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Canavero I, Storti B, Marinoni G, De Souza DA, Moro E, Gatti L, Sacco S, Lorenzano S, Sandset EC, Poggesi A, Carrozzini T, Pollaci G, Potenza A, Gorla G, Wardlaw JM, Zedde ML, Bersano A. COVID-19 and stroke in women: impact on clinical, psychosocial and research aspects. Neurol Sci 2024; 45:4647-4655. [PMID: 39103735 DOI: 10.1007/s10072-024-07716-0] [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: 06/24/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
Despite the growing interest in gender medicine, the influence of sex and gender on human diseases, including stroke, continues to be underestimated and understudied. The COVID-19 pandemic has overall impacted not only the occurrence and management of stroke but has also exacerbated sex and gender disparities among both patients and healthcare providers. This paper aims to provide an updated overview on the influence of sex and gender in stroke pathophysiology and care during COVID-19 pandemic, through biological, clinical, psychosocial and research perspectives. Gender equity and awareness of the importance of sexual differences are sorely needed, especially in times of health crisis but have not yet been achieved to date. To this purpose, the sudden yet worldwide diffusion of COVID-19 represents a unique learning experience that highlights critical unmet needs also in gender medicine. The failures of this recent past should be kept as food for thought to inspire proper strategies reducing inequalities and to address women's health and wellbeing issues, particularly in case of future pandemics.
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Affiliation(s)
- Isabella Canavero
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Giulia Marinoni
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Diana Aguiar De Souza
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHULN, University of Lisbon, Lisbon, Portugal
| | - Elena Moro
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, Grenoble Alpes University, Grenoble, France
| | - Laura Gatti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Else C Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Anna Poggesi
- NEUROFARBA Department, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
- Don Carlo Gnocchi Foundation, Florence, Italy
| | - Tatiana Carrozzini
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Giuliana Pollaci
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Antonella Potenza
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Gemma Gorla
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy.
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Vannorsdall TD, Oh ES, Parker AM. Neuropsychiatric and work outcomes after COVID-19 hospitalisation. Lancet Psychiatry 2024; 11:667-669. [PMID: 39096932 DOI: 10.1016/s2215-0366(24)00250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/24/2024] [Indexed: 08/05/2024]
Affiliation(s)
- Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Nursing, Baltimore, MD 21224, USA; Department of Neurology, Johns Hopkins University School of Nursing, Baltimore, MD 21224, USA.
| | - Esther S Oh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Nursing, Baltimore, MD 21224, USA; Department of Medicine, Johns Hopkins University School of Nursing, Baltimore, MD 21224, USA; Department of Pathology, Johns Hopkins University School of Nursing, Baltimore, MD 21224, USA; Johns Hopkins University School of Medicine, Johns Hopkins University School of Nursing, Baltimore, MD 21224, USA
| | - Ann M Parker
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Nursing, Baltimore, MD 21224, USA; Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University School of Nursing, Baltimore, MD 21224, USA
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Daynes E, Mills G, Hull JH, Bishop NC, Bakali M, Burtin C, McAuley HJC, Singh SJ, Greening NJ. Pulmonary Rehabilitation for People With Persistent Symptoms After COVID-19. Chest 2024; 166:461-471. [PMID: 38246521 DOI: 10.1016/j.chest.2024.01.029] [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: 07/03/2023] [Revised: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
TOPIC IMPORTANCE COVID-19 can cause ongoing and persistent symptoms (such as breathlessness and fatigue) that lead to reduced functional capacity. There are parallels in symptoms and functional limitations in adults with post-COVID symptoms and adults with chronic respiratory diseases. Pulmonary rehabilitation is a key treatment for adults with chronic respiratory diseases, with the aims to improve symptom management and increase functional capacity. Given the similarities in presentation and aims, a pulmonary rehabilitation program may be optimal to meet the needs of those with ongoing symptoms after COVID-19. REVIEW FINDINGS Aerobic and strength training has shown benefit for adults living with long COVID, although there is little evidence on structured education in this population. Breathing pattern disorder is common in adults with long COVID, and considerations on treatment before rehabilitation, or alongside rehabilitation, are necessary. Considerations on postexertional malaise are important in this population, and evidence from the chronic fatigue syndrome literature supports the need for individualization of exercise programs, and considerations for those who have an adverse reaction to activity and/or exercise. SUMMARY This narrative review summarizes the current evidence on pulmonary rehabilitation programs in a long-COVID population. Where the evidence is lacking in long COVID the supporting evidence of these programs in chronic respiratory diseases has highlighted the importance of aerobic and strength training, considerations for fatigue, potential mechanisms for immunology improvement, and management of breathing pattern disorders in these programs.
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Affiliation(s)
- Enya Daynes
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England.
| | - George Mills
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England
| | - James H Hull
- Respiratory Medicine, Royal Brompton Hospital, London, England; Institute of Sport, Exercise and Health, University College London, London, England
| | - Nicolette C Bishop
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, England
| | - Majda Bakali
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, England
| | - Chris Burtin
- REVAL Rehabilitation Center, BIOMED Biomedical Research Institute, Hasselt University, Belgium
| | - Hamish J C McAuley
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England
| | - Sally J Singh
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England
| | - Neil J Greening
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England; Department of Respiratory Sciences, University of Leicester, Leicester, England
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Taquet M, Skorniewska Z, De Deyn T, Hampshire A, Trender WR, Hellyer PJ, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Rogers N, Houchen-Wolloff L, Greening NJ, Mansoori P, Harrison EM, Docherty AB, Lone NI, Quint J, Brightling CE, Wain LV, Evans RA, Geddes JR, Harrison PJ. Cognitive and psychiatric symptom trajectories 2-3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK. Lancet Psychiatry 2024; 11:696-708. [PMID: 39096931 DOI: 10.1016/s2215-0366(24)00214-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2-3 years, and whether symptoms at 2-3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2-3 years were associated with occupation change. People with lived experience were involved in the study. FINDINGS 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2-3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16-1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2-3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2-3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0-48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0-17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2-3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6-31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04-2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21-1·98] for every point increase in CCI-20). INTERPRETATION Psychiatric and cognitive symptoms appear to increase over the first 2-3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19. FUNDING National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research.
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Affiliation(s)
- Maxime Taquet
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK.
| | - Zuzanna Skorniewska
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Thomas De Deyn
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Adam Hampshire
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Peter J Hellyer
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- MRC Translational Immune Discovery Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunity, University College London, London, UK
| | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Olivia C Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Matthew Richardson
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Omer Elneima
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Hamish J C McAuley
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Marco Sereno
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Ruth M Saunders
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Victoria C Harris
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Linzy Houchen-Wolloff
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK; Therapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Neil J Greening
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Ewen M Harrison
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Nazir I Lone
- Population Health Sciences, The Usher Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Jennifer Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Christopher E Brightling
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Louise V Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rachael A Evans
- The Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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Claessens G, Gerritzen I, van Osch F, van den Bergh JP, Verberne D, Gach D, van Balen E, van Heugten CM. Prevalence and predictors of persistent cognitive and psychological symptoms in non-hospitalized post-COVID-19 patients seeking care at an outpatient post-COVID-19 clinic. Front Psychol 2024; 15:1396963. [PMID: 39193035 PMCID: PMC11347444 DOI: 10.3389/fpsyg.2024.1396963] [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: 03/06/2024] [Accepted: 07/15/2024] [Indexed: 08/29/2024] Open
Abstract
Introduction There is still much uncertainty about why some people develop persistent cognitive and mental health problems after SARS-CoV-2 infection and require additional care while others do not. In this study, we investigated the cognitive and psychological outcomes of non-hospitalized post-COVID-19 patients referred to an outpatient post-COVID-19 clinic for persistent symptoms more than 3 months after infection. Additionally, we aimed to explore the influence of demographic, physical, and personal factors on these outcomes. Methods This cross-sectional study was conducted at an outpatient post-COVID-19 clinic located at a prominent clinical teaching hospital in the Netherlands. Participants included non-hospitalized patients referred between 2020 and 2022, more than 3 months after SARS-CoV-2 infection, experiencing persistent symptoms. Main outcome measures included levels of anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress symptoms (PTSS) (Post-traumatic Stress Symptoms Checklist 14), and cognitive symptoms (Checklist for Cognitive and Emotional Consequences). Data analysis employed Spearman correlation and hierarchical multiple regression analyses. Results A total of 265 patients (61% female; mean age of 51.7 ± 13.7 years) were included in the study, with an average of 7.6 ± 4.5 months following SARS-CoV-2 infection. Among them, 104 patients (40%) reported high levels of anxiety, 111 patients (43%) showed high levels depressive symptoms, and 71 patients (31%) demonstrated high levels of PTSS. Additionally, 200 patients (79%) reported experiencing more than 2 cognitive symptoms. Bivariate analyses indicated associations between psychiatric history and increased cognitive and psychological symptoms. Multivariate analyses revealed positive associations between physical symptoms and cognitive and psychological symptoms, and catastrophizing thoughts were associated with higher anxiety levels (β = 0.217, p < 0.001). Conversely, positive refocusing was associated with lower depressive symptoms (β = -0.325, p < 0.001), PTSS (β = -0.290, p < 0.001), and cognitive symptoms (β = -0.220, p < 0.001). Discussion Among non-hospitalized COVID-19 patients seeking care for persistent symptoms, approximately one-third reported high levels of psychological symptoms, and more than three-quarter experienced cognitive symptoms. Physical symptoms, psychiatric history, and a tendency to catastrophize were identified as potential risk factors for persistent psychological and cognitive symptoms. Conversely, positive refocusing demonstrated a protective effect. These findings contribute to the understanding of long-term COVID-19 outcomes and emphasize the importance of integrating a biopsychosocial perspective into treatment approaches.
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Affiliation(s)
- Gisela Claessens
- Department of Medical Psychology, VieCuri Medical Center, Venlo, Netherlands
| | - Iris Gerritzen
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, Netherlands
| | - Frits van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Joop P. van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
| | - Daan Verberne
- Department of Medical Psychology, VieCuri Medical Center, Venlo, Netherlands
| | - Debbie Gach
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Eric van Balen
- Department of Medical Psychology, VieCuri Medical Center, Venlo, Netherlands
| | - Caroline M. van Heugten
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, Netherlands
- Limburg Brain Injury Center, Maastricht University, Maastricht, Netherlands
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Boutry C, Patel P, Holmes J, Radford K, Bolton CE, Evangelou N, das Nair R, Morriss R. Returning to work with long covid in the UK during lockdown and other COVID-19 restrictions: A qualitative study. PLoS One 2024; 19:e0307062. [PMID: 39133715 PMCID: PMC11318866 DOI: 10.1371/journal.pone.0307062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/30/2024] [Indexed: 08/15/2024] Open
Abstract
Few previous studies have considered the experiences of people with long covid returning to work beyond symptoms in terms of employer and other support factors. The aim of this research was to understand the experience of returning to work for those with long covid symptoms in contrast to the non-long covid group who had not experienced COVID-19 during the time restrictions were imposed to limit the spread of COVID-19 infection. Twenty-one participants with long covid and 13 participants who had not had COVID-19 were interviewed. Themes were identified from transcripts using framework analysis. Participants with long covid experienced difficulties returning to work, particularly from fatigue, cognitive symptoms and breathlessness. Symptoms were heterogeneous and fluctuated in severity over time. A lack of understanding from colleagues and managers sometimes led to a premature return to work without adequate support, associated with further long covid relapse. Outside-of-work, support was salient for a successful return to work. The standard phased return offered by employers may be too short and rigid for some people with long covid. They may benefit from a tailored intervention to support a return to work that targets symptom management, and engages with work colleagues, managers, and family members.
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Affiliation(s)
- Clement Boutry
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
- National Institute for Health and Care Research, Applied Research Collaboration East Midland, University of Nottingham, Nottinghamshire, United Kingdom
| | - Priya Patel
- National Institute for Health and Care Research, Applied Research Collaboration East Midland, University of Nottingham, Nottinghamshire, United Kingdom
| | - Jain Holmes
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - Kathryn Radford
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - Charlotte E. Bolton
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nikos Evangelou
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - Roshan das Nair
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
- Health Division, SINTEF, Trondheim, Norway
| | - Richard Morriss
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
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Fessler SN, Liu L, Chang Y, Johnston CS. Body Mass Index Is Associated with Post-Acute Elevations in Biomarkers of Platelet Activation and Inflammation in Unvaccinated Adults Diagnosed with COVID-19 in the Previous 8 Weeks. Obes Facts 2024:1-6. [PMID: 39116840 DOI: 10.1159/000540343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Obesity has arisen as a prominent risk factor for COVID-19 severity and long COVID, potentially owed in part to the obesity-induced proinflammatory state. This study aimed to examine relationships among circulating inflammatory biomarkers and body mass index in nonhospitalized adults recently diagnosed with COVID-19. METHODS This analysis included participants who completed a randomized placebo-controlled trial conducted in October 2020-March 2021. Participants (19-53 years) were unvaccinated and enrolled following COVID-19 diagnosis as allowed by CDC return-to-work guidance. Anthropometrics and biomarkers were assessed at study baseline and week four. We examined the associations between body mass index (BMI) and inflammatory biomarkers via multiple regression models. RESULTS At study baseline (i.e., the point of enrollment following COVID-19 diagnosis) across all participants (N = 60), a higher BMI was associated with elevations in several inflammatory biomarkers including IL-6 (β = 7.63, 95% CI = 3.54, 11.89, p = 0.0004), ferritin (β = 6.31, 95% CI = 1.97, 10.83, p = 0.0047), high sensitivity C-reactive protein (β = 13.1, 95% CI = 8.03, 18.42, p = < 0.0001), tumor necrosis factor-α (β = 3.23, 95% CI = 0.91, 5.60, p = 0.0069), IL-12p40 (β = 3.69, 95% CI = 0.93, 6.52, p = 0.0094), IL-13 (β = 5.11, 95% CI = 1.00, 9.40, p = 0.0154), and IL-1Ra (β = 7.57, 95% CI = 3.61, 11.70, p = 0.0003). In control group participants (n = 30) after 4 weeks, a higher BMI was associated with elevations in IL-4 (β = 17.8, 95% CI = 0.84, 37.6, p = 0.0397) and sP-selectin (β = 1.16, 95% CI = 0.22, 2.11, p = 0.0182), controlling for baseline and covariates. CONCLUSIONS Here, BMI was positively associated with circulating biomarkers of platelet activation and inflammation in adults recently diagnosed with COVID-19 after 4 weeks. The shift in post-acute COVID-19 inflammatory biomarkers associated with an increasing BMI noted here shares similarities to biomarkers of LC reported in the literature.
