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Manca E, di Toma M, Esotico M, Soldano L, Polito AN, Mongelli G, Guglielmi L, Scaltrito F, Campanozzi A. Asymptomatic SARS-COV2 Infection or COVID-19 vaccination effect for severe multisystem inflammatory syndrome in a 6-year-old girl: case report and review of the literature. Ital J Pediatr 2024; 50:194. [PMID: 39334454 PMCID: PMC11438245 DOI: 10.1186/s13052-024-01758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication, which develops within 3-6 weeks after SARS-CoV2 infection. The coronavirus disease 2019 (COVID-19) vaccine was firstly introduced in adults and adolescents and later in patients aged 5-11 years old. Although a reduced incidence of MIS-C and with less severe symptoms has been reported in vaccinated adolescents, there is little knowledge in children younger than 12 years of age. In addition, it is not understood whether MIS-C in vaccinated patients can be triggered by Covid19 vaccination or be secondary to a recent asymptomatic Sars-Cov2 infection. CASE PRESENTATION We describe the case of a Caucasian 6-year-old girl, one month after double COVID-19 vaccination, who presented fever, acute abdominal pain, rash, pharyngotonsillitis, cheilitis, cervical lymphadenopathy without a prior detected Sars-Cov2 infection. She also had lymphopenia, increase in inflammatory markers, cardiac and pulmonary involvement. Therefore, we dosed both anti Sars-Cov2 Spike and Nucleocapsid antibodies, which were positive and allowed us to confirm the diagnosis of MIS-C. We promptly administered intravenous immunoglobulins and methylprednisone, resulting in the initial regression of fever. During the hospitalization, the child also developed pancreatitis and severe neurological involvement, including irritability, drowsiness, distal tremor, dyskinesia and buccal asymmetry with complete resolution after 2 months. After 3 months from the onset of the symptoms, she reported a transient loss of hair compatible with telogen effluvium. After 12 months of follow-up, she did not show any symptomatic sequelae. CONCLUSIONS This case raises the question of whether COVID-19 vaccination may be involved in the pathogenesis of MIS-C in children between the ages of 5 and 11 years old.
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Affiliation(s)
- Enrica Manca
- Pediatrics Department, University Hospital of Foggia, Foggia, Italy.
- IDESP, UA11-INSERM, University of Montpellier, Montpellier, France.
| | - Michele di Toma
- Pediatrics Department, University Hospital of Foggia, Foggia, Italy
| | | | - Lucia Soldano
- Pediatrics Department, University Hospital of Foggia, Foggia, Italy
| | - Anna Nunzia Polito
- Department of Woman and Child, Neuropsychiatry for Child and Adolescent Unit, University Hospital of Foggia, Foggia, Italy
| | | | | | | | - Angelo Campanozzi
- Pediatrics Department, University Hospital of Foggia, Foggia, Italy
- University of Foggia, Foggia, Italy
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Jimeno Ortega I, Stefanato CM. Telogen effluvium: a 360 degree review. Ital J Dermatol Venerol 2023; 158:457-466. [PMID: 38015483 DOI: 10.23736/s2784-8671.23.07579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Telogen effluvium (TE) is one of the most common presentations of diffuse non-cicatricial alopecia and is generally self-limited. Multiple causes are associated with TE onset and its maintenance, with stress being felt the most common factor. The multifactorial etiologies involved in TE makes it a complex disorder to diagnose and treat often placing this entity into a "waste basket" diagnosis. By critically assessing the available scientific literature we aimed to review the multifaceted aspects of TE. Our objectives were to review the pathogenesis with the role of stress (including Coronavirus 19-associated TE), as well as to describe the main clinical findings, its differential diagnosis and the current knowledge on TE treatments along with the future treatment's insights.
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Wadhwa D, Monga A, Kumar N, Khullar G, Karmakar S, Khunger N. A Cross-Sectional Study on Post-Coronavirus Disease (COVID-19) Hair Loss at a Tertiary Care Hospital. Dermatol Pract Concept 2023; 13:dpc.1304a263. [PMID: 37992388 PMCID: PMC10656157 DOI: 10.5826/dpc.1304a263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) was responsible for coronavirus disease (COVID-19) pandemic. As patients recovered from COVID-19 infection, hair loss was increasingly observed as a distressing symptom. METHODS This was a cross-sectional study of patients with post COVID-19 hair loss between July to December 2021 at a tertiary care center. Detailed history, clinical examination, trichoscopy and biochemical tests were performed and recorded. COVID-19 disease severity was assessed based on duration of COVID-19 infection and place of management. RESULTS The study included 120 patients with a mean age of 39.6 years. The majority of the patients were females treated at home and had COVID-19 infection for >2 weeks. The mean visual analog scale (VAS) score for stress was 5.25. Vitamin D deficiency was present in 56.7% and low ferritin in 30% of cases. The mean time of onset of hair loss post COVID-19 was 49 days. Patients mainly presented with diffuse hair loss. Trichodynia was present in 15.8% of cases. The degree of hair loss was severe in 55.8% of the subjects. Positive hair pull test was seen in 65% of patients. Most common trichoscopic features included single hair follicles (81.7%) and vellus hair >10% (60%). CONCLUSIONS The mean time of onset of hair loss post COVID-19 infection was less than 2 months. Majority patients had diffuse pattern and severe degree of hair loss. Trichoscopy can aid in unmasking co-existing patterned hair loss in patients presenting clinically with diffuse hair loss.
