
- Respiratory therapy department, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | - Dalia Alburaiki
- Respiratory therapy department, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | - Abdulrahaman AlGhamdi
- Respiratory therapy department, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | - Mohammed AlOthaiqy
- Respiratory therapy department, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | - Sarah Tayeb
- Infection Control Department, King Fahad Armed Forces Hospital Jeddah, Saudi Arabia
| | - Nesreen Tayeb
- Infection Control Department, King Fahad Armed Forces Hospital Jeddah, Saudi Arabia
| | - Salimah Abdraboh
- Infection Control Department, King Fahad Armed Forces Hospital Jeddah, Saudi Arabia
| | - Amani Khairi
- Infection Control Department, King Fahad Armed Forces Hospital Jeddah, Saudi Arabia
| | - Lujain Alshareef
- Infection Control Department, King Fahad Armed Forces Hospital Jeddah, Saudi Arabia
| | - Asma AlHarbi
- Infection Control Department, King Fahad Armed Forces Hospital Jeddah, Saudi Arabia
| | - Saad AlRabeeah
- Department of Respiratory care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah S Alqahtani
- Department of Respiratory care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Fatimah Hassan Hakami
- Infection Control Department, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | - Thekra N Al-Maqati
- Department of Clinical Laboratory Science, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | | | | | - Asmaa AlAbbadi
- Infection Control Department, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | - Mariam Hassan Hakami
- Infection Control Department, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | - Osama Faqihi
- Respiratory therapy department, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | | | | | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
13
|
Brunner-Ziegler S, Bäuerle M, Brühl P, Kornek G, Parschalk B, Savic R, Schnetzinger M, Spath T, Straßl RP, Handisurya A, Thalhammer F. Long COVID symptoms in hospital employees after post-vaccination SARS-CoV-2 infection in Austria: A study on self-reported incidence and associated factors. J Infect Public Health 2023; 16:596-602. [PMID: 36842195 PMCID: PMC9946725 DOI: 10.1016/j.jiph.2023.02.017] [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: 10/26/2022] [Revised: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Post acute sequelae of SARS-CoV-2 infection are defined by persistence or re-occurrence of symptoms six to 12 weeks after SARS-CoV-2 infections. METHODS Twice vaccinated hospital employees after mild to moderate post-vaccination SARS-CoV-2 infection completed a questionnaire on the incidence of general, respiratory, neuropsychiatric, dermatological and gastrointestinal symptoms, experienced during their acute infection and eight weeks after recovery. Post acute sequelae of SARS-CoV-2 infection were analysed in relation to socio-demographic-, health-, virus- and acute infection-related characteristics. RESULTS 73 participants, 25 women and 48 men with a mean age of 40.9 years, with a post-vaccination SARS-CoV-2 infection completed the survey. Out of these 93 % reported at least one symptom at time of initial SARS-CoV-2 infection, 31.5 %, predominantly women, reported post acute sequelae at least eight weeks after the acute infection stage. Fatigue, dysgeusia and dysosmia, headache or difficulty concentrating and shortness of breath during acute infection, BMI> 25 and pre-existing pulmonary disorders were associated with post acute sequelae of SARS-CoV-2 infection. Participants with initially more than five symptoms were four times more likely to report post acute sequelae. CONCLUSION It is suggested that the multiplicity of symptoms during acute SARS-CoV-2 infections increases the risk for post acute symptoms.
Collapse
Affiliation(s)
- Sophie Brunner-Ziegler
- Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria.
| | - Martin Bäuerle
- Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Peter Brühl
- Medical Directorate, Vienna General Hospital, Vienna, Austria
| | - Gabriela Kornek
- Medical Directorate, Vienna General Hospital, Vienna, Austria
| | - Bernhard Parschalk
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Rebeka Savic
- Department of Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Maximilian Schnetzinger
- Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Tibor Spath
- Department of Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Robert Paul Straßl
- Division of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | | | | |
Collapse
|
14
|
J. Rodriguez-Morales A, Katterine Bonilla-Aldana D. Introductory Chapter: Lessons from SARS-CoV-2/COVID-19 after Two Years of Pandemic. Infect Dis (Lond) 2023. [DOI: 10.5772/intechopen.108769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
|
15
|
Jassat W, Mudara C, Vika C, Welch R, Arendse T, Dryden M, Blumberg L, Mayet N, Tempia S, Parker A, Nel J, Perumal R, Groome MJ, Conradie F, Ndjeka N, Sigfrid L, Merson L, Cohen C. A cohort study of post-COVID-19 condition across the Beta, Delta, and Omicron waves in South Africa: 6-month follow-up of hospitalized and nonhospitalized participants. Int J Infect Dis 2023; 128:102-111. [PMID: 36587841 PMCID: PMC9800016 DOI: 10.1016/j.ijid.2022.12.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The study aimed to describe the prevalence of and risk factors for post-COVID-19 condition (PCC). METHODS This was a prospective, longitudinal observational cohort study. Hospitalized and nonhospitalized adults were randomly selected to undergo telephone assessment at 1, 3, and 6 months. Participants were assessed using a standardized questionnaire for the evaluation of symptoms and health-related quality of life. We used negative binomial regression models to determine factors associated with the presence of ≥1 symptoms at 6 months. RESULTS A total of 46.7% of hospitalized and 18.5% of nonhospitalized participants experienced ≥1 symptoms at 6 months (P ≤0.001). Among hospitalized people living with HIV, 40.4% had persistent symptoms compared with 47.1% among participants without HIV (P = 0.108). The risk factors for PCC included older age, female sex, non-Black race, presence of a comorbidity, greater number of acute COVID-19 symptoms, hospitalization/COVID-19 severity, and wave period (lower risk of persistent symptoms for the Omicron compared with the Beta wave). There were no associations between self-reported vaccination status with persistent symptoms. CONCLUSION The study revealed a high prevalence of persistent symptoms among South African participants at 6 months but decreased risk for PCC among participants infected during the Omicron BA.1 wave. These findings have serious implications for countries with resource-constrained health care systems.