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Affiliation(s)
- Samantha N Fessler
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Li Liu
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
- Biodesign Institute, Arizona State University, Tempe, Arizona, USA
| | - Yung Chang
- Biodesign Institute, Arizona State University, Tempe, Arizona, USA
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Carol S Johnston
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
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Dang W, Li W, Liu H, Li C, Zhu T, Bai L, Yang R, Wang J, Liao X, Liu B, Zhang S, Yuan M, Zhang W. Psychosocial Factors Associated With Long-Term Cognitive Impairment Among COVID-19 Survivors: A Cross-Sectional Study. J Nerv Ment Dis 2024; 212:437-444. [PMID: 39008889 DOI: 10.1097/nmd.0000000000001792] [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] [Indexed: 07/17/2024]
Abstract
ABSTRACT COVID-19 survivors complained of the experience of cognitive impairments, which also called "brain fog" even recovered. The study aimed to describe long-term cognitive change and determine psychosocial factors in COVID-19 survivors. A cross-sectional study was recruited 285 participants from February 2020 to April 2020 in 17 hospitals in Sichuan Province. Cognitive function, variables indicative of the virus infection itself, and psychosocial variables were collected by telephone interview. Univariate logistic regression and Lasso logistic regression models were used for variable selection which plugged into a multiple logistics model. Overall prevalence of moderate or severe cognitive impairment was 6.3%. Logistic regression showed that sex, religion, smoking status, occupation, self-perceived severity of illness, sleep quality, perceived mental distress after COVID-19, perceived discrimination from relatives and friends, and suffered abuse were associated with cognitive impairment. The long-term consequences of cognitive function are related to multiple domains, in which psychosocial factors should be taken into consideration.
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Affiliation(s)
| | | | - Haotian Liu
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Lin Bai
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Runnan Yang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Jingyi Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao Liao
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Liu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
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9
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Pantazidou A, Grylli C, Klomfar S, Mora-Theuer E, Schöggl J, Macura S, Schaller L, Pokorny I, Greber-Platzer S. A pilot study evaluating stress factors during and after the COVID-19 pandemic in Viennese families who have the suspicion of child maltreatment or abuse. Wien Klin Wochenschr 2024; 136:449-457. [PMID: 38730067 PMCID: PMC11327178 DOI: 10.1007/s00508-024-02371-z] [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: 09/19/2023] [Accepted: 04/16/2024] [Indexed: 05/12/2024]
Abstract
The global population was affected by the unprecedented coronavirus COVID-19 pandemic. The impact of the pandemic on children who suffer child maltreatment has not been explored sufficiently. Child abuse is known to increase in stressful circumstances, and therefore potentially during this pandemic.We aimed to identify and measure the impact of pandemic-related stress in families with a suspicion or confirmed child maltreatment. In addition, other parameters were determined, including resilience factors and family dynamics.We conducted a pilot study at the Medical University of Vienna, Forensic Examination Centre for Children and Adolescents (FOKUS Safeguarding team). Parents, carers and legal guardians of children who were referred for potential child abuse (study group) participated by completing two questionnaires, one year apart, covering the following periods: pre-COVID, during-COVID and post-COVID. Simultaneously, a control group was devised with patients who presented to the Paediatric Emergency Department with unrelated conditions (other than child maltreatment concerns). The questionnaires addressed psychological stress factors and were completed face-to-face and/or via telephone. A total of 35 carers participated, with almost equal numbers in both intervention and control groups.Results show that there was statistically significantly higher stress level perception before and during the pandemic period in the study group. Several families in this group commented on the positive effect of support received from health professionals, especially after the pandemic.
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Affiliation(s)
- Anastasia Pantazidou
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria
| | - Chryssa Grylli
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria
| | - Sophie Klomfar
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria
| | - Eva Mora-Theuer
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria
| | - Johanna Schöggl
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria
| | - Sarah Macura
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria
| | - Laura Schaller
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria
| | - Iulia Pokorny
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria
| | - Susanne Greber-Platzer
- Forensische Kinder- und Jugenduntersuchungsstelle (FOKUS), Clinical Division for Pediatric Pulmonology, Allergology and Endocrinology, Department for Pediatric & Adolescent Medicine, (Universitätsklinik für Kinder- und Jugendheilkunde), Medical University Vienna, Vienna, Austria.
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10
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Gupta A, Nicholas R, McGing JJ, Nixon AV, Mallinson JE, McKeever TM, Bradley CR, Piasecki M, Cox EF, Bonnington J, Lord JM, Brightling CE, Evans RA, Hall IP, Francis ST, Greenhaff PL, Bolton CE. DYNamic Assessment of Multi-Organ level dysfunction in patients recovering from COVID-19: DYNAMO COVID-19. Exp Physiol 2024; 109:1274-1291. [PMID: 38923603 PMCID: PMC11291868 DOI: 10.1113/ep091590] [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: 12/30/2023] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
We evaluated the impacts of COVID-19 on multi-organ and metabolic function in patients following severe hospitalised infection compared to controls. Patients (n = 21) without previous diabetes, cardiovascular or cerebrovascular disease were recruited 5-7 months post-discharge alongside controls (n = 10) with similar age, sex and body mass. Perceived fatigue was estimated (Fatigue Severity Scale) and the following were conducted: oral glucose tolerance (OGTT) alongside whole-body fuel oxidation, validated magnetic resonance imaging and spectroscopy during resting and supine controlled exercise, dual-energy X-ray absorptiometry, short physical performance battery (SPPB), intra-muscular electromyography, quadriceps strength and fatigability, and daily step-count. There was a greater insulin response (incremental area under the curve, median (inter-quartile range)) during the OGTT in patients [18,289 (12,497-27,448) mIU/min/L] versus controls [8655 (7948-11,040) mIU/min/L], P < 0.001. Blood glucose response and fasting and post-prandial fuel oxidation rates were not different. This greater insulin resistance was not explained by differences in systemic inflammation or whole-body/regional adiposity, but step-count (P = 0.07) and SPPB scores (P = 0.004) were lower in patients. Liver volume was 28% greater in patients than controls, and fat fraction adjusted liver T1, a measure of inflammation, was raised in patients. Patients displayed greater perceived fatigue scores, though leg muscle volume, strength, force-loss, motor unit properties and post-exercise muscle phosphocreatine resynthesis were comparable. Further, cardiac and cerebral architecture and function (at rest and on exercise) were not different. In this cross-sectional study, individuals without known previous morbidity who survived severe COVID-19 exhibited greater insulin resistance, pointing to a need for physical function intervention in recovery.
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Affiliation(s)
- Ayushman Gupta
- NIHR Nottingham Biomedical Research CentreNottinghamUK
- Centre for Respiratory Research, Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
- Nottingham University Hospitals NHS TrustNottinghamUK
| | - Rosemary Nicholas
- Sir Peter Mansfield Imaging Centre, School of Physics & AstronomyUniversity of NottinghamNottinghamUK
| | - Jordan J. McGing
- David Greenfield Human Physiology Unit, School of Life SciencesUniversity of NottinghamNottinghamUK
| | - Aline V. Nixon
- David Greenfield Human Physiology Unit, School of Life SciencesUniversity of NottinghamNottinghamUK
| | - Joanne E. Mallinson
- David Greenfield Human Physiology Unit, School of Life SciencesUniversity of NottinghamNottinghamUK
| | - Tricia M. McKeever
- NIHR Nottingham Biomedical Research CentreNottinghamUK
- Centre for Respiratory Research, Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
| | - Christopher R. Bradley
- Sir Peter Mansfield Imaging Centre, School of Physics & AstronomyUniversity of NottinghamNottinghamUK
| | - Mathew Piasecki
- NIHR Nottingham Biomedical Research CentreNottinghamUK
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing ResearchUniversity of NottinghamNottinghamUK
| | - Eleanor F. Cox
- Sir Peter Mansfield Imaging Centre, School of Physics & AstronomyUniversity of NottinghamNottinghamUK
| | | | - Janet M. Lord
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing ResearchUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research CentreUniversity of BirminghamBirminghamUK
| | | | - Rachael A. Evans
- NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | - Ian P. Hall
- NIHR Nottingham Biomedical Research CentreNottinghamUK
- Centre for Respiratory Research, Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
- Nottingham University Hospitals NHS TrustNottinghamUK
| | - Susan T. Francis
- NIHR Nottingham Biomedical Research CentreNottinghamUK
- Sir Peter Mansfield Imaging Centre, School of Physics & AstronomyUniversity of NottinghamNottinghamUK
| | - Paul L. Greenhaff
- NIHR Nottingham Biomedical Research CentreNottinghamUK
- David Greenfield Human Physiology Unit, School of Life SciencesUniversity of NottinghamNottinghamUK
- MRC‐Versus Arthritis Centre for Musculoskeletal Ageing ResearchUniversity of NottinghamNottinghamUK
| | - Charlotte E. Bolton
- NIHR Nottingham Biomedical Research CentreNottinghamUK
- Centre for Respiratory Research, Translational Medical Sciences, School of MedicineUniversity of NottinghamNottinghamUK
- Nottingham University Hospitals NHS TrustNottinghamUK
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11
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Farmakis IT, Konstantinides SV. COVID-19 changed the world - without changing CTEPH. Eur Respir J 2024; 64:2401467. [PMID: 39209467 DOI: 10.1183/13993003.01467-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Ioannis T Farmakis
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
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12
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Reddy SA, Newman J, Leavy OC, Ghani H, Pepke-Zaba J, Cannon JE, Sheares KK, Taboada D, Bunclark K, Lawrie A, Sudlow CL, Berry C, Wild JM, Mitchell JA, Quint J, Rossdale J, Price L, Howard LS, Wilkins M, Sattar N, Chowienczyk P, Thompson R, Wain LV, Horsley A, Ho LP, Chalmers JD, Marks M, Poinasamy K, Raman B, Harris VC, Houchen-Wolloff L, Brightling CE, Evans RA, Toshner MR. Chronic thromboembolic pulmonary hypertension is an uncommon complication of COVID-19: UK national surveillance and observational screening cohort studies. Eur Respir J 2024; 64:2301742. [PMID: 39060016 PMCID: PMC11358513 DOI: 10.1183/13993003.01742-2023] [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] [Received: 10/12/2023] [Accepted: 06/09/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Pulmonary embolism (PE) is a well-recognised complication of coronavirus disease 2019 (COVID-19) infection, and chronic thromboembolic pulmonary disease with and without pulmonary hypertension (CTEPD/CTEPH) are potential life-limiting consequences. At present the burden of CTEPD/CTEPH is unclear and optimal and cost-effective screening strategies yet to be established. METHODS We evaluated the CTEPD/CTEPH referral rate to the UK national multidisciplinary team (MDT) during the 2017-2022 period to establish the national incidence of CTEPD/CTEPH potentially attributable to COVID-19-associated PE with historical comparator years. All individual cases of suspected CTEPH were reviewed by the MDT for evidence of associated COVID-19. In a separate multicentre cohort, the risk of developing CTEPH following hospitalisation with COVID-19 was calculated using simple clinical parameters at a median of 5 months post-hospital discharge according to existing risk scores using symptoms, ECG and N-terminal pro-brain natriuretic peptide. RESULTS By the second year of the pandemic, CTEPH diagnoses had returned to the pre-pandemic baseline (23.1 versus 27.8 cases per month; p=0.252). Of 334 confirmed CTEPD/CTEPH cases, four (1.2%) patients were identified to have CTEPH potentially associated with COVID-19 PE, and a further three (0.9%) CTEPD without PH. Of 1094 patients (mean age 58 years, 60.4% male) hospitalised with COVID-19 screened across the UK, 11 (1.0%) were at high risk of CTEPH at follow-up, none of whom had a diagnosis of CTEPH made at the national MDT. CONCLUSION A priori risk of developing CTEPH following COVID-19-related hospitalisation is low. Simple risk scoring is a potentially effective way of screening patients for further investigation.
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Affiliation(s)
- S Ashwin Reddy
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
- Joint first authors
| | - Joseph Newman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
- Joint first authors
| | - Olivia C Leavy
- University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Hakim Ghani
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | | | - John E Cannon
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | - Allan Lawrie
- Sheffield Teaching NHS Foundation Trust and University of Sheffield, Sheffield, UK
| | | | - Colin Berry
- NHS Greater Glasgow and Clyde Health Board, and University of Glasgow, Glasgow, UK
| | - James M Wild
- Sheffield Teaching NHS Foundation Trust and University of Sheffield, Sheffield, UK
| | | | | | | | - Laura Price
- Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | | | | | - Naveed Sattar
- NHS Greater Glasgow and Clyde Health Board, and University of Glasgow, Glasgow, UK
| | | | - Roger Thompson
- Sheffield Teaching NHS Foundation Trust and University of Sheffield, Sheffield, UK
| | - Louise V Wain
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Alexander Horsley
- Manchester University NHS Foundation Trust and University of Manchester, Manchester, UK
| | | | | | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Christopher E Brightling
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Rachael A Evans
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Mark R Toshner
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
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13
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Sha'ari NI, Ismail A, Abdul Aziz AF, Suddin LS, Azzeri A, Sk Abd Razak R, Mad Tahir NS. Cardiovascular diseases as risk factors of post-COVID syndrome: a systematic review. BMC Public Health 2024; 24:1846. [PMID: 38987743 PMCID: PMC11238467 DOI: 10.1186/s12889-024-19300-4] [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: 09/13/2023] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND A growing proportion of people experience incomplete recovery months after contracting coronavirus disease 2019 (COVID-19). These COVID-19 survivors develop a condition known as post-COVID syndrome (PCS), where COVID-19 symptoms persist for > 12 weeks after acute infection. Limited studies have investigated PCS risk factors that notably include pre-existing cardiovascular diseases (CVD), which should be examined considering the most recent PCS data. This review aims to identify CVD as a risk factor for PCS development in COVID-19 survivors. METHODS Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist, systematic literature searches were performed in the PubMed, Scopus, and Web of Science databases from the earliest date available to June 2023. Data from observational studies in English that described the association between CVD and PCS in adults (≥ 18 years old) were included. A minimum of two authors independently performed the screening, study selection, data extraction, data synthesis, and quality assessment (Newcastle-Ottawa Scale). The protocol of this review was registered under PROSPERO (ID: CRD42023440834). RESULTS In total, 594 studies were screened after duplicates and non-original articles had been removed. Of the 11 included studies, CVD including hypertension (six studies), heart failure (three studies), and others (two studies) were significantly associated with PCS development with different factors considered. The included studies were of moderate to high methodological quality. CONCLUSION Our review highlighted that COVID-19 survivors with pre-existing CVD have a significantly greater risk of developing PCS symptomology than survivors without pre-existing CVD. As heart failure, hypertension and other CVD are associated with a higher risk of developing PCS, comprehensive screening and thorough examinations are essential to minimise the impact of PCS and improve patients' disease progression.
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Affiliation(s)
- Nur Insyirah Sha'ari
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Aniza Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia.
- Faculty of Public Health, Universitas Sumatera Utara, North Sumatra, Jalan Universitas No. 21 Kampus USU, Medan, 20155, Indonesia.