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Affiliation(s)
- Dhaarna Wadhwa
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi, India
| | - Avneet Monga
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi, India
| | - Neha Kumar
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi, India
| | - Geeti Khullar
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi, India
| | - Sanchita Karmakar
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi, India
| | - Niti Khunger
- Department of Dermatology and STD, Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi, India
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Sharma D, Joshi M, Apparsundaram S, Goyal RK, Patel B, Dhobi M. Solanum nigrum L. in COVID-19 and post-COVID complications: a propitious candidate. Mol Cell Biochem 2023; 478:2221-2240. [PMID: 36689040 PMCID: PMC9868520 DOI: 10.1007/s11010-022-04654-3] [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: 07/22/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023]
Abstract
COVID-19 is caused by severe acute respiratory syndrome coronavirus-2, SARS-CoV-2. COVID-19 has changed the world scenario and caused mortality around the globe. Patients who recovered from COVID-19 have shown neurological, psychological, renal, cardiovascular, pulmonary, and hematological complications. In some patients, complications lasted more than 6 months. However, significantly less attention has been given to post-COVID complications. Currently available drugs are used to tackle the complications, but new interventions must address the problem. Phytochemicals from natural sources have been evaluated in recent times to cure or alleviate COVID-19 symptoms. An edible plant, Solanum nigrum, could be therapeutic in treating COVID-19 as the AYUSH ministry of India prescribes it during the pandemic. S. nigrum demonstrates anti-inflammatory, immunomodulatory, and antiviral action to treat the SARS-CoV-2 infection and its post-complications. Different parts of the plant represent a reduction in proinflammatory cytokines and prevent multi-organ failure by protecting various organs (liver, kidney, heart, neuro, and lung). The review proposes the possible role of the plant S. nigrum in managing the symptoms of COVID-19 and its post-COVID complications based on in silico docking and pharmacological studies. Further systematic and experimental studies are required to validate our hypothesis.
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Affiliation(s)
- Divya Sharma
- Delhi Pharmaceutical Sciences and Research University, 110017, New Delhi, India
| | - Mit Joshi
- Institute of Pharmacy, Nirma University, 382481, Ahmedabad, Gujarat, India
| | - Subbu Apparsundaram
- Delhi Pharmaceutical Sciences and Research University, 110017, New Delhi, India
| | - Ramesh K Goyal
- Delhi Pharmaceutical Sciences and Research University, 110017, New Delhi, India
| | - Bhoomika Patel
- National Forensic Sciences University, Sector-9, Gandhinagar-382007, Gujarat, India.
| | - Mahaveer Dhobi
- Delhi Pharmaceutical Sciences and Research University, 110017, New Delhi, India.
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5
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Chávez-Chavira G. [Review of the post-COVID-19 syndrome associated to acute telogen effluvium]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:496-501. [PMID: 37540705 PMCID: PMC10521875 DOI: 10.5281/zenodo.8200471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/30/2023] [Indexed: 08/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has impacted our society in numerous ways. So far (November 2022) around 640 million SARS-CoV-2 infections have been confirmed worldwide. It is known that this disease has a main affection at the cardiopulmonary level, however, it affects almost all the organs and systems of the body, including the skin. Post-COVID-19 syndrome occurs in some patients, leaving significant sequelae that impact their quality of life. Among the most common sequelae are: cough, dyspnea, chronic fatigue, hyposmia and dysosmia. In addition to these, other sequelae not related to respiratory syndrome have been reported, such as hair loss, which has been observed in around 20% of post-COVID-19 patients, this could be attributable to acute telogen effluvium (TE). To date, no study has been conducted to determine the relationship of ET in those who have had COVID-19. Acute ET is defined as diffuse, non-scarring hair loss, usually self-limited, lasting for about 6 months. Within its etiology, severe systemic febrile illness, pregnancy, restrictive diets, severe stress and various drugs have been described. It seriously affects the quality of life of patients and is often associated with loss of confidence and low self-esteem.
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Affiliation(s)
- Grecia Chávez-Chavira
- Universidad Autónoma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, División de Investigación y Posgrado. Chihuahua, Chihuahua, MéxicoUniversidad Autónoma de ChihuahuaMéxico
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6
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Bostan E, Cakir A. The Effect of Covid-19 on the Hair Diseases Observed in Health Care Providers: Analysis of 513 Participants. Dermatol Pract Concept 2023; 13:dpc.1301a36. [PMID: 36892342 PMCID: PMC9946114 DOI: 10.5826/dpc.1301a36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The Covid-19 pandemic has been shown to have major acute and chronic impacts on the skin. Various studies reported that there has been an increase in the number of patients referred to outpatient dermatology clinics with the complaint of variable hair diseases during the era of Covid-19. Hair seems to be substantially affected by both the infection itself and anxiety/stress provoked by the pandemic. Therefore, understanding the impact of Covid-19 on the clinical course of variable hair diseases has become a major concern in dermatology practice. OBJECTIVES To examine the frequency and types of various hair diseases, both new-onset and ingravescent, observed in healthcare providers. METHODS A web-based questionnaire related to the hair diseases seen in healthcare providers both prior to the Covid-19 pandemic and after the start of the pandemic was created. The type of both new-onset and pre-existing hair diseases and ongoing hair diseases observed during Covid-19 were investigated. RESULTS A total number of 513 participants were included in the study. One hundred seventy cases were diagnosed with Covid-19. During the Covid-19 pandemic, 228 reported having at least one hair disease; the most common one being telogen effluvium, followed by hair greying and seborrheic dermatitis. There was a statistically significant relationship between the presence of a new-onset hair disease during the pandemic and being diagnosed with Covid-19 (p=0.004). CONCLUSION Our study shows that Covid-19 infection has a significant impact on the emergence of new-onset hair diseases.