Collapse
Affiliation(s)
- Waasila Jassat
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; Right to Care, Centurion, South Africa.
| | - Caroline Mudara
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Caroline Vika
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Richard Welch
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; Right to Care, Centurion, South Africa
| | - Tracy Arendse
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; Right to Care, Centurion, South Africa
| | - Murray Dryden
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Lucille Blumberg
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; Right to Care, Centurion, South Africa
| | - Natalie Mayet
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Stefano Tempia
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Arifa Parker
- Divisions of General Medicine and Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jeremy Nel
- Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Rubeshan Perumal
- Division of Pulmonology and Critical Care, Department of Medicine, University of KwaZulu-Natal, Berea, Durban, South Africa; South African Medical Research Council-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Michelle J Groome
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Francesca Conradie
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Norbert Ndjeka
- Drug-Resistant TB, TB & HIV Directorate, National Department of Health, Pretoria, South Africa and University of KwaZulu-Natal, Durban, South Africa
| | - Louise Sigfrid
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Laura Merson
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Cheryl Cohen
- National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
16
|
Sadretdinova LD, Gantseva KK, Galina II, Tyurin AV. The duration of gastrointestinal symptom persistence at various periods of coronavirus infection. ALMANAC OF CLINICAL MEDICINE 2023; 50:392-399. [DOI: 10.18786/2072-0505-2022-50-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Aim: To analyze prevalence and type of symptomatic gastrointestinal involvement during symptomatic COVID-19 (up to 412 weeks after the disease) and post-COVID-19 syndrome (more than 12 weeks from the disease onset).
Materials and methods: We retrospectively analyzed the data from 785 in-patients with the diagnosis of COVID-19, who were treated in the infectious disease hospital from May to December 2020. At the first phase of the study we analyzed how frequently they were referred for out-patient care by a gastroenterology specialist after they were discharged from the hospital (all 785 patient medical files). At the 2nd study phase we performed phone calls to 247 patients, that were discharged from the infectious disease hospital, during which a specially designed questionnaire was filled with items on their comorbidities, general and specific complaints, as well as the standardized Gastrointestinal Symptom Rating Scale (GSRS).
Results: Within 2 years after their discharge from the infectious disease hospital, 88 patients asked for specialized gastroenterological care on an out-patient basis. The most common diagnoses were pancreatic diseases (33%), gastric disorders (31%), intestinal disorders (25%), liver and biliary disorders (11%). At referral, the most common complaints were dyspeptic: nausea, bitter taste in the mouth, heartburn, bloating (25%), abdominal pains of various location (17%) and stool abnormalities, such as diarrhea and constipation (11%).
Among patients who participated in the phone survey (N = 247), symptomatic COVID-19 was observed in 90 (11.46%) cases, with predominant complaints being loss of taste, loss of smell, and fever. Post-COVID-19 syndrome was identified in 157 (20%) cases, with their main complaints being weakness, shortness of breath and joint pain. Stool abnormalities and abdominal pain occurred during symptomatic COVID-19 and in the post-COVID-19 period with the same frequency (9% and 10%, respectively). According to the GSRS results, the post-COVID-19 dyspeptic syndrome was characterized by prevailing complaints of heartburn (24%), upper abdominal pain and discomfort (20%), and bloating (15%).
Conclusion: In the patients with a history of COVID-19, along with respiratory syndromes, gastrointestinal symptoms are seen, with their types being variable at various period of the coronavirus infection. In the early COVID-19, these are stool abnormalities and abdominal pain, and during the post-COVID-19 syndrome, nausea, bitter taste in the mouth, heartburn and bloating are more common.