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Leny Suzana Suddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, 47000, Selangor, Malaysia
| | - Amirah Azzeri
- Department of Primary Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, Negeri Sembilan, Nilai, 71800, Malaysia
| | - Ruhana Sk Abd Razak
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Campus, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Nur Syazana Mad Tahir
- Federal Government Administrative Centre, Ministry of Health Malaysia, Pusat Pentadbiran Kerajaan Persekutuan, Wilayah Persekutuan Putrajaya, Putrajaya, 62000, Malaysia
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14
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Cataneo-Piña DJ, Castorena-Maldonado A, González-Islas D, Galicia-Amor S, Orea-Tejeda A, Pelaez-Hernández V, Gutiérrez-Álvarez AD, Rojas-Serrano J, Ortiz-Reyes E, Mendoza-Méndez A, Mendoza-Escamilla Á, Fabre-Alonso S, Buendía-Roldán I, Gochicoa-Rangel L, López-García C, Radillo-Gil M, Hernández Favela CG, Monraz-Perez S, Salas-Hernández J, Santillán-Doherty P. Enhancing quality of life in severe post-COVID-19 survivors through multidisciplinary care. ERJ Open Res 2024; 10:00214-2024. [PMID: 39104955 PMCID: PMC11299004 DOI: 10.1183/23120541.00214-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/05/2024] [Indexed: 08/07/2024] Open
Abstract
Background COVID-19 survivors who were hospitalised continue to experience long-term multisystemic sequelae and symptoms, impacting their health-related quality of life (HRQoL). The complexity of post-COVID-19 conditions underscores the importance of adopting a multidisciplinary, patient-centric approach to ensure ongoing care. This study aims to assess HRQoL and post-COVID symptoms in a cohort of severe COVID-19 survivors depending on their participation in a multidisciplinary programme. Methods This prospective study was conducted in a post-COVID clinic staffed by a multidisciplinary team (physical rehabilitator, nutritionist, psychologist, including experts in pulmonary rehabilitation, nutrition, psychology and others). Subjects over 18 years old who were hospitalised due to severe COVID-19 during the acute phase and had attended the post-COVID clinic within the first 3 months following discharge were included. Subjects who were unable or unwilling to provide informed consent to participate in the protocol were excluded. Linear mixed-effect models were employed to examine changes in 12-Item Short-Form Health Survey (SF-12) component scores. The resolution of post-COVID symptom clusters was compared using the Cox model. Results A total of 730 patients were included, with a mean±sd age of 55.78±15.43 years; 60.55% were male and 90.62% required mechanical ventilation during hospitalisation. Programme attendants demonstrated improved SF-12 physical and mental component scores at 3 and 12 months. A reduction in the prevalence of post-COVID symptoms was observed in both groups, with greater reductions in those attending the programme. Conclusion Our study showed that patients enrolled on the multidisciplinary programme experienced improvements in fatigue, musculoskeletal, gastrointestinal, neuropsychiatric and respiratory symptoms, along with enhanced SF-12 mental and physical component scores.
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Affiliation(s)
- Daniela Josefina Cataneo-Piña
- Geriatrics, Palliative Care Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Armando Castorena-Maldonado
- Otorhinolaryngology Department, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Dulce González-Islas
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Susana Galicia-Amor
- Pulmonary Rehabilitation Department, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Arturo Orea-Tejeda
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Viridiana Pelaez-Hernández
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Alma Delia Gutiérrez-Álvarez
- Psychiatric Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Jorge Rojas-Serrano
- Rheumatology Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Eduardo Ortiz-Reyes
- Geriatrics, Palliative Care Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Aline Mendoza-Méndez
- Geriatrics, Palliative Care Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Ángel Mendoza-Escamilla
- Geriatrics, Palliative Care Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Sinuhe Fabre-Alonso
- Geriatrics, Palliative Care Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Ivette Buendía-Roldán
- Translational Research Laboratory on Aging and Pulmonary Fibrosis, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Department of Pulmonary Physiology at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Carlos López-García
- Otorhinolaryngology Department, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Marian Radillo-Gil
- Otorhinolaryngology Department, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Celia Gabriela Hernández Favela
- Geriatrics, Palliative Care Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Sergio Monraz-Perez
- Medical Direction, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Jorge Salas-Hernández
- Medical Direction, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | - Patricio Santillán-Doherty
- Medical Direction, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
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15
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Huang J, Qiao X, Song K, Liu R, Huang S, He J, Zhu S, Reinhardt JD, He C. Effectiveness of Rehabilitation Interventions in Individuals With Emerging Virtual Respiratory Tract Infectious Disease: A Systematic Review and Meta-Analysis. Clin Rehabil 2024; 38:857-883. [PMID: 38629433 DOI: 10.1177/02692155241239881] [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] [Indexed: 05/24/2024]
Abstract
OBJECTIVE Assessing rehabilitation effectiveness for persistent symptoms post-infection with emerging viral respiratory diseases. DATA SOURCES Systematic review of seven databases (MEDLINE, EMBASE, Cochrane Library, PEDro, MedRxiv, CNKI, Wanfang) until 30 December 2023. REVIEW METHODS Evaluated 101 studies (9593 participants) on respiratory function, exercise capacity, and quality of life. Methodological quality was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized controlled trials (RCTs), the Newcastle-Ottawa Scale (NOS) for observational studies and non-RCTs, and the NIH Quality Assessment Tools for before-after studies. RESULTS The most common rehabilitation program combined breathing exercises with aerobic exercise or strength training. Rehabilitation interventions significantly enhanced respiratory function, as evidenced by improvements on the Borg Scale (MD, -1.85; 95% CI, -3.00 to -0.70, low certainty), the mMRC Dyspnea Scale (MD, -0.45; 95% CI, -0.72 to -0.18, low certainty), and the Multidimensional Dyspnoea-12 Scale (MD, -4.64; 95% CI, -6.54 to -2.74, moderate certainty). Exercise capacity also improved, demonstrated by results from the Six-Minute Walk Test (MD, 38.18; 95% CI, 25.33-51.03, moderate certainty) and the Sit-to-Stand Test (MD, 3.04; 95% CI, 1.07-5.01, low certainty). CONCLUSION Rehabilitation interventions are promising for survivors of viral respiratory diseases, yet gaps in research remain. Future investigations should focus on personalizing rehabilitation efforts, utilizing remote technology-assisted programs, improving research quality, and identifying specific subgroups for customized rehabilitation strategies to achieve the best outcomes for survivors.
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Affiliation(s)
- Jinming Huang
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xu Qiao
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Kangping Song
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rong Liu
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Shuangshuang Huang
- Rehabilitation Medicine Department, The Fifth People's Hospital of Sichuan Province, Chengdu, China
| | - Jing He
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Siyi Zhu
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jan D Reinhardt
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Center for Rehabilitation Research, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Chengqi He
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Rehabilitation Medical Center, West China Hospital, and Institute for Disaster Management and Reconstruction, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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16
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Elneima O, Hurst JR, Echevarria C, Quint JK, Walker S, Siddiqui S, Novotny P, Pfeffer PE, Brown JS, Shankar-Hari M, McAuley HJ, Leavy OC, Shikotra A, Singapuri A, Sereno M, Richardson M, Saunders RM, Harris VC, Houchen-Wolloff L, Greening NJ, Harrison EM, Docherty AB, Lone NI, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Evans RA, Wain LV, Sheikh A, Brightling CE, De Soyza A, Heaney LG. Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airway diseases in the UK: a multicentre, longitudinal cohort study - PHOSP-COVID. ERJ Open Res 2024; 10:00982-2023. [PMID: 39010888 PMCID: PMC11247371 DOI: 10.1183/23120541.00982-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/06/2024] [Indexed: 07/17/2024] Open
Abstract
Background The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airway diseases are unknown. Methods Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at 5 months and 1 year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health-related quality of life (HRQoL) of individuals with pre-existing airway disease (i.e., asthma, COPD or bronchiectasis) were compared to the non-airways group. Results A total of 615 out of 2697 (22.8%) participants had a history of pre-existing airway diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At 1 year, the airways group participants were less likely to feel fully recovered (20.4% versus 33.2%, p<0.001), had higher burden of anxiety (29.1% versus 22.0%, p=0.002), depression (31.2% versus 24.7%, p=0.006), higher percentage of impaired mobility using short physical performance battery ≤10 (57.4% versus 45.2%, p<0.001) and 27% had a new disability (assessed by the Washington Group Short Set on Functioning) versus 16.6%, p=0.014. HRQoL assessed using EQ-5D-5L Utility Index was lower in the airways group (mean±SD 0.64±0.27 versus 0.73±0.25, p<0.001). Burden of breathlessness, fatigue and cough measured using a study-specific tool was higher in the airways group. Conclusion Individuals with pre-existing airway diseases hospitalised due to COVID-19 were less likely to feel fully recovered, had lower physiological performance measurements, more burden of symptoms and reduced HRQoL up to 1 year post-hospital discharge.
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Affiliation(s)
- Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - John R. Hurst
- UCL Respiratory, Department of Medicine, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Carlos Echevarria
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | | | - Salman Siddiqui
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Petr Novotny
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Paul E. Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jeremy S. Brown
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Manu Shankar-Hari
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Hamish J.C. McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Olivia C. Leavy
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Ruth M. Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Victoria C. Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Linzy Houchen-Wolloff
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK
| | - Neil J. Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Ewen M. Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B. Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir I. Lone
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - James D. Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- MRC Translational Discovery Immunology Unit, University of Oxford, Oxford, UK
- NIHR Oxford BRC, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
| | | | - Betty Raman
- NIHR Oxford BRC, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rachael A. Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
| | - Louise V. Wain
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Chris E. Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre – Respiratory, University of Leicester, Leicester, UK
- Joint senior authors
| | - Anthony De Soyza
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Joint senior authors
| | - Liam G. Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK
- Belfast Health and Social Care Trust, Belfast, UK
- Joint senior authors
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Sudre CH, Antonelli M, Cheetham NJ, Molteni E, Canas LS, Bowyer V, Murray B, Rjoob K, Modat M, Capdevila Pujol J, Hu C, Wolf J, Spector TD, Hammers A, Steves CJ, Ourselin S, Duncan EL. Symptoms before and after COVID-19: a population and case-control study using prospective data. Eur Respir J 2024; 64:2301853. [PMID: 38575161 PMCID: PMC11255388 DOI: 10.1183/13993003.01853-2023] [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] [Received: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Some individuals experience prolonged illness after acute coronavirus disease 2019 (COVID-19). We assessed whether pre-infection symptoms affected post-acute COVID illness duration. METHODS Survival analysis was performed in adults (n=23 452) with community-managed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prospectively self-logging data through the ZOE COVID Symptom Study app, at least weekly, from 8 weeks before to 12 weeks after COVID-19 onset, conditioned on presence versus absence of baseline symptoms (4-8 weeks before COVID-19). A case-control study was performed in 1350 individuals with long illness (≥8 weeks, including 906 individuals (67.1%) with illness ≥12 weeks), matched 1:1 (for age, sex, body mass index, testing week, prior infection, vaccination, smoking, index of multiple deprivation) with 1350 individuals with short illness (<4 weeks). Baseline symptoms were compared between the two groups, and against post-COVID symptoms. RESULTS Individuals reporting baseline symptoms had longer COVID-related symptom duration (median 15 days versus 10 days for individuals without baseline symptoms) with baseline fatigue nearly doubling duration. Two-thirds (910 (67.4%) of 1350) of individuals with long illness were asymptomatic beforehand. However, 440 (32.6%) had baseline symptoms, versus 255 (18.9%) of 1350 individuals with short illness (p<0.0001). Baseline symptoms doubled the odds ratio for long illness (2.14, 95% CI 1.78-2.57). Prior comorbidities were more common in individuals with long versus short illness. In individuals with long illness, baseline symptomatic (versus asymptomatic) individuals were more likely to be female, younger, and have prior comorbidities; and baseline and post-acute symptoms, and symptom burden, correlated strongly. CONCLUSIONS Individuals experiencing symptoms before COVID-19 had longer illness duration and increased odds of long illness. However, many individuals with long illness were well before SARS-CoV-2 infection.
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Affiliation(s)
- Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nathan J Cheetham
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Vicky Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
| | - Ben Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Khaled Rjoob
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | | | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' PET Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, School of Life Course and Population Sciences, King's College London, London, UK
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Schreiber CS, Wiesweg I, Stanelle-Bertram S, Beck S, Kouassi NM, Schaumburg B, Gabriel G, Richter F, Käufer C. Sex-specific biphasic alpha-synuclein response and alterations of interneurons in a COVID-19 hamster model. EBioMedicine 2024; 105:105191. [PMID: 38865747 PMCID: PMC11293593 DOI: 10.1016/j.ebiom.2024.105191] [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: 12/13/2023] [Revised: 05/02/2024] [Accepted: 05/25/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) frequently leads to neurological complications after recovery from acute infection, with higher prevalence in women. However, mechanisms by which SARS-CoV-2 disrupts brain function remain unclear and treatment strategies are lacking. We previously demonstrated neuroinflammation in the olfactory bulb of intranasally infected hamsters, followed by alpha-synuclein and tau accumulation in cortex, thus mirroring pathogenesis of neurodegenerative diseases such as Parkinson's or Alzheimer's disease. METHODS To uncover the sex-specific spatiotemporal profiles of neuroinflammation and neuronal dysfunction following intranasal SARS-CoV-2 infection, we quantified microglia cell density, alpha-synuclein immunoreactivity and inhibitory interneurons in cortical regions, limbic system and basal ganglia at acute and late post-recovery time points. FINDINGS Unexpectedly, microglia cell density and alpha-synuclein immunoreactivity decreased at 6 days post-infection, then rebounded to overt accumulation at 21 days post-infection. This biphasic response was most pronounced in amygdala and striatum, regions affected early in Parkinson's disease. Several brain regions showed altered densities of parvalbumin and calretinin interneurons which are involved in cognition and motor control. Of note, females appeared more affected. INTERPRETATION Our results demonstrate that SARS-CoV-2 profoundly disrupts brain homeostasis without neuroinvasion, via neuroinflammatory and protein regulation mechanisms that persist beyond viral clearance. The regional patterns and sex differences are in line with neurological deficits observed after SARS-CoV-2 infection. FUNDING Federal Ministry of Health, Germany (BMG; ZMV I 1-2520COR501 to G.G.), Federal Ministry of Education and Research, Germany (BMBF; 03COV06B to G.G.), Ministry of Science and Culture of Lower Saxony in Germany (14-76403-184, to G.G. and F.R.).
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Affiliation(s)
- Cara Sophie Schreiber
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany
| | - Ivo Wiesweg
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Sebastian Beck
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Nancy Mounogou Kouassi
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Berfin Schaumburg
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Gülsah Gabriel
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany; Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Franziska Richter
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany.
| | - Christopher Käufer
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany.