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Affiliation(s)
- Ecem Bostan
- Cihanbeyli State Hospital, Dermatology and Venereology Clinic, Konya, Turkey
| | - Aysel Cakir
- Lokman Hekim Atay Hospital, Dermatology and Venereology Clinic, Ankara, Turkey
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7
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Baskett WI, Qureshi AI, Shyu D, Armer JM, Shyu CR. COVID-Specific Long-term Sequelae in Comparison to Common Viral Respiratory Infections: An Analysis of 17 487 Infected Adult Patients. Open Forum Infect Dis 2022; 10:ofac683. [PMID: 36686632 PMCID: PMC9846186 DOI: 10.1093/ofid/ofac683] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background A better understanding of long-term health effects after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become one of the health care priorities in the current pandemic. We analyzed a large and diverse patient cohort to study health effects related to SARS-CoV-2 infection occurring >1 month postinfection. Methods We analyzed 17 487 patients who received diagnoses for SARS-CoV-2 infection in a total of 122 health care facilities in the United States before April 14, 2022. Patients were propensity score-matched with patients diagnosed with the common cold, influenza, or viral pneumonia from March 1, 2020, to April 1, 2021. For each outcome, SARS-CoV-2 was compared with a generic viral respiratory infection (VRI) by predicting diagnoses in the period between 30 and 365 days postinfection. Both coronavirus disease 2019 (COVID-19) and VRI patients were propensity score-matched with patients with no record of COVID-19 or VRI, and the same methodology was applied. Diagnoses where COVID-19 infection was a significant positive predictor in both COVID-19 vs VRI and COVID-19 vs control comparisons were considered COVID-19-specific effects. Results Compared with common VRIs, SARS-CoV-2 was associated with diagnoses of palpitations, hair loss, fatigue, chest pain, dyspnea, joint pain, and obesity in the postinfectious period. Conclusions We identify that some diagnoses commonly described as "long COVID" do not appear significantly more frequent post-COVID-19 infection compared with other common VRIs. We also identify sequelae that are specifically associated with a prior SARS-CoV-2 infection.
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Affiliation(s)
- William I Baskett
- Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Adnan I Qureshi
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Daniel Shyu
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Chi-Ren Shyu
- Correspondence: Chi-Ren Shyu, PhD, FAMIA, 22G Heinkel Building, Columbia, MO 65211 ()
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Silva CC, Bichara CNC, Carneiro FRO, Palacios VRDCM, den Berg AVSV, Quaresma JAS, Magno Falcão LF. Muscle dysfunction in the long coronavirus disease 2019 syndrome: Pathogenesis and clinical approach. Rev Med Virol 2022; 32:e2355. [PMID: 35416359 PMCID: PMC9111061 DOI: 10.1002/rmv.2355] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/20/2022] [Accepted: 04/01/2022] [Indexed: 01/08/2023]
Abstract
In long coronavirus disease 2019 (long COVID-19), involvement of the musculoskeletal system is characterised by the persistence or appearance of symptoms such as fatigue, muscle weakness, myalgia, and decline in physical and functional performance, even at 4 weeks after the onset of acute symptoms of COVID-19. Muscle injury biomarkers are altered during the acute phase of the disease. The cellular damage and hyperinflammatory state induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may contribute to the persistence of symptoms, hypoxaemia, mitochondrial damage, and dysregulation of the renin-angiotensin system. In addition, the occurrence of cerebrovascular diseases, involvement of the peripheral nervous system, and harmful effects of hospitalisation, such as the use of drugs, immobility, and weakness acquired in the intensive care unit, all aggravate muscle damage. Here, we review the multifactorial mechanisms of muscle tissue injury, aggravating conditions, and associated sequelae in long COVID-19.