Collapse
|
17
|
Muacevic A, Adler JR, Alduraibi K, Alshathri AH, Alanazi TF, Alandijani H, Almajed JA, Wajdi KA. Long-Term Outcomes of COVID-19 Otolaryngology Symptoms in Saudi Arabia. Cureus 2023; 15:e33461. [PMID: 36751176 PMCID: PMC9899518 DOI: 10.7759/cureus.33461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The objectives of the study are to measure the prevalence of the most common symptoms and different long-term otorhinolaryngology manifestations among COVID-19-positive patients in Saudi Arabia. METHODS This is a cross-sectional study. Data were collected using a Google form questionnaire sent to the study sample. The data were entered and then analyzed using SPSS version 25.0 (IBM Corp, Armonk, NY). RESULTS A total of 13,530 COVID-19-positive adult patients were enrolled in the current study. The most reported initial symptom was fever (53.3%) followed by headache (49.3%), sore throat (48.9%), nasal congestion, rhinorrhea (42.1%), and loss of smell and/or loss of taste (37.8%). Regarding the continuation of the symptoms, vertigo was mentioned by 5852 (43.3%) followed by fever (16.1%) and blocked ear sensation (15.6%). CONCLUSION The most commonly reported initial symptom was fever followed by headache. Interestingly, vertigo is a frequent long-term complication after a COVID-19 infection. Other otology-related symptoms include hearing loss and ear blockage, while rhinology and upper airway-related symptoms were less frequent in the long term after the acute phase of the infection.
Collapse
|
18
|
Sampogna G, Di Vincenzo M, Giallonardo V, Perris F, Volpicelli A, Del Vecchio V, Luciano M, Fiorillo A. The Psychiatric Consequences of Long-COVID: A Scoping Review. J Pers Med 2022; 12:1767. [PMID: 36579511 PMCID: PMC9697474 DOI: 10.3390/jpm12111767] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 01/01/2023] Open
Abstract
The COVID-19 pandemic has represented a new form of traumatic event, affecting the general population worldwide and causing severe disruption of daily routine. A new urgent concern is related to the burden associated with COVID-19 symptoms that persist beyond the onset of infection, the so-called long-COVID syndrome. The present paper aims to: (1) describe the most frequent psychiatric symptoms reported by patients affected by long-COVID syndrome; (2) evaluate methodological discrepancies among the available studies; (3) inform clinicians and policy-makers on the possible strategies to be promoted in order to manage the psychiatric consequences of long-COVID syndrome. Twenty-one papers have been included in the present review, mostly with a cross-sectional or cohort design. Significant heterogeneity of long-COVID syndrome definitions was found. The presence of psychiatric symptoms was evaluated with very different assessment tools. The most common psychiatric symptoms of the long-COVID syndrome included fatigue, cognitive disturbances/impairment, depression, and anxiety symptoms. The rate of fatigue varied from 93.2-82.3% to 11.5%, cognitive impairment/cognitive dysfunction from 61.4% to 23.5% and depressive-anxiety symptoms from 23.5%to 9.5%.
Collapse
Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Al-Tawfiq JA, Chu DT, Hoang VT, Memish ZA. From Pandemicity to Endemicity: The Journey of SARS-CoV-2. J Epidemiol Glob Health 2022; 12:147-149. [PMID: 35704175 PMCID: PMC9198624 DOI: 10.1007/s44197-022-00046-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam
| | - Van-Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Ziad A Memish
- Director Research and Innovation Centre, King Saud Medical City, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| |
Collapse
|
20
|
Jabali MA, Alsabban AS, Bahakeem LM, Zwawy MA, Bagasi AT, Bagasi HT, Aldosary TA. Persistent Symptoms Post-COVID-19: An Observational Study at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Cureus 2022; 14:e24343. [PMID: 35607525 PMCID: PMC9123896 DOI: 10.7759/cureus.24343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background As the prevalence of COVID-19 recovery cases increased, patients started to notice new symptoms after being cured of the acute infection. We aimed to study the type of persistent symptoms post-COVID-19 infection, their prevalence, and factors that play a role in developing the post-COVID-19 symptoms among COVID-19 patients at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Methods A cross-sectional study was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, from the period of September 2021 to December 2021. Participants were contacted via a phone interview. Statistical analysis was performed using IBM SPSS Statistics, and p-values of ≤0.05 were considered significant. Results A total of 327 participants completed the study, of which 169 (51.7%) were male. Nearly half of the patients, 161 (49.09%), had persistent symptoms. The most common symptoms were loss of smell, loss of taste, cough, and fatigue (22.6%, 19.2%, 11.6%, and 9.1% respectively). They were followed by an equal percentage of shortness of breath, headache, and hair loss (7.3%). Gender was found to be significant in loss of smell, loss of taste, and hair loss, with p-values of 0.016, 0.018, and <0.001, respectively. Conclusion A large proportion of patients with COVID-19 developed persistent symptoms. The most common symptoms were loss of smell and taste, cough, and fatigue. Some factors played a role in acquiring post-COVID-19 symptoms, including gender and place of treatment. Gender was significantly associated with hair loss. Follow-up after recovery is required to maintain individual well-being.
Collapse
Affiliation(s)
- Maryam A Jabali
- Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| | - Ahmad S Alsabban
- Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| | - Lujain M Bahakeem
- Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| | - Mohammad A Zwawy
- Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| | - Abdulaziz T Bagasi
- Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| | | | - Taghreed A Aldosary
- Medical Sciences - Oral Biology, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| |
Collapse
|