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Burton A, Bone JK, Lawrence-Lunniss K, Philip KE. Acceptability and feasibility of a theatre-based wellness programme to support people living with long COVID: a single-arm feasibility study. BMJ Open 2024; 14:e083224. [PMID: 38951002 PMCID: PMC11218014 DOI: 10.1136/bmjopen-2023-083224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/12/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES To determine acceptability and feasibility of a theatre-based wellness programme to support the health and well-being of people with long COVID. DESIGN Single-group, repeated-measures feasibility study. SETTING Community centre and online. PARTICIPANTS Adults with diagnosed long COVID experiencing breathlessness, pain and/or loneliness. INTERVENTION Six-week participatory creative programme delivered to one online and one in-person group facilitated by movement, voice and drama consultants using breathing, visualisation, singing, poetry, storytelling and movement exercises. PRIMARY OUTCOME MEASURES Programme acceptability and feasibility measured via uptake, reasons for non-attendance and barriers to engagement. SECONDARY OUTCOME MEASURES Feasibility of recruitment and data collection procedures measured through proportion of missing data and follow-up rates, mechanisms of action of the programme identified through qualitative interviews, changes in mental health, well-being, quality of life, loneliness, social support, fatigue, breathlessness and post-COVID-19 functional status at 8-week follow-up. RESULTS 21 people expressed interest in participating, 20 people took part in the programme, 19 completed baseline and 16 completed follow-up assessments. Participants attended an average of 4.8 of 6 sessions (SD=1.5, range 2-6). Exploratory analyses demonstrated significant improvements in self-rated health (t-test mean difference=0.12, 95% CI=0.00, 0.23, p=0.04) and chronic fatigue symptoms (mean difference=-3.50, 95% CI=-6.97, -0.03, p=0.05) at 8 weeks. Key mechanisms of action that supported health and well-being included: increased sense of community, illness acceptance, experiencing joy, increased confidence in managing everyday life, increased ability to relax and reconnection with previous identity. Barriers to engagement included: activities being outside of the participant's comfort zone, ongoing long COVID symptoms, emotional consequences of sharing experiences and connectivity and connecting online. CONCLUSIONS A 6-week theatre-based programme was perceived as acceptable to most participants and resulted in some positive psychosocial impacts. The findings provide a rationale for supporting the ongoing development and scale-up of this and related arts programmes to support people living with long COVID.
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Affiliation(s)
- Alexandra Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jessica K Bone
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Keir Ej Philip
- National Heart and Lung Institute, Imperial College London, UK; and NIHR Imperial Biomedical Research Centre, London, UK
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20
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Musonye HA, He YS, Bekele MB, Jiang LQ, Fan Cao, Xu YQ, Gao ZX, Ge M, He T, Zhang P, Zhao CN, Chen C, Wang P, Pan HF. Exploring the association between ambient air pollution and COVID-19 risk: A comprehensive meta-analysis with meta-regression modelling. Heliyon 2024; 10:e32385. [PMID: 39183866 PMCID: PMC11341291 DOI: 10.1016/j.heliyon.2024.e32385] [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: 01/25/2024] [Revised: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Air pollution is speculated to increase the risk of Coronavirus disease-2019 (COVID-19). Nevertheless, the results remain inconsistent and inconclusive. This study aimed to explore the association between ambient air pollution (AAP) and COVID-19 risks using a meta-analysis with meta-regression modelling. Methods The inclusion criteria were: original studies quantifying the association using effect sizes and 95 % confidence intervals (CIs); time-series, cohort, ecological or case-crossover peer-reviewed studies in English. Exclusion criteria encompassed non-original studies, animal studies, and data with common errors. PubMed, Web of Science, Embase and Google Scholar electronic databases were systemically searched for eligible literature, up to 31, March 2023. The risk of bias (ROB) was assessed following the Agency for Healthcare Research and Quality parameters. A random-effects model was used to calculate pooled risk ratios (RRs) and their 95 % CIs. Results A total of 58 studies, between 2020 and 2023, met the inclusion criteria. The global representation was skewed, with major contributions from the USA (24.1 %) and China (22.4 %). The distribution included studies on short-term (43.1 %) and long-term (56.9 %) air pollution exposure. Ecological studies constituted 51.7 %, time-series-27.6 %, cohorts-17.2 %, and case crossover-3.4 %. ROB assessment showed low (86.2 %) and moderate (13.8 %) risk. The COVID-19 incidences increased with a 10 μg/m3 increase in PM2.5 [RR = 4.9045; 95 % CI (4.1548-5.7895)], PM10 [RR = 2.9427: (2.2290-3.8850)], NO2 [RR = 3.2750: (3.1420-3.4136)], SO2 [RR = 3.3400: (2.7931-3.9940)], CO [RR = 2.6244: (2.5208-2.7322)] and O3 [RR = 2.4008: (2.1859-2.6368)] concentrations. A 10 μg/m3 increase in concentrations of PM2.5 [RR = 3.0418: (2.7344-3.3838)], PM10 [RR = 2.6202: (2.1602-3.1781)], NO2 [RR = 3.2226: (2.1411-4.8504)], CO [RR = 1.8021 (0.8045-4.0370)] and O3 [RR = 2.3270 (1.5906-3.4045)] was significantly associated with COVID-19 mortality. Stratified analysis showed that study design, exposure period, and country influenced exposure-response associations. Meta-regression model indicated significant predictors for air pollution-COVID-19 incidence associations. Conclusion The study, while robust, lacks causality demonstration and focuses only on the USA and China, limiting its generalizability. Regardless, the study provides a strong evidence base for air pollution-COVID-19-risks associations, offering valuable insights for intervention measures for COVID-19.
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Affiliation(s)
- Harry Asena Musonye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yi-Sheng He
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Merga Bayou Bekele
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Ling-Qiong Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fan Cao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui, China
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yi-Qing Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Zhao-Xing Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Man Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tian He
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Peng Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Chan-Na Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Cong Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Peng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Hospital of Anhui Medical University 678 Furong Road, Hefei, 230601, Anhui, China
- Anhui Provincial Institute of Translational Medicine, No. 81 Meishan Road, Hefei, 230032, Anhui, China
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21
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Fumagalli R. Please wear a mask: a systematic case for mask wearing mandates. JOURNAL OF MEDICAL ETHICS 2024; 50:501-510. [PMID: 36810325 PMCID: PMC11228218 DOI: 10.1136/jme-2022-108736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
This paper combines considerations from ethics, medicine and public health policy to articulate and defend a systematic case for mask wearing mandates (MWM). The paper argues for two main claims of general interest in favour of MWM. First, MWM provide a more effective, just and fair way to tackle the ongoing COVID-19 pandemic than policy alternatives such as laissez-faire approaches, mask wearing recommendations and physical distancing measures. And second, the proffered objections against MWM may justify some exemptions for specific categories of individuals, but do not cast doubt on the justifiability of these mandates. Hence, unless some novel decisive objections are put forward against MWM, governments should adopt MWM.
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Affiliation(s)
- Roberto Fumagalli
- Political Economy, King's College London, London, UK
- Philosophy, The London School of Economics and Political Science, London, UK
- Behavioral Ethics Lab, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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22
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Nantakool S, Sa-nguanmoo P, Konghakote S, Chuatrakoon B. Effects of Exercise Rehabilitation on Cardiorespiratory Fitness in Long-COVID-19 Survivors: A Meta-Analysis. J Clin Med 2024; 13:3621. [PMID: 38930148 PMCID: PMC11204731 DOI: 10.3390/jcm13123621] [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: 04/22/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Poor cardiorespiratory fitness poses the highest risk of mortality. Long-COVID-19 survivors exhibit a reduced cardiorespiratory fitness (CRF). While exercise rehabilitation, such as cardiopulmonary exercise, is used for long-COVID-19 survivors, the effects of exercise on CRF in this population remain inconclusive. In this study, we aim to systematically summarise and synthesise whether exercise rehabilitation improves CRF among long-COVID-19 survivors. Methods: A comprehensive search was performed through PubMed, CINAHL, Embase, Scopus, and the Cochrane Library (since their inception to November 2023) and study reference lists. Studies presenting the effects of exercise rehabilitation on CRF (peak oxygen consumption (VO2peak) and six-minute walk distance (6MWD)) in long-COVID-19 survivors were identified. The standardised mean difference (SMD), mean difference (MD), and 95% confidence interval (CI) were used for analyses. The certainty of evidence was measured using a Grading of Recommendation Assessment, Development and Evaluation approach. Results: Twelve eligible studies (five RCTs and seven non-RCTs) with 682 participants were analysed. The meta-analysis showed significantly improved 6MWDs (MD 76.47, 95% CI 59.19-93.71, low certainty) and significantly greater 6MWDs (SMD 0.85, 95% CI 0.11-1.59, very low certainty) in the exercise rehabilitation group compared to the control group. A significantly improved 6MWD was found in subgroups of young to middle-aged adults and subgroups of patients who undertook aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. Conclusions: Exercise rehabilitation is effective for improving CRF, as measured by the 6MWD in long-COVID-19 survivors. Improvements are likely to be more pronounced in specific subgroups of young to middle-aged adults and patients undertaking aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. However, recommendations for clinical practice are limited due to the very low evidence certainty.
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Affiliation(s)
- Sothida Nantakool
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Piangkwan Sa-nguanmoo
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.-n.); (S.K.)
| | - Supatcha Konghakote
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.-n.); (S.K.)
| | - Busaba Chuatrakoon
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.-n.); (S.K.)
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23
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Chau SWH, Chue TM, Chan RNY, Lai YL, Wong PWC, Li SX, Liu Y, Chan JWY, Chan PKS, Lai CKC, Leung TWH, Wing YK. Chronic post-COVID neuropsychiatric symptoms persisting beyond one year from infection: a case-control study and network analysis. Transl Psychiatry 2024; 14:261. [PMID: 38898009 PMCID: PMC11187160 DOI: 10.1038/s41398-024-02978-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/18/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
Our study aims to delineate the phenotypes of chronic neuropsychiatric symptoms among adult subjects recovering from their first COVID that occurred more than one year ago. We also aim to explore the clinical and socioeconomic risk factors of having a high loading of chronic neuropsychiatric symptoms. We recruited a post-COVID group who suffered from their first pre-Omicron COVID more than a year ago, and a control group who had never had COVID. The subjects completed app-based questionnaires on demographic, socioeconomic and health status, a COVID symptoms checklist, mental and sleep health measures, and neurocognitive tests. The post-COVID group has a statistically significantly higher level of fatigue compared to the control group (p < 0.001). Among the post-COVID group, the lack of any COVID vaccination before the first COVID and a higher level of material deprivation before the COVID pandemic predicts a higher load of chronic post-COVID neuropsychiatric symptoms. Partial correlation network analysis suggests that the chronic post-COVID neuropsychiatric symptoms can be clustered into two major (cognitive complaints -fatigue and anxiety-depression) and one minor (headache-dizziness) cluster. A higher level of material deprivation predicts a higher number of symptoms in both major clusters, but the lack of any COVID vaccination before the first COVID only predicts a higher number of symptoms in the cognitive complaints-fatigue cluster. Our result suggests heterogeneity among chronic post-COVID neuropsychiatric symptoms, which are associated with the complex interplay of biological and socioeconomic factors.
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Affiliation(s)
- Steven Wai Ho Chau
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Timothy Mitchell Chue
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Rachel Ngan Yin Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yee Lok Lai
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul W C Wong
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong, China
| | - Shirley Xin Li
- Department of Psychology, Faculty of Social Science, The University of Hong Kong, Hong Kong, China
| | - Yaping Liu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Joey Wing Yan Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul Kay-Sheung Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Christopher K C Lai
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W H Leung
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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24
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Beauchamp M, Kirkwood R, Duong M, Ho T, Raina P, Kruisselbrink R, Jones A, Girolametto C, Costa A. Long-Term Functional Limitations and Predictors of Recovery After COVID-19: A Multicenter Prospective Cohort Study. Am J Med 2024:S0002-9343(24)00351-6. [PMID: 38878946 DOI: 10.1016/j.amjmed.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Limited data exist on post-severe COVID-19 functional trajectory, particularly considering premorbid status. We characterized 1-year functional recovery post-hospitalization for COVID-19, highlighting predictors of long-term recovery. METHODS We enrolled adult patients with lab-confirmed SARS-CoV-2 infection and hospitalized for COVID-19 sequelae, from five major Ontario, Canada hospitals in a prospective cohort study. Assessments included telephone interviews on admission followed by telephone and in-person assessments at 3-, 6-, 9-, and 12-months post-discharge. The Activity-Measure for Post-Acute Care (AM-PAC) Mobility and Cognition scales were administered at baseline and every 3 months for 1 year. Secondary outcomes included symptoms, spirometry, physical performance, dyspnea, fatigue, distress, anxiety and depression, and quality of life. RESULTS A total of 254 patients (57.1% male) with a mean age of 60.0 (±13.1) years and an average hospital stay of 14.3 (±19.7) days agreed to participate. At 12 months, 55.3% demonstrated clinically important deficits in mobility and 38.8% had cognitive deficits compared to premorbid levels. Fatigue was reported in 44.2%, followed by difficulty walking long distances in 35.8% and dyspnea in 33.0%. Almost 40% of patients had an FEV1(% Pred) < 80% at 12 months, 60.3% had impairments in physical performance, and 44.5% had problems with anxiety or depression. Predictors of better mobility at 12 months included higher premorbid mobility status, male sex, shorter hospital stay, fewer comorbidities, and higher FEV1 (% pred) at the 3-month follow-up. CONCLUSIONS Our study provides compelling evidence of the long-term impact of COVID-19 on functional and cognitive status 1-year post-infection.
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Affiliation(s)
- Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ont, Canada.
| | - Renata Kirkwood
- School of Rehabilitation Science, McMaster University, Hamilton, Ont, Canada
| | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Ont, Canada; Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Ont, Canada
| | - Terence Ho
- Department of Medicine, McMaster University, Hamilton, Ont, Canada; Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Ont, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont, Canada
| | | | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont, Canada
| | - Carla Girolametto
- Research, Innovation and Clinical Trials, Grand River Hospital, Kitchener, Ont, Canada
| | - Andrew Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont, Canada
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25
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Austin TA, Thomas ML, Lu M, Hodges CB, Darowski ES, Bergmans R, Parr S, Pickell D, Catazaro M, Lantrip C, Twamley EW. Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection. Neuropsychol Rev 2024:10.1007/s11065-024-09642-6. [PMID: 38862725 DOI: 10.1007/s11065-024-09642-6] [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: 06/02/2022] [Accepted: 04/22/2024] [Indexed: 06/13/2024]
Abstract
To effectively diagnose and treat subjective cognitive symptoms in post-acute sequalae of COVID-19 (PASC), it is important to understand objective cognitive impairment across the range of acute COVID-19 severity. Despite the importance of this area of research, to our knowledge, there are no current meta-analyses of objective cognitive functioning following non-severe initial SARS-CoV-2 infection. The aim of this meta-analysis is to describe objective cognitive impairment in individuals with non-severe (mild or moderate) SARS-CoV-2 cases in the post-acute stage of infection. This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA checklist for reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Fifty-nine articles (total participants = 22,060) with three types of study designs met our full criteria. Individuals with non-severe (mild/moderate) initial SARS-CoV-2 infection demonstrated worse objective cognitive performance compared to healthy comparison participants. However, those with mild (nonhospitalized) initial SARS-CoV-2 infections had better objective cognitive performance than those with moderate (hospitalized but not requiring ICU care) or severe (hospitalized with ICU care) initial SARS-CoV-2 infections. For studies that used normative data comparisons instead of healthy comparison participants, there was a small and nearly significant effect when compared to normative data. There were high levels of heterogeneity (88.6 to 97.3%), likely reflecting small sample sizes and variations in primary study methodology. Individuals who have recovered from non-severe cases of SARS-CoV-2 infections may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.
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Affiliation(s)
- Tara A Austin
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA.
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA.