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Affiliation(s)
- Camilla Costa Silva
- Center for Biological and Health SciencesState University of ParaBelémBrazil
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9
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Singh R, Freeman EE. Viruses, Variants, and Vaccines: How COVID-19 Has Changed the Way We Look at Skin. CURRENT DERMATOLOGY REPORTS 2022; 11:289-312. [PMID: 36274754 PMCID: PMC9574791 DOI: 10.1007/s13671-022-00370-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rhea Singh
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St, Boston, MA 02114 USA
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Esther E. Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St, Boston, MA 02114 USA
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
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10
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Alkeraye S, Alrashidi A, Alotaibi NS, Almajli N, Alkhalifah B, Bajunaid N, Alharthi R, AlKaff T, Alharbi K. The Association Between Hair Loss and COVID-19: The Impact of Hair Loss After COVID-19 Infection on the Quality of Life Among Residents in Saudi Arabia. Cureus 2022; 14:e30266. [DOI: 10.7759/cureus.30266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
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Yang T, Yan MZ, Li X, Lau EHY. Sequelae of COVID-19 among previously hospitalized patients up to 1 year after discharge: a systematic review and meta-analysis. Infection 2022; 50:1067-1109. [PMID: 35750943 PMCID: PMC9244338 DOI: 10.1007/s15010-022-01862-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/21/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although complications and clinical symptoms of COVID-19 have been elucidated, the prevalence of long-term sequelae of COVID-19 is less clear in previously hospitalized COVID-19 patients. This review and meta-analysis present the occurrence of different symptoms up to 1 year of follow-up for previously hospitalized patients. METHODS We performed a systematic review from PubMed and Web of Science using keywords such as "COVID-19", "SARS-CoV-2", "sequelae", "long-term effect" and included studies with at least 3-month of follow-up. Meta-analyses using random-effects models were performed to estimate the pooled prevalence for different sequelae. Subgroup analyses were conducted by different follow-up time, regions, age and ICU admission. RESULTS 72 articles were included in the meta-analyses after screening 11,620 articles, identifying a total of 167 sequelae related to COVID-19 from 88,769 patients. Commonly reported sequelae included fatigue (27.5%, 95% CI 22.4-33.3%, range 1.5-84.9%), somnipathy (20.1%, 95% CI 14.7-26.9%, range 1.2-64.8%), anxiety (18.0%, 95% CI 13.8-23.1%, range 0.6-47.8%), dyspnea (15.5%, 95% CI 11.3-20.9%, range 0.8-58.4%), PTSD (14.6%, 95% CI 11.3-18.7%, range 1.2-32.0%), hypomnesia (13.4%, 95% CI 8.4-20.7%, range 0.6-53.8%), arthralgia (12.9%, 95% CI 8.4-19.2%, range 0.0-47.8%), depression (12.7%, 95% CI 9.3-17.2%, range 0.6-37.5%), alopecia (11.2%, 95% CI 6.9-17.6%, range 0.0-47.0%) over 3-13.2 months of follow-up. The prevalence of most symptoms reduced after > 9 months of follow-up, but fatigue and somnipathy persisted in 26.2% and 15.1%, respectively, of the patients over a year. COVID-19 patients from Asia reported a lower prevalence than those from other regions. CONCLUSIONS This review identified a wide spectrum of COVID-19 sequelae in previously hospitalized COVID-19 patients, with some symptoms persisting up to 1 year. Management and rehabilitation strategies targeting these symptoms may improve quality of life of recovered patients.
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Affiliation(s)
- Tianqi Yang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Michael Zhipeng Yan
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xingyi Li
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Eric H Y Lau
- School of Public Health, The University of Hong Kong, Hong Kong, China.
- Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, Hong Kong, China.
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Fernandes AL, Sales LP, Santos MD, Caparbo VF, Murai IH, Pereira RMR. Persistent or new symptoms 1 year after a single high dose of vitamin D3 in patients with moderate to severe COVID-19. Front Nutr 2022; 9:979667. [PMID: 36176639 PMCID: PMC9513442 DOI: 10.3389/fnut.2022.979667] [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: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to investigate the reported persistent or new symptoms 1 year after a single dose of 200,000 IU of vitamin D3 and hospitalization in patients with moderate to severe COVID-19. Methods This is a post-hoc, exploratory analysis from a multicenter, double-blind, placebo-controlled, randomized clinical trial from two hospitals in São Paulo, Brazil, registered in ClinicalTrials.gov, NCT04449718. Discharged patients were followed for up to 1 year and evaluated by telephone interviews at 6 and 12 months. The primary and secondary outcomes were previously published. These post-hoc exploratory secondary outcomes are the persistent or new symptoms and quality of life (QoL) at the post-viral stage of COVID-19. Generalized estimating equations (GEE) for repeated measures with Bonferroni’s adjustment were used for testing outcomes. Results Between 2 June and 27 August 2020, we randomized 240 patients of which 144 were included in this study [the vitamin D3 (n = 71) or placebo (n = 73) group]. The mean (SD) age was 54.3 (13.1) years, and body mass index (BMI) was 32.4 (6.5) kg/m2. Fever demonstrated a significant main effect of time (P < 0.001) with a reduction from baseline to 6 (52–0) and 12 months (52–0). No significant differences between groups were observed for fever, cough, fatigue, fever, myalgia, joint pain, runny nose, nasal congestion, sore throat, hypertension, diabetes, cardiovascular disease, rheumatic disease, asthma, chronic obstructive pulmonary, chronic kidney disease, QoL, and new or persistent symptoms up to 1-year of follow-up. Conclusion The findings do not support the use of 200,000 IU of vitamin D3 compared to placebo for the management of persistence or new symptoms, and QoL reported by moderate to severe patients after hospitalization for COVID-19.
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Huo L, Zhao R, Zhao L. Effects of official information and rumor on resource-epidemic coevolution dynamics. JOURNAL OF KING SAUD UNIVERSITY - COMPUTER AND INFORMATION SCIENCES 2022. [PMID: 37521178 PMCID: PMC9452419 DOI: 10.1016/j.jksuci.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Epidemic-related information and resources have proven to have a significant impact on the spread of the epidemic during the Corona Virus Disease 2019 (COVID-19) pandemic. The various orientation role of information has different effects on the epidemic spreading process, which will affect the individual’ awareness of resources allocation and epidemic spreading scale. Based on this, a three-layer network is established to describe the dynamic coevolution process among information dissemination, resource allocation, and epidemic spreading. In order to analyze dynamic coevolution process, the microscopic Markov chain (MMC) theory is used. Then, the threshold of epidemic spreading is deduced. Our results indicated that the official information orientation intensity inhibits the epidemics spreading, while rumor orientation intensity promotes epidemic spreading. At the same time, the efficiency of resource utilization restrains the expansion of the infection scale. The two kinds of information are combined with resources respectively. Official information will enhance the inhibitory effect of resources epidemics spreading, while rumor will do the opposite.