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Colorado Springs, Fort Collins, USA
| | - Min Lu
- University of Miami, Miami, FL, USA
| | - Cooper B Hodges
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | | | - Rachel Bergmans
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Parr
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Delaney Pickell
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA
| | - Mikayla Catazaro
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Crystal Lantrip
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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26
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Rhead R, Wels J, Moltrecht B, Shaw RJ, Silverwood R, Zhu J, Hughes A, Chaturvedi N, Demou E, Katikireddi SV, Ploubidis G. Long COVID and financial outcomes: evidence from four longitudinal population surveys. J Epidemiol Community Health 2024; 78:458-465. [PMID: 38508701 PMCID: PMC11187380 DOI: 10.1136/jech-2023-221059] [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: 06/30/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Long-term sequelae of COVID-19 (long COVID) include muscle weakness, fatigue, breathing difficulties and sleep disturbance over weeks or months. Using UK longitudinal data, we assessed the relationship between long COVID and financial disruption. METHODS We estimated associations between long COVID (derived using self-reported length of COVID-19 symptoms) and measures of financial disruption (subjective financial well-being, new benefit claims, changes in household income) by analysing data from four longitudinal population studies, gathered during the first year of the pandemic. We employed modified Poisson regression in a pooled analysis of the four cohorts adjusting for a range of potential confounders, including pre-pandemic (pre-long COVID) factors. RESULTS Among the 20 112 observations across four population surveys, 13% reported having COVID-19 with symptoms that impeded their ability to function normally-10.7% had such symptoms for <4 weeks (acute COVID-19), 1.2% had such symptoms for 4-12 weeks (ongoing symptomatic COVID-19) and 0.6% had such symptoms for >12 weeks (post-COVID-19 syndrome). We found that post-COVID-19 syndrome was associated with worse subjective financial well-being (adjusted relative risk ratios (aRRRs)=1.57, 95% CI=1.25, 1.96) and new benefit claims (aRRR=1.79, CI=1.27, 2.53). Associations were broadly similar across sexes and education levels. These results were not meaningfully altered when scaled to represent the population by age. CONCLUSIONS Long COVID was associated with financial disruption in the UK. If our findings reflect causal effects, extending employment protection and financial support to people with long COVID may be warranted.
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Affiliation(s)
- Rebecca Rhead
- Department of Psychological Medicine, King's College London, London, UK
- University College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Jacques Wels
- University College London, London, UK
- BE, Washington, District of Columbia, USA
| | | | - Richard John Shaw
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Jingmin Zhu
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | | | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - George Ploubidis
- Centre of Longitudinal Studies, University College London, London, UK
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27
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Gutiérrez-Canales LG, Muñoz-Corona C, Barrera-Chávez I, Viloria-Álvarez C, Macías AE, Martínez-Navarro LJ, Alvarez JA, Scavo-Montes DA, Guaní-Guerra E. Persistence of COVID-19 Symptoms and Quality of Life at Three and Twelve Months after Hospital Discharge. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:944. [PMID: 38929561 PMCID: PMC11205838 DOI: 10.3390/medicina60060944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Medical and public recognition of "long-COVID or post-COVID syndrome", as well as its impact on the quality of life (QoL), is required to better address the disease burden. Objectives: We aimed to describe the persistence of COVID-19 symptoms and QoL among patients at three and twelve months after their discharge from the hospital. Materials and Methods: We conducted an observational, prospective, and longitudinal analytic study from September 2021 to April 2022. To measure QoL, we used a validated version of the 36-item Short-Form Health Survey (SF-36). Results: We included 68 patients in the study. A total of 54 (79.4%) patients reported at least one persistent symptom at three months vs. 52 (76.4%) at twelve months (p = 0.804). Some persistent symptoms (myalgia, alopecia, and cough) decreased significantly at twelve months (50% vs. 30.9%, 29.4% vs. 13.2%, and 23.5% vs. 7.4%; respectively, p = 0.007); in contrast, other persistent symptoms (sleep-wake and memory disorders) were more frequent (5.9% vs. 32.4% and 4.4% vs. 20.6%; respectively, p = ≤0.001). Regarding QoL, a statistically significant improvement was observed in some scores over time, p = ≤0.037. At twelve months, dyspnea, myalgia, and depression were risk factors associated with a poor physical component summary (PCS), p = ≤0.027, whereas anxiety, depression, and fatigue were associated with a poor mental component summary (MCS), p = ≤0.015. Conclusion: As the proportion of persistent symptoms at twelve months is high, we suggest that patients must continue under long-term follow up to reclassify, diagnose, and treat new onset symptoms/diseases.
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Affiliation(s)
- Lizeth Guadalupe Gutiérrez-Canales
- General Directorate of Quality and Health Education, Ministry of Health, Ciudad de Mexico 11410, Mexico;
- Department of Medicine, University of Guanajuato, León 37670, Guanajuato, Mexico; (C.M.-C.); (I.B.-C.); (C.V.-Á.); (A.E.M.); (J.A.A.)
| | - Carolina Muñoz-Corona
- Department of Medicine, University of Guanajuato, León 37670, Guanajuato, Mexico; (C.M.-C.); (I.B.-C.); (C.V.-Á.); (A.E.M.); (J.A.A.)
| | - Isaac Barrera-Chávez
- Department of Medicine, University of Guanajuato, León 37670, Guanajuato, Mexico; (C.M.-C.); (I.B.-C.); (C.V.-Á.); (A.E.M.); (J.A.A.)
| | - Carlos Viloria-Álvarez
- Department of Medicine, University of Guanajuato, León 37670, Guanajuato, Mexico; (C.M.-C.); (I.B.-C.); (C.V.-Á.); (A.E.M.); (J.A.A.)
| | - Alejandro E. Macías
- Department of Medicine, University of Guanajuato, León 37670, Guanajuato, Mexico; (C.M.-C.); (I.B.-C.); (C.V.-Á.); (A.E.M.); (J.A.A.)
| | - Liz Jovanna Martínez-Navarro
- Servicios de Salud del Instituto Mexicano del Seguro Social Para el Bienestar (IMSS-BIENESTAR), Hospital Regional de Alta Especialidad del Bajío, León 37544, Guanajuato, Mexico;
| | - Jose A. Alvarez
- Department of Medicine, University of Guanajuato, León 37670, Guanajuato, Mexico; (C.M.-C.); (I.B.-C.); (C.V.-Á.); (A.E.M.); (J.A.A.)
- Servicios de Salud del Instituto Mexicano del Seguro Social Para el Bienestar (IMSS-BIENESTAR), Hospital Regional de Alta Especialidad del Bajío, León 37544, Guanajuato, Mexico;
| | | | - Eduardo Guaní-Guerra
- Department of Medicine, University of Guanajuato, León 37670, Guanajuato, Mexico; (C.M.-C.); (I.B.-C.); (C.V.-Á.); (A.E.M.); (J.A.A.)
- Servicios de Salud del Instituto Mexicano del Seguro Social Para el Bienestar (IMSS-BIENESTAR), Hospital Regional de Alta Especialidad del Bajío, León 37544, Guanajuato, Mexico;
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28
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Antoncecchi V, Antoncecchi E, Orsini E, D'Ascenzo G, Oliviero U, Savino K, Aloisio A, Casalino L, Lillo A, Chiuini E, Santoro G, Manfrè V, Rizzo V, Zito GB. High prevalence of cardiac post-acute sequelae in patients recovered from Covid-19. Results from the ARCA post-COVID study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200267. [PMID: 38638196 PMCID: PMC11024661 DOI: 10.1016/j.ijcrp.2024.200267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
Background Many data were published about Long-Covid prevalence, very few about the findings of new cardiac alterations (NCA) in COVID-19-recovered people. ARCA-post-COVID is an observational study designed to investigate the prevalence of NCA in patients recovered from Covid-19.Methods: from June 2020 to December 2022, we enrolled 502 patients with a positive nasopharyngeal swab for SARS-CoV2 and a subsequent negative one. We performed anamnesis, lab-test, and routine cardiological tests (ECG, Holter, TTE). Results The median age was 56 years (IQR 44-67); women were 52.19%; in the acute phase 24.1% of patients were treated in a medical department, 7.2% in the ICU and the others at home. At the visit, 389 patients (77.49%) complained of a broad range of symptoms. We reported patients' characteristics according to the course of the disease and the persistence of symptoms. NCA were found in 138 patients (27.49%): among them 60 cases (11.95%) of pericardial effusion. Patients with NCA were older (median 60y, IQR: 47-72, vs median 56y, IQR 42-65), had a higher prevalence of smokers (27% vs 17%; p0.014), CAD (11% vs 6%; p0.048) and stroke/TIA (3.6% vs 0.3%; p0.002) and a lower prevalence of hypercholesterolemia (18% vs 30%; p0.007). The prevalence of NCA seems constant with different subtypes of the virus. Conclusion the prevalence of NCA in patients who recovered from COVID-19 is high and constant since the beginning of the pandemic; it is predictable based on hospitalization and long-lasting symptoms (9.64%-42.52%). Patients with one of these characteristics should undergo cardiological screening.
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Affiliation(s)
| | - Ettore Antoncecchi
- Servizio di Cardiologia Centro Polispecialistico Medigea, Modugno, (Bari), Italy
| | | | | | - Ugo Oliviero
- Past dirigente medico, AUO Federico II, Napoli, Italy
| | - Ketty Savino
- Cardiologia e Fisiopatologia Cardiovascolare, Università e Azienda Ospedaliera di Perugia, Italy
| | - Angelo Aloisio
- UDD Cardiologia/UTIC, Casa di Cura Villa Verde, Taranto, Italy
| | | | - Adele Lillo
- Cardiologia, Distretto Socio-Sanitario 10, Ospedale Fallacara, Triggiano, (BA), Italy
| | | | - Giosuè Santoro
- Associazioni Regionali Cardiologi Ambulatoriali (ARCA), Campania, Italy
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29
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Song X, Song W, Cui L, Duong TQ, Pandy R, Liu H, Zhou Q, Sun J, Liu Y, Li T. A Comprehensive Review of the Global Epidemiology, Clinical Management, Socio-Economic Impacts, and National Responses to Long COVID with Future Research Directions. Diagnostics (Basel) 2024; 14:1168. [PMID: 38893693 PMCID: PMC11171614 DOI: 10.3390/diagnostics14111168] [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: 04/24/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Long COVID, characterized by a persistent symptom spectrum following SARS-CoV-2 infection, poses significant health, social, and economic challenges. This review aims to consolidate knowledge on its epidemiology, clinical features, and underlying mechanisms to guide global responses; Methods: We conducted a literature review, analyzing peer-reviewed articles and reports to gather comprehensive data on long COVID's epidemiology, symptomatology, and management approaches; Results: Our analysis revealed a wide array of long COVID symptoms and risk factors, with notable demographic variability. The current understanding of its pathophysiology suggests a multifactorial origin yet remains partially understood. Emerging diagnostic criteria and potential therapeutic strategies were identified, highlighting advancements in long COVID management; Conclusions: This review highlights the multifaceted nature of long COVID, revealing a broad spectrum of symptoms, diverse risk factors, and the complex interplay of physiological mechanisms underpinning the condition. Long COVID symptoms and disorders will continue to weigh on healthcare systems in years to come. Addressing long COVID requires a holistic management strategy that integrates clinical care, social support, and policy initiatives. The findings underscore the need for increased international cooperation in research and health planning to address the complex challenges of long COVID. There is a call for continued refinement of diagnostic and treatment modalities, emphasizing a multidisciplinary approach to manage the ongoing and evolving impacts of the condition.
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Affiliation(s)
- Xiufang Song
- National Science Library, Chinese Academy of Sciences, Beijing 100190, China;
- Department of Information Resources Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Weiwei Song
- Jiangsu Taizhou People’s Hospital, Taizhou 225306, China;
- School of Integrative Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, China
| | - Lizhen Cui
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China;
| | - Tim Q. Duong
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA;
| | - Rajiv Pandy
- Indian Council of Forestry Research & Education, Dehradun 248006, India;
| | - Hongdou Liu
- Centre for Planetary Health and Food Security, School of Environment and Science, Griffith University, Nathan, Brisbane, QLD 4111, Australia;
| | - Qun Zhou
- Department of Library, China Agricultural University (East Campus), 17 Qinghua East Road, Haidian District, Beijing 100193, China; (Q.Z.); (J.S.)
| | - Jiayao Sun
- Department of Library, China Agricultural University (East Campus), 17 Qinghua East Road, Haidian District, Beijing 100193, China; (Q.Z.); (J.S.)
| | - Yanli Liu
- National Science Library, Chinese Academy of Sciences, Beijing 100190, China;
- Department of Information Resources Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Tong Li
- School of Agriculture and Food Sustainability, The University of Queensland, St. Lucia, Brisbane, QLD 4072, Australia
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Aghaei A, Qiao S, Chi Tam C, Yuan G, Li X. Role of self-esteem and personal mastery on the association between social support and resilience among COVID-19 long haulers. Heliyon 2024; 10:e31328. [PMID: 38818142 PMCID: PMC11137413 DOI: 10.1016/j.heliyon.2024.e31328] [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: 05/13/2023] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024] Open
Abstract
Although the COVID-19 mortality rate is declining, the number of individuals dealing with persistent COVID-19 symptoms is increasing worldwide, making long COVID a global public health concern. People with long COVID (long haulers) often deal with physical and mental stressors. Long haulers' psychological resilience could play a key role in coping with these stressors in intercorrelation with psychosocial resources. The current study aims to test a hypothesized relationship between social support and its functions (i.e., instrumental and emotional) and the resilience of long haulers through serial mediation by personal mastery and self-esteem. A cross-sectional and self-administered online survey was conducted among 460 individuals with long COVID recruited from COVID-19 Facebook support groups in the United States. Analyzing data indicated a positive correlation between social support and the resilience of long haulers. Structural equation modeling suggested that self-esteem and personal mastery fully mediated the association between social (instrumental) support and resilience. Personal mastery also mediated the association between self-esteem and resilience in social (instrumental) support models. However, in the emotional support model, the indirect effect was non-significant for the mediation by personal mastery and self-esteem. Findings suggest that social support, mainly instrumental support, may protect long haulers by promoting their resilience through self-esteem and personal mastery. This study emphasizes the importance of including social support services in designing programs for COVID-19 long haulers.
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Affiliation(s)
- Atefeh Aghaei
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center of Healthcare Quality, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center of Healthcare Quality, Columbia, SC, USA
| | - Cheuk Chi Tam
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center of Healthcare Quality, Columbia, SC, USA
| | - Guangzhe Yuan
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center of Healthcare Quality, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center of Healthcare Quality, Columbia, SC, USA
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31
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Evans RA. The Rationale, Evidence, and Adaptations to Pulmonary Rehabilitation for Chronic Respiratory Diseases Other Than COPD. Respir Care 2024; 69:697-712. [PMID: 38806225 PMCID: PMC11147632 DOI: 10.4187/respcare.12089] [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] [Indexed: 05/30/2024]
Abstract
Over the last 3 decades, pulmonary rehabilitation (PR) has become an integral part of the management of COPD. Many other chronic respiratory diseases have similar systemic manifestations including skeletal muscle impairment, commonly through deconditioning, and may benefit from PR. However, whereas many programs may accept patients with other respiratory diseases, the program may need several adaptations to optimally manage patients. This article uses the examples of interstitial lung disease including idiopathic pulmonary fibrosis, bronchiectasis, pulmonary hypertension, post lung transplantation, and post-COVID condition to highlight exemplar clinical problems. In addition, the rationale and latest evidence for PR are described alongside the adaptations to the program, including education needs of the delivery team and close integrated care with the wider clinical team. Finally, future directions for clinical care and research are discussed.