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Czech T, Sugihara S, Nishimura Y. Characteristics of Hair Loss after COVID-19: Systematic Scoping Review. J Cosmet Dermatol 2022; 21:3655-3662. [PMID: 35801366 PMCID: PMC9349634 DOI: 10.1111/jocd.15218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/18/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
While there are literature reporting increased incidence of hair loss in COVID-19 patients, insufficient evidence exists on the topic to date. This review aims to identify the existing evidence and clinical characteristics of hair loss with COVID-19 infection. Following the PRISMA Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer-reviewed articles with relevant keywords including "Alopecia", "Telogen Effluvium (TE)" and "COVID-19" from their inception to November 20, 2021. A total of 26 articles, with 9 observational studies and 17 case reports or series (total of 58 cases) were included. Most studies dealt with TE. There were no clear trends between COVID-19 severity and the extent of hair loss. Analysis of the 58 cases also found similar results with most of the cases being female (82.8%), the median onset of hair loss of 2.0 months, and the median time to recovery of hair loss of 5.0 months with a resolution rate of 95%. While this systematic review revealed uncertainty and a lack of strong evidence regarding the association of COVID-19 and hair loss, hair loss in COVID-19 may mainly include TE and be reversible in nature. Future studies are warranted to determine the detailed pathophysiology and risk factors of hair loss in COVID-19, including possible roles of estrogen, progesterone, and pro-inflammatory cytokines.
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Affiliation(s)
- Torrey Czech
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Satoru Sugihara
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
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15
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Pendlebury GA, Oro P, Haynes W, Merideth D, Bartling S, Bongiorno MA. The Impact of COVID-19 Pandemic on Dermatological Conditions: A Novel, Comprehensive Review. Dermatopathology (Basel) 2022; 9:212-243. [PMID: 35892480 PMCID: PMC9326733 DOI: 10.3390/dermatopathology9030027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background: The earliest cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019. Since the declaration as a pandemic on 11 March 2020, further dermatological conditions continue to be documented. We herein present a novel literature review of dermatological manifestations associated with the Coronavirus Disease 2019 (COVID-19) pandemic. To date, this literature review is the first broad-spectrum examination that analyzes a range of dermatological manifestations related to the COVID-19 pandemic: infection, vaccinations, personal protective equipment (PPE), and psychosocial factors. Methods: A detailed literature search was conducted using key terms for cutaneous manifestations associated with the scope of this review. The search retrieved 2199 articles. Results: The COVID-19 pandemic has triggered a significant range of dermatologic sequela. Etiologies of lesions continue to be investigated. Proposed mechanisms include inflammatory response to spike protein, vitamin D deficiency, ACE2 receptor activation, androgen levels, and increased psychological stress. One prominent mechanism describes viral spike protein invasion into the dermis by binding to the angiotensin-converting enzyme 2 (ACE-2) receptors in keratinocytes, with a secondary immunological response. Conclusions: Dermatologists play an integral role in the proper diagnosis and treatment of COVID-related lesions. Early treatment regimens and timely prophylaxis have been shown to safely reduce infection-related dermatological sequelae. Additional investigations and data collection can reduce disease burden and improve overall prognosis.
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Affiliation(s)
- Gehan A. Pendlebury
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Peter Oro
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - William Haynes
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Drew Merideth
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Samantha Bartling
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
| | - Michelle A. Bongiorno
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
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16
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Aryanian Z, Balighi K, Hatami P, Afshar ZM, Mohandesi NA. The role of SARS-CoV-2 infection and its vaccines in various types of hair loss. Dermatol Ther 2022; 35:e15433. [PMID: 35266262 PMCID: PMC9111640 DOI: 10.1111/dth.15433] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/05/2022] [Indexed: 11/26/2022]
Abstract
The prevalence of hair loss has increased during COVID-19. In this study, we review the current literature on incidence and characteristics of various types of COVID-19-related and COVID-19-vaccine- related hair loss including telogen effluvium, alopecia areata, friction alopecia and anagen effluvium. Regarding most of them, the more severe the infection, the more profound and prolonged the course of alopecia. However, the most important issue is reassuring the patients of the non-serious nature of this complication, since psychological support is the most important factor in the earlier resolution of the condition.
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Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
- Department of DermatologyBabol University of Medical SciencesBabolIran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
- Department of Dermatology, School of Medicine Razi HospitalTehran University of Medical SciencesTehranIran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
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17
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COVID-19-induced Scalp Alopecia Treated Effectively with Stem Cell Serum. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4423. [PMID: 35733924 PMCID: PMC9208741 DOI: 10.1097/gox.0000000000004423] [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: 02/18/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
Up to 36.7% of symptomatic COVID-19 patients will have telogen effluvium (TE), which refers to diffuse scalp alopecia. With the continuing global pandemic, a review of literature reports unpredictable and incomplete recovery with conventional treatment like minoxidil. The pathogenesis of COVID-19-induced TE may be more severe than that of conventional TE as the hair follicles are proposed to be directly damaged by cytokines and thromboembolism. There is no current standardized treatment for COVID-19-induced TE. We present a patient with severe chronic TE, with no spontaneous recovery after 6 months of hair loss and minimal response to minoxidil. We commenced monthly applications of stem cell serum (Calecim). We present the results of five treatments spaced monthly, after which he experienced effective regrowth of scalp hair. We propose stem cell serum for patients who have failed conventional treatment or as an adjunct to conventional therapy in COVID-19-induced TE.