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Affiliation(s)
- Rachael A Evans
- National Institute for Health Research Biomedical Research Centre, Respiratory, Department of Respiratory Medicine, University of Leicester Glenfield Hospital, Leicester, United Kingdom.
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32
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Dehhaghi M, Heydari M, Panahi HKS, Lewin SR, Heng B, Brew BJ, Guillemin GJ. The roles of the kynurenine pathway in COVID-19 neuropathogenesis. Infection 2024:10.1007/s15010-024-02293-y. [PMID: 38802702 DOI: 10.1007/s15010-024-02293-y] [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: 03/07/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the highly contagious respiratory disease Corona Virus Disease 2019 (COVID-19) that may lead to various neurological and psychological disorders that can be acute, lasting days to weeks or months and possibly longer. The latter is known as long-COVID or more recently post-acute sequelae of COVID (PASC). During acute COVID-19 infection, a strong inflammatory response, known as the cytokine storm, occurs in some patients. The levels of interferon-γ (IFN-γ), interferon-β (IFN-β), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) are particularly increased. These cytokines are known to activate the enzyme indoleamine 2,3-dioxygenase 1 (IDO-1), catalysing the first step of tryptophan (Trp) catabolism through the kynurenine pathway (KP) leading to the production of several neurotoxic and immunosuppressive metabolites. There is already data showing elevation in KP metabolites both acutely and in PASC, especially regarding cognitive impairment. Thus, it is likely that KP involvement is significant in SARS-CoV-2 pathogenesis especially neurologically.
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Affiliation(s)
- Mona Dehhaghi
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mostafa Heydari
- Department of Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran
| | - Hamed Kazemi Shariat Panahi
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Benjamin Heng
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Bruce J Brew
- Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia.
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, NSW, Australia.
- Departments of Neurology and Immunology, St. Vincent's Hospital, Sydney, NSW, Australia.
- University of Notre Dame, Darlinghurst, Sydney, NSW, Australia.
| | - Gilles J Guillemin
- Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, Institut Pertanian Bogor University, Bogor, Indonesia
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Lawson CA, Moss AJ, Arnold JR, Bagot C, Banerjee A, Berry C, Greenwood J, Hughes AD, Khunti K, Mills NL, Neubauer S, Raman B, Sattar N, Leavy OC, Richardson M, Elneima O, McAuley HJ, Shikotra A, Singapuri A, Sereno M, Saunders R, Harris V, Houchen-Wolloff L, Greening NJ, Harrison E, Docherty AB, Lone NI, Quint JK, Chalmers J, Ho LP, Horsley A, Marks M, Poinasamy K, Evans R, Wain LV, Brightling C, McCann GP. Long COVID and cardiovascular disease: a prospective cohort study. Open Heart 2024; 11:e002662. [PMID: 38802280 PMCID: PMC11131117 DOI: 10.1136/openhrt-2024-002662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known. OBJECTIVES To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors. METHODS In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health. RESULTS From a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86). CONCLUSION Patients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need. TRAIL REGISTRATION NUMBER ISRCTN10980107.
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Affiliation(s)
| | - Alastair James Moss
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Catherine Bagot
- Department of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, Glasgow, UK
| | - Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - John Greenwood
- Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Olivia C Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Rachael Evans
- The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Louise V Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Chris Brightling
- The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
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Naik H, Wilton J, Tran KC, Janjua NZ, Levin A, Zhang W. Long-Term Health-Related Quality of Life in Working-Age COVID-19 Survivors: A Cross-Sectional Study. Am J Med 2024:S0002-9343(24)00338-3. [PMID: 38795939 DOI: 10.1016/j.amjmed.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Most working-age (18-64) adults have been infected with SARS-CoV-2, and some may have developed post-COVID-19 condition (PCC). However, long-term health-related quality of life (HRQOL) following infection remains uncharacterized. METHODS In this cross-sectional study, COVID-19 survivors from throughout British Columbia (BC), Canada, completed a questionnaire >2 years after infection. PCC status was self-reported, and HRQOL was assessed using the EuroQol 5-dimension 5-level (EQ-5D-5L) instrument. We compared HRQOL in those with current PCC, those with recovered PCC, and those without a history of PCC. Multivariable analyses were weighted to be representative of COVID-19 survivors in BC. RESULTS Of the 1,135 analyzed participants, 19.2% had current PCC, and 27.6% had recovered PCC. Compared to those without a history of PCC, participants with recovered PCC had a similar mean EQ-5D health utility (adjusted difference -0.02 [95%CI -0.03, 0.00]), but those with current PCC had a lower health utility (adjusted difference -0.08 [95%CI -0.12, -0.05]). Participants with current PCC were also more likely to report problems with mobility (adjusted odds ratio (aOR) 6.00 [95%CI 2.88-12.52]), self-care (aOR 5.96 [95%CI 1.84-19.32]), usual activities (aOR 8.00 [95%CI 4.27-14.99]), pain/discomfort (aOR 4.28 [95%CI 2.46-7.48]), and anxiety/depression (aOR 3.45 [95%CI 1.90-6.27]). CONCLUSIONS In working-age adults who have survived >2 years following COVID-19, HRQOL is high among those who never had PCC or have recovered from PCC. However, individuals with ongoing symptoms have lower HRQOL and are more likely to have functional deficits. These findings underscore the importance of implementing targeted healthcare interventions to improve HRQOL in adults with long-term PCC.
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Affiliation(s)
- Hiten Naik
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - James Wilton
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Karen C Tran
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Naveed Zafar Janjua
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adeera Levin
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Wei Zhang
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
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35
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Coskun AK, Aydin A, Tosun S, To U, Rubman S, Schilsky ML, Zimbrean PC. Wilson Disease and the COVID-19 pandemic: exploring patients' mental health and vaccination attitudes in a longitudinal study. Front Psychol 2024; 15:1326802. [PMID: 38803830 PMCID: PMC11129684 DOI: 10.3389/fpsyg.2024.1326802] [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: 10/23/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The COVID-19 pandemic significantly impacted the mental health of individuals with chronic conditions such as Wilson's Disease (WD). This study investigates stress, anxiety, depression, quality of life, cognitive function, vaccination rates, infection rates, and perceptions related to the pandemic and vaccines among WD patients. Methods The study analyzed COVID-19 perceptions and vaccine attitudes of 62 adult WD patients enrolled in the international multisite WD Registry. A subgroup of 33 participants completed a series of mental health scales. The effect of working essentially, income loss, wellness activity initiation, and infection of COVID-19 during the pandemic was observed. Results Results indicate that, overall, the pandemic did not exacerbate anxiety or cognitive function in WD patients but did lead to increased depression among essential workers. Patients experiencing income loss exhibited higher levels of stress and anxiety. Despite these challenges, WD patients showed high vaccination rates and positive attitudes towards vaccines. Discussion The findings underscore the significant impact of the pandemic on the mental health of WD patients.
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Affiliation(s)
- Ayse K. Coskun
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Adem Aydin
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Sumeyra Tosun
- Medgar Evers College, CUNY, Brooklyn, NY, United States
| | - Uyen To
- Medicine and Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Susan Rubman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Michael L. Schilsky
- Medicine and Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Paula C. Zimbrean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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36
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Volpe MS, dos Santos ACC, Gaspar S, de Melo JL, Harada G, Ferreira PRA, da Silva KRS, Souza NTS, Toufen C, Chiavegato LD, Amato MBP, Feltrim MIZ, de Carvalho CRR. A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19. CRITICAL CARE SCIENCE 2024; 36:e20240284en. [PMID: 38716961 PMCID: PMC11098067 DOI: 10.62675/2965-2774.20240284-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/22/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To examine the physical function and respiratory muscle strength of patients - who recovered from critical COVID-19 - after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment. METHODS This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group). RESULTS Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 - 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength. CONCLUSION Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.
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Affiliation(s)
- Marcia Souza Volpe
- Universidade Federal de São PauloDepartment of Human Movement SciencesSantosSPBrazilDepartment of Human Movement Sciences, Universidade Federal de São Paulo - Santos (SP), Brazil.
| | - Ana Carolina Cardoso dos Santos
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Sílvia Gaspar
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Jade Lara de Melo
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Gabriela Harada
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Patrícia Rocha Alves Ferreira
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Karina Ramiceli Soares da Silva
- Universidade Federal de São PauloDepartment of Human Movement SciencesSantosSPBrazilDepartment of Human Movement Sciences, Universidade Federal de São Paulo - Santos (SP), Brazil.
| | - Natália Tiemi Simokomaki Souza
- Universidade Federal de São PauloDiscipline of PneumologySão PauloSPBrazilDiscipline of Pneumology, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
| | - Carlos Toufen
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Luciana Dias Chiavegato
- Universidade Federal de São PauloDiscipline of PneumologySão PauloSPBrazilDiscipline of Pneumology, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
| | - Marcelo Britto Passos Amato
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Maria Ignez Zanetti Feltrim
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Carlos Roberto Ribeiro de Carvalho
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
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Gonsard A, Mekov E, Barron S, Castellana G, Khurtsidze E, Vontetsianos A, Pennati F, Sivapalan P, Latimer LE, Marillier M, Hui CY, Kaltsakas G, Kolekar S, Vagheggini G, Vicente C, Drummond D, Poberezhets V, Bayat S, Franssen FM, Vogiatzis I, Gille T. ERS International Congress 2023: highlights from the Respiratory Clinical Care and Physiology Assembly. ERJ Open Res 2024; 10:00178-2024. [PMID: 38770003 PMCID: PMC11103686 DOI: 10.1183/23120541.00178-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 05/22/2024] Open
Abstract
It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, clinical trials and qualitative research that were presented during the 2023 European Respiratory Society International Congress within the sessions from the five groups of Assembly 1 (Respiratory Clinical Care and Physiology). Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, electronic/mobile health (e-health/m-health), clinical respiratory physiology, exercise and functional imaging.
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Affiliation(s)
- Apolline Gonsard
- Department of Paediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP and Université Paris Cité, Paris, France
- These authors have contributed equally to this work and share first authorship
| | - Evgeni Mekov
- Department of Pulmonary Diseases, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
- These authors have contributed equally to this work and share first authorship
| | - Sarah Barron
- Tallaght University Hospital, Dublin, Ireland
- These authors have contributed equally to this work and share first authorship
| | - Giorgio Castellana
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
- These authors have contributed equally to this work and share first authorship
| | - Elene Khurtsidze
- Alte University, Tbilisi, Georgia
- Clinical Department, Geo Hospitals, Tbilisi, Georgia
- These authors have contributed equally to this work and share first authorship
| | - Angelos Vontetsianos
- 1st Respiratory Medicine Department, “Sotiria” Hospital for Diseases of the Chest, National and Kapodistrian University of Athens Medical School, Athens, Greece
- These authors have contributed equally to this work and share first authorship
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
- These authors have contributed equally to this work and share first authorship
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- University of Copenhagen, Faculty of Health Sciences, Department of Clinical Medicine, Copenhagen, Denmark
- These authors have contributed equally to this work and share first authorship
| | - Lorna E. Latimer
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, National Institute for Health Research Leicester Biomedical Research Centre – Respiratory, Glenfield Hospital, Leicester, UK
- These authors have contributed equally to this work and share first authorship
| | - Mathieu Marillier
- Université Grenoble Alpes, Inserm, Laboratoire HP2, Grenoble, France
- Laboratory of Clinical Exercise Physiology, Queen's University, Kingston, ON, Canada
- These authors have contributed equally to this work and share first authorship
| | - Chi-Yan Hui
- The University of Edinburgh, Allergy and Respiratory Research Group, Usher Institute, Edinburgh, UK
- These authors have contributed equally to this work and share first authorship
| | - Georgios Kaltsakas
- 1st Respiratory Medicine Department, “Sotiria” Hospital for Diseases of the Chest, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Lane Fox Respiratory Service, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Centre of Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shailesh Kolekar
- University of Copenhagen, Faculty of Health Sciences, Department of Clinical Medicine, Copenhagen, Denmark
- Zealand University Hospital Roskilde, Department of Internal Medicine, Roskilde, Denmark
| | - Guido Vagheggini
- Azienda USL Toscana Nord Ovest, Department of Medical Specialties, Chronic Respiratory Failure Care Pathway, Volterra, Italy
- Fondazione Volterra Ricerche Onlus, Volterra, Italy
| | | | - David Drummond
- Department of Paediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP and Université Paris Cité, Paris, France
- Inserm UMR 1138, HeKA team, Centre de Recherche des Cordeliers, Paris, France
| | - Vitalii Poberezhets
- Department of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Sam Bayat
- CHU Grenoble Alpes, Service de Pneumologie et de Physiologie, Grenoble, France
- Université Grenoble Alpes, Inserm UA07 STROBE, Grenoble, France
| | - Frits M.E. Franssen
- Maastricht Universitair Medisch Centrum+, Department of Respiratory Medicine, Maastricht, The Netherlands
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Thomas Gille
- Physiologie et Explorations Fonctionnelles, DMU NARVAL, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Bobigny, France
- Inserm UMR 1272 “Hypoxia & the Lung”, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
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Wodecka L, Koulouglioti C, Gonçalves AC, Hill A, Hodgson L. Exploring the recovery journey of COVID-19 critical care survivors during the first year after hospital discharge. J Intensive Care Soc 2024; 25:181-189. [PMID: 38737315 PMCID: PMC11086722 DOI: 10.1177/17511437241227738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Objectives To explore the longitudinal recovery of patients admitted to critical care following COVID-19 over the year following hospital discharge. To understand the important aspects of the patients' recovery process and key elements of their caregivers' experiences during this time. Design A longitudinal qualitative study using semi-structured interviews. Setting Two acute hospitals in South East England and follow-up in the community. Participants Six COVID-19 critical care survivors from the first wave of the pandemic (March-May 2020) and five relatives were interviewed 3 months after hospital discharge. The same six survivors and one relative were interviewed again at 1 year. Interviews were transcribed verbatim, anonymised and a reflexive thematic analysis was conducted. Results Three themes were developed: (1) 'The cycle of guilt, fear and stigma'; (2) 'Facing the uncertainties of recovery' and (3) 'Coping with lingering symptoms - the new norm'. The first theme highlights survivors' reluctance to share their experiences associated with contracting the disease. The second theme, explores challenges faced by the survivors and their relatives in navigating the recovery process, given the unknown nature of the illness. The final theme illustrates the mechanisms survivors develop to come to terms with the remnants of their illness and critical care stay. Conclusions The longitudinal nature of the study highlighted the persisting symptoms of long COVID-19, their impact on survivors and coping methods amidst the ongoing pandemic. Further research into the experiences of those affected in the first and subsequent waves of the COVID-19 pandemic, is desirable to help guide the formulation of the optimally supported recovery pathways.