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18
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Popescu MN, Berteanu M, Beiu C, Popa LG, Mihai MM, Iliescu MG, Stănescu AMA, Ionescu AM. Complementary Strategies to Promote Hair Regrowth in Post-COVID-19 Telogen Effluvium. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:735-743. [PMID: 35497690 PMCID: PMC9042074 DOI: 10.2147/ccid.s359052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/31/2022] [Indexed: 01/13/2023]
Abstract
Post-COVID-19 telogen effluvium has been largely reported as a sequela in the post-acute phase of COVID-19, causing major emotional distress among the affected patients. The affected individuals are further exposed to a vast amount of misinformation from the internet and social media and it is important for physicians to be familiar with the phenomenon and provide appropriate counselling to their patients regarding this condition. This article aims to review the evidence-based complementary strategies that can help enhance hair regrowth after post-COVID-19 hair loss, from psychological support and patient education to the importance of optimal nutrition and potential indications and benefits of oral nutritional supplementation, as well as the role of both topical and injectable hair growth stimulators.
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Affiliation(s)
- Marius Nicolae Popescu
- Department of Physical and Rehabilitation Medicine-Elias Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Berteanu
- Department of Physical and Rehabilitation Medicine-Elias Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Beiu
- Department of Oncologic Dermatology-Elias Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology-Elias Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology-Elias Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Anca Mirela Ionescu
- Department of Physical and Rehabilitation Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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19
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Hawwam SA, Ismail M, Elhawary EE. The Role of Autologous Micrografts Injection from The Scalp Tissue in The Treatment of Covid-19 Associated Telogen Effluvium: Clinical and Trichoscopic Evaluation. Dermatol Ther 2022; 35:e15545. [PMID: 35486375 PMCID: PMC9111843 DOI: 10.1111/dth.15545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/16/2022] [Accepted: 04/27/2022] [Indexed: 12/01/2022]
Abstract
The clinical presentation of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2 COVID‐19) varies from asymptomatic infection to a life‐threatening, multiorgan disease. One of these manifestations is telogen effluvium (TE) which is characterized by diffuse hair loss occurring in patients previously infected with SARS‐CoV‐2 and lasts ~3 months, after which excessive hair loss follows. Hair follicles are known to contain a well‐characterized niche for adult stem cells which is the bulge containing epithelial and melanocytic stem cells. Stem cells in the hair bulge, a demarcated structure within the lower permanent portion of hair follicles, can generate the interfollicular epidermis, hair follicle structures, and sebaceous glands. This study aims to evaluate autologous micrografts from scalp tissues as a therapeutic modality in the management of TE caused by COVID‐19. Twenty patients of previous COVID‐19 infection suffered from TE were included in this study for human follicle stem cells micrograft scalp treatment and they were evaluated after 3 months of treatment and after 6 months. There was significant improvement of the hair thickness and density compared with the start of the treatment and 6 months of follow‐up. Autologous micrograft of the scalp showed marked improvement in the treatment of COVID‐19 TE.
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Affiliation(s)
- Soha Abdalla Hawwam
- Dermatology & Venereology Department, Faculty of MedicineTanta UniversityTantaEgypt
| | - Mayada Ismail
- Dermatology & Venereology Department, Faculty of MedicineTanta UniversityTantaEgypt
| | - Esraa E. Elhawary
- Dermatology & Venereology Department, Faculty of MedicineTanta UniversityTantaEgypt
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20
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Abstract
Coronavirus disease 2019 (COVID-19) is the third deadly coronavirus infection of the 21st century that has proven to be significantly more lethal than its predecessors, with the number of infected patients and deaths still increasing daily. From December 2019 to July 2021, this virus has infected nearly 200 million people and led to more than 4 million deaths. Our understanding of COVID-19 is constantly progressing, giving better insight into the heterogeneous nature of its acute and long-term effects. Recent literature on the long-term health consequences of COVID-19 discusses the need for a comprehensive understanding of the multisystemic pathophysiology, clinical predictors, and epidemiology to develop and inform an evidence-based, multidisciplinary management approach. A PubMed search was completed using variations on the term post-acute COVID-19. Only peer-reviewed studies in English published by July 17, 2021 were considered for inclusion. All studies discussed in this text are from adult populations unless specified (as with multisystem inflammatory syndrome in children). The preliminary evidence on the pulmonary, cardiovascular, neurological, hematological, multisystem inflammatory, renal, endocrine, gastrointestinal, and integumentary sequelae show that COVID-19 continues after acute infection. Interdisciplinary monitoring with holistic management that considers nutrition, physical therapy, psychological management, meditation, and mindfulness in addition to medication will allow for the early detection of post-acute COVID-19 sequelae symptoms and prevent long-term systemic damage. This review serves as a guideline for effective management based on current evidence, but clinicians should modify recommendations to reflect each patient's unique needs and the most up-to-date evidence. The presence of long-term effects presents another reason for vaccination against COVID-19.
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Affiliation(s)
- Shreeya Joshee
- University of Nevada-Reno, School of Medicine, Reno, NV, USA
| | - Nikhil Vatti
- Department of Family Medicine, Southern Illinois University School of Medicine, Decatur, IL, USA
| | - Christopher Chang
- Division of Immunology, Allergy and Rheumatology, Memorial Healthcare System, Hollywood, FL, USA; Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, CA, USA.
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21
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Qamar MA, Martins RS, Dhillon RA, Tharwani A, Irfan O, Suriya QF, Rizwan W, Khan JA, Zubairi ABS. Residual symptoms and the quality of life in individuals recovered from COVID-19 infection: A survey from Pakistan. Ann Med Surg (Lond) 2022; 75:103361. [PMID: 35186286 PMCID: PMC8832846 DOI: 10.1016/j.amsu.2022.103361] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background There remains scarcity of literature regarding the patient's health status post-COVID-19 infection. This study analyzes the prevalence of residual symptoms and quality of life (QoL) after COVID-19. Methods An anonymous online survey was administrated in Pakistan from November 2020 to April 2021 in COVID-19 survivors. The questionnaire used the 12-Item Short Form Health Survey (SF-12) to assess mental and physical QoL. Multivariate linear regression was used to explore factors associated with mental and physical QoL scores. Results A total of 331 COVID-19 survivors participated in our survey. Around 42.0% of the cohort reported within 1–3 months of diagnosis of COVID-19. The common residual symptoms were body aches (39.9%), low mood (32.6%), and cough (30.2%). Better physical QoL was associated with being male (adjusted beta: 3.328) and having no residual symptoms (6.955). However, suffering from nausea/vomiting during initial COVID-19 infection (−4.026), being admitted to the ICU during COVID-19 infection (−9.164), and suffering from residual body aches (−5.209) and low mood (−2.959) was associated with poorer QoL. Better mental QoL was associated with being asymptomatic during initial COVID-19 infection (6.149) and post-COVID (6.685), while experiencing low mood post-COVID was associated with poorer mental QoL (−8.253 [-10.914, −5.592]). Conclusion Despite presumed “recovery” from COVID-19, patients still face a wide range of residual symptoms months after initial infection, which contributes towards poorer QoL. Healthcare professionals must remain alert to the long-lasting effects of COVID-19 infection and aim to address them appropriately to improve patients’ QoL. COVID-19 survivors are currently facing the problem of “Long COVID Syndrome”. The syndrome is an illness that is cyclical, progressive, and multiphasic or multi-organ symptoms with the time duration varying from more than 1–2 months. Quality of Life of COVID-19 survivors is affected with this syndrome where the most common symptoms are fatigue and dyspnea.
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Affiliation(s)
| | | | - Rubaid Azhar Dhillon
- Medical College, Riphah International University, Rawalpindi, Pakistan
- Corresponding author.
| | | | - Omar Irfan
- Amaris Consulting, Toronto, Ontario, Canada
| | | | - Wajiha Rizwan
- Department of Pediatrics, Children Hospital, Lahore, Pakistan
| | - Javaid Ahmed Khan
- Department of Pulmonology, Aga Khan University Hospital, Karachi, Pakistan
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22
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Karimi S, Derakhshan M, Tondro A. Evaluation of the Relationship between Stress and Severity of Covid-19 Symptoms and Sleep Quality in Covid-19 Patients. MAEDICA 2022; 17:129-133. [PMID: 35733762 PMCID: PMC9168563 DOI: 10.26574/maedica.2022.17.1.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction and aim:Coronavirus 2019 (Covid-19) is a viral disease that appeared in late 2019 in China. Different factors can cause psychological problems in Covid-19 patients. Stress is one of the most common problems in people with communicable diseases. The aim of the present study was to investigate the relationship between stress and the severity of symptoms and sleep quality in Covid-19 patients. Methods:This was a descriptive-analytical study. The sample size included 300 Covid-19 patients. Demographic information form, Pittsburgh Sleep Quality Index (PSQI) and researcher-made questionnaire were used to collect data. Data analysis was carried out using SPSS ver.16. Results:The majority of participants obtained a stress score between 4 and 6 (moderate). Most of them felt stressed regarding the risk of transmitting the disease to their family members (63%) and more than half (56.3%) had the highest stress level during the first week of the disease because they were frightened by the Covid-19 infection and its prognosis. With regard to sleep, most participants had between six and 10 hours of sleep (53.7%). Conclusion:The results of the present study showed that perceived stress among Covid-19 patients had a direct effect on the severity of respiratory and neurological symptoms and affected their sleep quality.
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Affiliation(s)
- Saba Karimi
- Department of Nursing and Midwifery School, Kermanshah University of Medical Sciences, Student Research Committee, Kermanshah, Iran
| | - Mehrdad Derakhshan
- Department of Nursing and Midwifery School, Kermanshah University of Medical Sciences, Student Research Committee, Kermanshah, Iran
| | - Amirhossein Tondro
- Department of Nursing and Midwifery School, Kermanshah University of Medical Sciences, Student Research Committee, Kermanshah, Iran
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23
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Nguyen B, Tosti A. Alopecia in COVID-19 Patients: Systematic Review and Meta-analysis. JAAD Int 2022; 7:67-77. [PMID: 35224518 PMCID: PMC8860672 DOI: 10.1016/j.jdin.2022.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 is associated with androgenetic alopecia (AGA), telogen effluvium (TE), and alopecia areata (AA). No studies have analyzed the aggregate data to date. Objective We conducted a systematic review to characterize the types, incidence, timing, and clinical outcomes of COVID-19–associated alopecia. Methods We searched PubMed/MEDLINE, Scopus, and Embase for articles published between November 2019 and August 2021 using the key words “alopecia” or “hair” and COVID-19–related search terms, identifying 41 original articles describing patients with alopecia and COVID-19. Results The current review included 1826 patients with alopecia and COVID-19 (mean age, 54.5 years; 54.3% male). The most common types of alopecia identified were AGA (30.7%, 86.4% male), TE (19.8%, 19.3% male), and AA (7.8%, 40.0% male). AGA preceded COVID-19 symptoms. TE was usually newly triggered by COVID-19 (93.6%). AA usually occurred in patients with preexisting disease (95.1%). Limitations Definitions of COVID-19 onset varied. Studies differed in methodology and were susceptible to reporting and sampling bias. Studies with large sample sizes may exert a disproportionate influence on data. Conclusion AGA may be a risk factor for severe COVID-19, whereas TE presents as a sequela of COVID-19. AA generally occurs as a relapse in patients with preexisting alopecia.