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Affiliation(s)
- Lena Wodecka
- Brighton and Sussex Medical School, Brighton and Hove, UK
| | - Christina Koulouglioti
- Research and Innovation Department, University Hospitals Sussex NHS Foundation Trust, UK
| | - Ana-Carolina Gonçalves
- Physiotherapy Department, University Hospitals Sussex NHS Foundation Trust, UK
- School of Sport, Health and Exercise Science, University of Portsmouth, UK
| | - Adele Hill
- Physiotherapy Department, University Hospitals Sussex NHS Foundation Trust, UK
| | - Luke Hodgson
- Intensive care and respiratory consultant, University Hospitals Sussex NHS Foundation Trust, Honorary Clinical Reader, BSMS, UK
- Honorary Clinical Reader, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton and Hove, UK
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Carlile O, Briggs A, Henderson AD, Butler-Cole BF, Tazare J, Tomlinson LA, Marks M, Jit M, Lin LY, Bates C, Parry J, Bacon SC, Dillingham I, Dennison WA, Costello RE, Walker AJ, Hulme W, Goldacre B, Mehrkar A, MacKenna B, Herrett E, Eggo RM. Impact of long COVID on health-related quality-of-life: an OpenSAFELY population cohort study using patient-reported outcome measures (OpenPROMPT). THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100908. [PMID: 38689605 PMCID: PMC11059448 DOI: 10.1016/j.lanepe.2024.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
Background Long COVID is a major problem affecting patient health, the health service, and the workforce. To optimise the design of future interventions against COVID-19, and to better plan and allocate health resources, it is critical to quantify the health and economic burden of this novel condition. We aimed to evaluate and estimate the differences in health impacts of long COVID across sociodemographic categories and quantify this in Quality-Adjusted Life-Years (QALYs), widely used measures across health systems. Methods With the approval of NHS England, we utilised OpenPROMPT, a UK cohort study measuring the impact of long COVID on health-related quality-of-life (HRQoL). OpenPROMPT invited responses to Patient Reported Outcome Measures (PROMs) using a smartphone application and recruited between November 2022 and October 2023. We used the validated EuroQol EQ-5D questionnaire with the UK Value Set to develop disutility scores (1-utility) for respondents with and without Long COVID using linear mixed models, and we calculated subsequent Quality-Adjusted Life-Months (QALMs) for long COVID. Findings The total OpenPROMPT cohort consisted of 7575 individuals who consented to data collection, with which we used data from 6070 participants who completed a baseline research questionnaire where 24.6% self-reported long COVID. In multivariable regressions, long COVID had a consistent impact on HRQoL, showing a higher likelihood or odds of reporting loss in quality-of-life (Odds Ratio (OR): 4.7, 95% CI: 3.72-5.93) compared with people who did not report long COVID. Reporting a disability was the largest predictor of losses of HRQoL (OR: 17.7, 95% CI: 10.37-30.33) across survey responses. Self-reported long COVID was associated with an 0.37 QALM loss. Interpretation We found substantial impacts on quality-of-life due to long COVID, representing a major burden on patients and the health service. We highlight the need for continued support and research for long COVID, as HRQoL scores compared unfavourably to patients with conditions such as multiple sclerosis, heart failure, and renal disease. Funding This research was supported by the National Institute for Health and Care Research (NIHR) (OpenPROMPT: COV-LT2-0073).
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Affiliation(s)
- Oliver Carlile
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Ben F.C. Butler-Cole
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laurie A. Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospital, London, WC1E 6JD, UK
- Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Liang-Yu Lin
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Chris Bates
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - John Parry
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Sebastian C.J. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Iain Dillingham
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | | | - Ruth E. Costello
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Alex J. Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - William Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Emily Herrett
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Rosalind M. Eggo
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Frallonardo L, Ritacco AI, Amendolara A, Cassano D, Manco Cesari G, Lugli A, Cormio M, De Filippis M, Romita G, Guido G, Piccolomo L, Giliberti V, Cavallin F, Segala FV, Di Gennaro F, Saracino A. Long-Term Impairment of Working Ability in Subjects under 60 Years of Age Hospitalised for COVID-19 at 2 Years of Follow-Up: A Cross-Sectional Study. Viruses 2024; 16:688. [PMID: 38793570 PMCID: PMC11125725 DOI: 10.3390/v16050688] [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: 03/22/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) can lead to persistent and debilitating symptoms referred to as Post-Acute sequelae of SARS-CoV-2 infection (PASC) This broad symptomatology lasts for months after the acute infection and impacts physical and mental health and everyday functioning. In the present study, we aimed to evaluate the prevalence and predictors of long-term impairment of working ability in non-elderly people hospitalised for COVID-19. Methods: This cross-sectional study involved 322 subjects hospitalised for COVID-19 from 1 March 2020 to 31 December 2022 in the University Hospital of Bari, Apulia, Italy, enrolled at the time of their hospital discharge and followed-up at a median of 731 days since hospitalization (IQR 466-884). Subjects reporting comparable working ability and those reporting impaired working ability were compared using the Mann-Whitney test (continuous data) and Fisher's test or Chi-Square test (categorical data). Multivariable analysis of impaired working ability was performed using a logistic regression model. Results: Among the 322 subjects who were interviewed, 184 reported comparable working ability (57.1%) and 134 reported impaired working ability (41.6%) compared to the pre-COVID-19 period. Multivariable analysis identified age at hospital admission (OR 1.02, 95% CI 0.99 to 1.04), female sex (OR 1.90, 95% CI 1.18 to 3.08), diabetes (OR 3.73, 95% CI 1.57 to 9.65), receiving oxygen during hospital stay (OR 1.76, 95% CI 1.01 to 3.06), and severe disease (OR 0.51, 95% CI 0.26 to 1.01) as independent predictors of long-term impaired working ability after being hospitalised for COVID-19. Conclusions: Our findings suggest that PASC promotes conditions that could result in decreased working ability and unemployment. These results highlight the significant impact of this syndrome on public health and the global economy, and the need to develop clinical pathways and guidelines for long-term care with specific focus on working impairment.
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Affiliation(s)
- Luisa Frallonardo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Annunziata Ilenia Ritacco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Angela Amendolara
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Domenica Cassano
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Giorgia Manco Cesari
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Alessia Lugli
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Mariangela Cormio
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Michele De Filippis
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Greta Romita
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Giacomo Guido
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Luigi Piccolomo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Vincenzo Giliberti
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | | | - Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari “Aldo Moro”, Piazza Giulio Cesare n. 11 Cap, 70124 Bari, Italy; (A.I.R.); (A.A.); (D.C.); (G.M.C.); (A.L.); (M.C.); (M.D.F.); (G.R.); (G.G.); (L.P.); (V.G.); (F.V.S.); (F.D.G.); (A.S.)
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Patton MJ, Benson D, Robison SW, Raval D, Locy ML, Patel K, Grumley S, Levitan EB, Morris P, Might M, Gaggar A, Erdmann N. Characteristics and determinants of pulmonary long COVID. JCI Insight 2024; 9:e177518. [PMID: 38652535 PMCID: PMC11141907 DOI: 10.1172/jci.insight.177518] [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: 11/15/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUNDPersistent cough and dyspnea are prominent features of postacute sequelae of SARS-CoV-2 (also termed "long COVID"); however, physiologic measures and clinical features associated with these pulmonary symptoms remain poorly defined. Using longitudinal pulmonary function testing (PFT) and CT imaging, this study aimed to identify the characteristics and determinants of pulmonary long COVID.METHODSThis single-center retrospective study included 1,097 patients with clinically defined long COVID characterized by persistent pulmonary symptoms (dyspnea, cough, and chest discomfort) lasting for 1 or more months after resolution of primary COVID infection.RESULTSAfter exclusion, a total of 929 patients with post-COVID pulmonary symptoms and PFTs were stratified as diffusion impairment and pulmonary restriction, as measured by percentage predicted diffusion capacity for carbon monoxide (DLCO) and total lung capacity (TLC). Longitudinal evaluation revealed diffusion impairment (DLCO ≤ 80%) and pulmonary restriction (TLC ≤ 80%) in 51% of the cohort overall (n = 479). In multivariable modeling regression analysis, invasive mechanical ventilation during primary infection conferred the greatest increased odds of developing pulmonary long COVID with diffusion impairment and restriction (adjusted odds ratio [aOR] = 9.89, 95% CI 3.62-26.9]). Finally, a subanalysis of CT imaging identified radiographic evidence of fibrosis in this patient population.CONCLUSIONLongitudinal PFTs revealed persistent diffusion-impaired restriction as a key feature of pulmonary long COVID. These results emphasize the importance of incorporating PFTs into routine clinical practice for evaluation of long COVID patients with prolonged pulmonary symptoms. Subsequent clinical trials should leverage combined symptomatic and quantitative PFT measurements for more targeted enrollment of pulmonary long COVID patients.FUNDINGNational Institute of Allergy and Infectious Diseases (AI156898, K08AI129705), National Heart, Lung, and Blood Institute (HL153113, OTA21-015E, HL149944), and the COVID-19 Urgent Research Response Fund at the University of Alabama at Birmingham.
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Affiliation(s)
- Michael John Patton
- Medical Scientist Training Program, Heersink School of Medicine
- Hugh Kaul Precision Medicine Institute
| | | | - Sarah W. Robison
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Dhaval Raval
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Morgan L. Locy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Kinner Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | | | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | | | - Amit Gaggar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
- Birmingham VA Medical Center, Pulmonary Section, Birmingham, Alabama, USA
| | - Nathaniel Erdmann
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kooner HK, Sharma M, McIntosh MJ, Dhaliwal I, Nicholson JM, Kirby M, Svenningsen S, Parraga G. 129Xe MRI Ventilation Textures and Longitudinal Quality-of-Life Improvements in Long-COVID. Acad Radiol 2024:S1076-6332(24)00156-9. [PMID: 38637239 DOI: 10.1016/j.acra.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
RATIONALE AND OBJECTIVES It remains difficult to predict longitudinal outcomes in long-COVID, even with chest CT and functional MRI. 129Xe MRI reflects airway dysfunction, measured using ventilation defect percent (VDP) and in long-COVID patients, MRI VDP was abnormal, suggestive of airways disease. While MRI VDP and quality-of-life improved 15-month post-COVID infection, both remained abnormal. To better understand the relationship of airways disease and quality-of-life improvements in patients with long-COVID, we extracted 129Xe ventilation MRI textures and generated machine-learning models in an effort to predict improved quality-of-life, 15-month post-infection. MATERIALS AND METHODS Long-COVID patients provided written-informed consent to 3-month and 15-month post-infection visits. Pyradiomics was used to extract 129Xe ventilation MRI texture features, which were ranked using a Random-Forest classifier. Top-ranking features were used in classification models to dichotomize patients based on St. George's Respiratory Questionnaire (SGRQ) score improvement greater than the minimal-clinically-important-difference (MCID). Classification performance was evaluated using the area under the receiver-operator-characteristic-curve (AUC), sensitivity, and specificity. RESULTS 120 texture features were extracted from 129Xe ventilation MRI in 44 long-COVID participants (54 ± 14 years), including 30 (52 ± 12 years) with ΔSGRQ≥MCID and 14 (58 ± 18 years) with ΔSGRQ CONCLUSION A machine learning model exclusively trained on 129Xe MRI ventilation textures explained improved SGRQ-scores 12 months later, and outperformed clinical models. Their unique spatial-intensity information helps build our understanding about long-COVID airway dysfunction.
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Affiliation(s)
- Harkiran K Kooner
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Maksym Sharma
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, Western University, London, Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, Western University, London, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
| | - Sarah Svenningsen
- Division of Respirology, Department of Medicine, McMaster University and Firestone Institute for Respiratory Health, St. Joseph's Health Care, Hamilton, Canada
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Division of Respirology, Department of Medicine, Western University, London, Canada.
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Bonfim LPF, Correa TR, Freire BCC, Pedroso TM, Pereira DN, Fernandes TB, Kopittke L, de Oliveira CRA, Teixeira AL, Marcolino MS. Post-COVID-19 cognitive symptoms in patients assisted by a teleassistance service: a retrospective cohort study. Front Public Health 2024; 12:1282067. [PMID: 38689777 PMCID: PMC11060150 DOI: 10.3389/fpubh.2024.1282067] [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: 08/25/2023] [Accepted: 03/04/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Four years after the onset of the COVID-19 pandemic, the frequency of long-term post-COVID-19 cognitive symptoms is a matter of concern given the impact it may have on the work and quality of life of affected people. Objective To evaluate the incidence of post-acute COVID-19 cognitive symptoms, as well as the associated risk factors. Methods Retrospective cohort, including outpatients with laboratory-confirmed COVID-19 and who were assisted by a public telehealth service provided by the Telehealth Network of Minas Gerais (TNMG), during the acute phase of the disease, between December/2020 and March/2022. Data were collected through a structured questionnaire, applied via phone calls, regarding the persistence of COVID-19 symptoms after 12 weeks of the disease. Cognitive symptoms were defined as any of the following: memory loss, problems concentrating, word finding difficulties, and difficulty thinking clearly. Results From 630 patients who responded to the questionnaire, 23.7% presented cognitive symptoms at 12 weeks after infection. These patients had a higher median age (33 [IQR 25-46] vs. 30 [IQR 24-42] years-old, p = 0.042) with a higher prevalence in the female sex (80.5% vs. 62.2%, p < 0.001) when compared to those who did not present cognitive symptoms, as well as a lower prevalence of smoking (8.7% vs. 16.2%, p = 0.024). Furthermore, patients with persistent cognitive symptoms were more likely to have been infected during the second wave of COVID-19 rather than the third (31.0% vs. 21.3%, p = 0.014). Patients who needed to seek in-person care during the acute phase of the disease were more likely to report post-acute cognitive symptoms (21.5% vs. 9.3%, p < 0,001). In multivariate logistic regression analysis, cognitive symptoms were associated with female sex (OR 2.24, CI 95% 1.41-3.57), fatigue (OR 2.33, CI 95% 1.19-4.56), depression (OR 5.37, CI 95% 2.19-13.15) and the need for seek in-person care during acute COVID-19 (OR 2.23, CI 95% 1.30-3.81). Conclusion In this retrospective cohort of patients with mostly mild COVID-19, cognitive symptoms were present in 23.7% of patients with COVID-19 at 12 weeks after infection. Female sex, fatigue, depression and the need to seek in-person care during acute COVID-19 were the risk factors independently associated with this condition.
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Affiliation(s)
- Lívia Paula Freire Bonfim
- Tropical Medicine and Infectious Disease Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thais Rotsen Correa
- Statistics Department, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruno Cabaleiro Cortizo Freire
- Tropical Medicine and Infectious Disease Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thais Marques Pedroso
- Tropical Medicine and Infectious Disease Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniella Nunes Pereira
- Tropical Medicine and Infectious Disease Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Luciane Kopittke
- Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Clara Rodrigues Alves de Oliveira
- Tropical Medicine and Infectious Disease Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Antonio Lucio Teixeira
- Tropical Medicine and Infectious Disease Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, UT Health Houston, Houston, TX, United States
| | - Milena Soriano Marcolino
- Tropical Medicine and Infectious Disease Program, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- National Institute for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil
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McGroder CF, Salvatore MM, D'Souza BM, Hoffman EA, Baldwin MR, Garcia CK. Improved pulmonary function and exercise tolerance despite persistent pulmonary fibrosis over 1 year after severe COVID-19 infection. Thorax 2024; 79:472-475. [PMID: 38514184 PMCID: PMC11044919 DOI: 10.1136/thorax-2023-220370] [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] [Indexed: 03/23/2024]
Abstract
We conducted a prospective single-centre cohort study of 104 multi-ethnic severe COVID-19 survivors from the first wave of the pandemic 15 months after hospitalisation. Of those who were assessed at 4 and 15 months, improvement of ground glass opacities correlated with worsened fibrotic reticulations. Despite a high prevalence of fibrotic patterns (64%), pulmonary function, grip strength, 6 min walk distance and frailty normalised. Overall, dyspnoea, cough and exhaustion did not improve and were not correlated with pulmonary function or radiographic fibrosis at 15 months, suggesting non-respiratory aetiologies. Monitoring persistent, and often subclinical, fibrotic interstitial abnormalities will be needed to determine their potential for future progression.
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Affiliation(s)
- Claire F McGroder
- Medicine/Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Mary M Salvatore
- Radiology, Columbia University Medical Center, New York, New York, USA
| | - Belinda M D'Souza
- Radiology, Columbia University Medical Center, New York, New York, USA
| | - Eric A Hoffman
- Radiology/Medicine/Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Matthew R Baldwin
- Medicine/Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Christine Kim Garcia
- Medicine/Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Precision Medicine Initiative and the Center for Precision Medicine and Genomics, Columbia University, New York, NY, USA
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45
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Greenhalgh T, Darbyshire JL, Lee C, Ladds E, Ceolta-Smith J. What is quality in long covid care? Lessons from a national quality improvement collaborative and multi-site ethnography. BMC Med 2024; 22:159. [PMID: 38616276 PMCID: PMC11017565 DOI: 10.1186/s12916-024-03371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality standards to reduce a so-called "postcode lottery" of care. The original aim of this study-to examine the nature of quality in long covid care and reduce unwarranted variation in services-evolved to focus on examining the reasons why standardizing care was so challenging in this condition. METHODS In 2021-2023, we ran a quality improvement collaborative across 10 UK sites. The dataset reported here was mostly but not entirely qualitative. It included data on the origins and current context of each clinic, interviews with staff and patients, and ethnographic observations at 13 clinics (50 consultations) and 45 multidisciplinary team (MDT) meetings (244 patient cases). Data collection and analysis were informed by relevant lenses from clinical care (e.g. evidence-based guidelines), improvement science (e.g. quality improvement cycles) and philosophy of knowledge. RESULTS Participating clinics made progress towards standardizing assessment and management in some topics; some variation remained but this could usually be explained. Clinics had different histories and path dependencies, occupied a different place in their healthcare ecosystem and served a varied caseload including a high proportion of patients with comorbidities. A key mechanism for achieving high-quality long covid care was when local MDTs deliberated on unusual, complex or challenging cases for which evidence-based guidelines provided no easy answers. In such cases, collective learning occurred through idiographic (case-based) reasoning, in which practitioners build lessons from the particular to the general. This contrasts with the nomothetic reasoning implicit in evidence-based guidelines, in which reasoning is assumed to go from the general (e.g. findings of clinical trials) to the particular (management of individual patients). CONCLUSION Not all variation in long covid services is unwarranted. Largely because long covid's manifestations are so varied and comorbidities common, generic "evidence-based" standards require much individual adaptation. In this complex condition, quality improvement resources may be productively spent supporting MDTs to optimise their case-based learning through interdisciplinary discussion. Quality assessment of a long covid service should include review of a sample of individual cases to assess how guidelines have been interpreted and personalized to meet patients' unique needs. STUDY REGISTRATION NCT05057260, ISRCTN15022307.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.
| | - Julie L Darbyshire
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Cassie Lee
- Imperial College Healthcare NHS Trust, London, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Jenny Ceolta-Smith
- LOCOMOTION Patient Advisory Group and Lived Experience Representative, London, UK
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46
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Diar Bakerly N, Smith N, Darbyshire JL, Kwon J, Bullock E, Baley S, Sivan M, Delaney B. Pathophysiological Mechanisms in Long COVID: A Mixed Method Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:473. [PMID: 38673384 PMCID: PMC11050596 DOI: 10.3390/ijerph21040473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Long COVID (LC) is a global public health crisis affecting more than 70 million people. There is emerging evidence of different pathophysiological mechanisms driving the wide array of symptoms in LC. Understanding the relationships between mechanisms and symptoms helps in guiding clinical management and identifying potential treatment targets. METHODS This was a mixed-methods systematic review with two stages: Stage one (Review 1) included only existing systematic reviews (meta-review) and Stage two (Review 2) was a review of all primary studies. The search strategy involved Medline, Embase, Emcare, and CINAHL databases to identify studies that described symptoms and pathophysiological mechanisms with statistical analysis and/or discussion of plausible causal relationships between mechanisms and symptoms. Only studies that included a control arm for comparison were included. Studies were assessed for quality using the National Heart, Lung, and Blood Institute quality assessment tools. RESULTS 19 systematic reviews were included in Review 1 and 46 primary studies in Review 2. Overall, the quality of reporting across the studies included in this second review was moderate to poor. The pathophysiological mechanisms with strong evidence were immune system dysregulation, cerebral hypoperfusion, and impaired gas transfer in the lungs. Other mechanisms with moderate to weak evidence were endothelial damage and hypercoagulation, mast cell activation, and auto-immunity to vascular receptors. CONCLUSIONS LC is a complex condition affecting multiple organs with diverse clinical presentations (or traits) underpinned by multiple pathophysiological mechanisms. A 'treatable trait' approach may help identify certain groups and target specific interventions. Future research must include understanding the response to intervention based on these mechanism-based traits.
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Affiliation(s)
- Nawar Diar Bakerly
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK
- Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK;
| | - Nikki Smith
- Locomotion Study Patient Advisory Group, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Level D, Martin Wing, Leeds General Infirmary, Leeds LS1 3EX, UK;
| | - Julie L. Darbyshire
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (J.L.D.); (J.K.)
| | - Joseph Kwon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (J.L.D.); (J.K.)
| | - Emily Bullock
- Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK;
| | - Sareeta Baley
- Birmingham Community Healthcare NHS Trust, Birmingham B7 4BN, UK;
| | - Manoj Sivan
- Rehabilitation Medicine, University of Leeds, Leeds Teaching Hospitals and Leeds Community Healthcare NHS Trusts, Leeds LS11 0DL, UK;
| | - Brendan Delaney
- Medical Informatics and Decision Making, Imperial College, London SW7 2AZ, UK;
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Ercoli T, Loy F, Masala C, Solla P. Neurological and Psychiatric Disorders in the COVID-19 Era. Brain Sci 2024; 14:355. [PMID: 38672007 PMCID: PMC11048350 DOI: 10.3390/brainsci14040355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Over the 4 last years, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has determined the diffusion of the coronavirus disease 2019 (COVID-19) global outbreak [...].
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Affiliation(s)
- Tommaso Ercoli
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy;
| | - Francesco Loy
- Department of Biomedical Sciences, University of Cagliari, SP8 Cittadella Universitaria Monserrato, 09042 Cagliari, Italy; (F.L.); (C.M.)
| | - Carla Masala
- Department of Biomedical Sciences, University of Cagliari, SP8 Cittadella Universitaria Monserrato, 09042 Cagliari, Italy; (F.L.); (C.M.)
| | - Paolo Solla
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy;
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Devine K, Russell CD, Blanco GR, Walker BR, Homer NZM, Denham SG, Simpson JP, Leavy OC, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Greening NJ, Lone NI, Thorpe M, Greenhalf W, Chalmers JD, Ho LP, Horsley A, Marks M, Raman B, Moore SC, Dunning J, Semple MG, Andrew R, Wain LV, Evans RA, Brightling CE, Kenneth Baillie J, Reynolds RM. Plasma steroid concentrations reflect acute disease severity and normalise during recovery in people hospitalised with COVID-19. Clin Endocrinol (Oxf) 2024; 100:317-327. [PMID: 38229583 DOI: 10.1111/cen.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Endocrine systems are disrupted in acute illness, and symptoms reported following coronavirus disease 2019 (COVID-19) are similar to those found with clinical hormone deficiencies. We hypothesised that people with severe acute COVID-19 and with post-COVID symptoms have glucocorticoid and sex hormone deficiencies. DESIGN/PATIENTS Samples were obtained for analysis from two UK multicentre cohorts during hospitalisation with COVID-19 (International Severe Acute Respiratory Infection Consortium/World Health Organisation [WHO] Clinical Characterization Protocol for Severe Emerging Infections in the UK study), and at follow-up 5 months after hospitalisation (Post-hospitalisation COVID-19 study). MEASUREMENTS Plasma steroids were quantified by liquid chromatography-mass spectrometry. Steroid concentrations were compared against disease severity (WHO ordinal scale) and validated symptom scores. Data are presented as geometric mean (SD). RESULTS In the acute cohort (n = 239, 66.5% male), plasma cortisol concentration increased with disease severity (cortisol 753.3 [1.6] vs. 429.2 [1.7] nmol/L in fatal vs. least severe, p < .001). In males, testosterone concentrations decreased with severity (testosterone 1.2 [2.2] vs. 6.9 [1.9] nmol/L in fatal vs. least severe, p < .001). In the follow-up cohort (n = 198, 62.1% male, 68.9% ongoing symptoms, 165 [121-192] days postdischarge), plasma cortisol concentrations (275.6 [1.5] nmol/L) did not differ with in-hospital severity, perception of recovery, or patient-reported symptoms. Male testosterone concentrations (12.6 [1.5] nmol/L) were not related to in-hospital severity, perception of recovery or symptom scores. CONCLUSIONS Circulating glucocorticoids in patients hospitalised with COVID-19 reflect acute illness, with a marked rise in cortisol and fall in male testosterone. These findings are not observed 5 months from discharge. The lack of association between hormone concentrations and common post-COVID symptoms suggests steroid insufficiency does not play a causal role in this condition.
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Affiliation(s)
- Kerri Devine
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clark D Russell
- University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK
| | - Giovanny R Blanco
- Edinburgh Cancer Research UK Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Brian R Walker
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Natalie Z M Homer
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, UK
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Scott G Denham
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Joanna P Simpson
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Olivia C Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Omer Elneima
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish J C McAuley
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M Saunders
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Victoria C Harris
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Neil J Greening
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Nazir I Lone
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mathew Thorpe
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - James D Chalmers
- Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Shona C Moore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Jake Dunning
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Ruth Andrew
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, UK
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Louise V Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rachael A Evans
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - John Kenneth Baillie
- Division of Genetics and Genomics, Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- BHF/University Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh Bioquarter, University of Edinburgh, Edinburgh, UK
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Liew F, Efstathiou C, Fontanella S, Richardson M, Saunders R, Swieboda D, Sidhu JK, Ascough S, Moore SC, Mohamed N, Nunag J, King C, Leavy OC, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Harris VC, Houchen-Wolloff L, Greening NJ, Lone NI, Thorpe M, Thompson AAR, Rowland-Jones SL, Docherty AB, Chalmers JD, Ho LP, Horsley A, Raman B, Poinasamy K, Marks M, Kon OM, Howard LS, Wootton DG, Quint JK, de Silva TI, Ho A, Chiu C, Harrison EM, Greenhalf W, Baillie JK, Semple MG, Turtle L, Evans RA, Wain LV, Brightling C, Thwaites RS, Openshaw PJM. Large-scale phenotyping of patients with long COVID post-hospitalization reveals mechanistic subtypes of disease. Nat Immunol 2024; 25:607-621. [PMID: 38589621 PMCID: PMC11003868 DOI: 10.1038/s41590-024-01778-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
One in ten severe acute respiratory syndrome coronavirus 2 infections result in prolonged symptoms termed long coronavirus disease (COVID), yet disease phenotypes and mechanisms are poorly understood1. Here we profiled 368 plasma proteins in 657 participants ≥3 months following hospitalization. Of these, 426 had at least one long COVID symptom and 233 had fully recovered. Elevated markers of myeloid inflammation and complement activation were associated with long COVID. IL-1R2, MATN2 and COLEC12 were associated with cardiorespiratory symptoms, fatigue and anxiety/depression; MATN2, CSF3 and C1QA were elevated in gastrointestinal symptoms and C1QA was elevated in cognitive impairment. Additional markers of alterations in nerve tissue repair (SPON-1 and NFASC) were elevated in those with cognitive impairment and SCG3, suggestive of brain-gut axis disturbance, was elevated in gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2-specific immunoglobulin G (IgG) was persistently elevated in some individuals with long COVID, but virus was not detected in sputum. Analysis of inflammatory markers in nasal fluids showed no association with symptoms. Our study aimed to understand inflammatory processes that underlie long COVID and was not designed for biomarker discovery. Our findings suggest that specific inflammatory pathways related to tissue damage are implicated in subtypes of long COVID, which might be targeted in future therapeutic trials.
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Affiliation(s)
- Felicity Liew
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Sara Fontanella
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Richardson
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth Saunders
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Dawid Swieboda
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jasmin K Sidhu
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephanie Ascough
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Shona C Moore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Noura Mohamed
- The Imperial Clinical Respiratory Research Unit, Imperial College NHS Trust, London, UK
| | - Jose Nunag
- Cardiovascular Research Team, Imperial College Healthcare NHS Trust, London, UK
| | - Clara King
- Cardiovascular Research Team, Imperial College Healthcare NHS Trust, London, UK
| | - Olivia C Leavy
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Omer Elneima
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish J C McAuley
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Victoria C Harris
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK
| | - Neil J Greening
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Matthew Thorpe
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Sarah L Rowland-Jones
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Onn Min Kon
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Daniel G Wootton
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Thushan I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Antonia Ho
- MRC Centre for Virus Research, School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Christopher Chiu
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - William Greenhalf
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - J Kenneth Baillie
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- The Roslin Institute, University of Edinburgh, Edinburgh, UK
- Pandemic Science Hub, University of Edinburgh, Edinburgh, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- The Pandemic Institute, University of Liverpool, Liverpool, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- The Pandemic Institute, University of Liverpool, Liverpool, UK
| | - Rachael A Evans
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Louise V Wain
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Christopher Brightling
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK.
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Longobardi I, Prado DMLD, de Andrade DCO, Goessler KF, de Oliveira Júnior GN, de Almeida Azevedo R, Leitão AE, Santos JVP, Pinto ALDS, Gualano B, Roschel H. Cardiorespiratory abnormalities in ICU survivors of COVID-19 with postacute sequelae of SARS-CoV-2 infection are unrelated to invasive mechanical ventilation. Am J Physiol Heart Circ Physiol 2024; 326:H907-H915. [PMID: 38334972 DOI: 10.1152/ajpheart.00073.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/10/2024]
Abstract
Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group (P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV.NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.
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Affiliation(s)
- Igor Longobardi
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Danilo Marcelo Leite do Prado
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Karla Fabiana Goessler
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Gersiel Nascimento de Oliveira Júnior
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Rafael de Almeida Azevedo
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Alice Erwig Leitão
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Jhonnatan Vasconcelos Pereira Santos
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ana Lucia de Sá Pinto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
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