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24
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Arora S, Singh GK, Das P, Rahman R, Bellad P, Shrivastav R, Bahuguna A, Sapra D, Gupta A. A study of COVID‐19 vaccine (Covishield) induced dermatological adverse effects from India. J Eur Acad Dermatol Venereol 2022; 36:e402-e404. [DOI: 10.1111/jdv.17951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/25/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- S Arora
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - G K Singh
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - P Das
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - R Rahman
- Department of Physiology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - P Bellad
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | | | - Amit Bahuguna
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - Devyani Sapra
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
| | - Akanksha Gupta
- Department of Dermatology Base Hospital Delhi Cantt & Army College of Medical Sciences New Delhi India
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25
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Tammaro A, Adebanjo GAR, Parisella FR, Luzi F, Scarabello A. The hair and nail manifestations of COVID-19. J Cosmet Dermatol 2022; 21:1339-1346. [PMID: 35032337 DOI: 10.1111/jocd.14774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Emerging literature evidence shows that the manifestations of the coronavirus disease 2019 (COVID-19), which is the disease caused by SARS-CoV-2, encompass alterations of the pulmonary, cardiovascular, gastrointestinal and neurological system. Moreover, hematologic and dermatologic manifestations have been documented. The aim of this review is to summarize the dermatologic manifestations of COVID-19 involving the hair and nails in a narrative way. A total of 1136 patients have been reported to have de-novo hair loss following COVID-19. Notably, 958 patients experienced telogen effluvium (TE) (female/male ratio = 3,86:1), two female patients experienced anagen effluvium and 176 people had alopecia areata (female/male ratio of 19:3). Ten patients were reported to have ungual changes following the infection with the novel coronavirus: the individuals affected were 6 women and 4 men. COVID-19 can be associated to hair and ungual manifestations. This review summarizes the evidence regarding the hair and ungual manifestations of COVID-19, which could be harnessed to better understand the clinical implications and pathophysiology of this disease that has been burdening society globally since December 2019.
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Affiliation(s)
- Antonella Tammaro
- NESMOS Dermatology Department, Sapienza University of Rome, Rome, Italy
| | | | | | - Fabiola Luzi
- NESMOS Dermatology Department, Sapienza University of Rome, Rome, Italy
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26
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Wong-Chew RM, Rodríguez Cabrera EX, Rodríguez Valdez CA, Lomelin-Gascon J, Morales-Juárez L, de la Cerda MLR, Villa-Romero AR, Arce Fernández S, Serratos Fernandez M, Bello HH, Castañeda LM, Avendaño MA, Hernández-Cruz JA, Álvarez Martínez N, Fernanda Contreras L, Rafael González de la Cerda L, Juárez Flores A, Martínez-Juarez LA, Álvarez-Hernández DA, Gallardo-Rincón H, Fajardo Dolci G, Tapia-Conyer R, Valdez-Vázquez RR. Symptom cluster analysis of long COVID-19 in patients discharged from the Temporary COVID-19 Hospital in Mexico City. Ther Adv Infect Dis 2022; 9:20499361211069264. [PMID: 35059196 PMCID: PMC8764618 DOI: 10.1177/20499361211069264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Several reports have emerged describing the long-term consequences of COVID-19 and its effects on multiple systems. Methods: As further research is needed, we conducted a longitudinal observational study to report the prevalence and associated risk factors of the long-term health consequences of COVID-19 by symptom clusters in patients discharged from the Temporary COVID-19 Hospital (TCH) in Mexico City. Self-reported clinical symptom data were collected via telephone calls over 90 days post-discharge. Among 4670 patients, we identified 45 symptoms across eight symptom clusters (neurological; mood disorders; systemic; respiratory; musculoskeletal; ear, nose, and throat; dermatological; and gastrointestinal). Results: We observed that the neurological, dermatological, and mood disorder symptom clusters persisted in >30% of patients at 90 days post-discharge. Although most symptoms decreased in frequency between day 30 and 90, alopecia and the dermatological symptom cluster significantly increased ( p < 0.00001). Women were more prone than men to develop long-term symptoms, and invasive mechanical ventilation also increased the frequency of symptoms at 30 days post-discharge. Conclusion: Overall, we observed that symptoms often persisted regardless of disease severity. We hope these findings will help promote public health strategies that ensure equity in the access to solutions focused on the long-term consequences of COVID-19.
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Affiliation(s)
| | | | | | - Julieta Lomelin-Gascon
- Temporary COVID-19 Hospital, Mexico City, Mexico
- Carlos Slim Foundation, Mexico City, Mexico
| | - Linda Morales-Juárez
- Temporary COVID-19 Hospital, Mexico City, Mexico
- Carlos Slim Foundation, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Roberto Tapia-Conyer
- National Autonomous University of Mexico, Mexico City, MexicoCarlos Slim Foundation, Mexico City, Mexico
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27
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Inamadar A. Covid induced telogen effluvium (CITE): An insight. Indian Dermatol Online J 2022; 13:445-448. [PMID: 36262583 PMCID: PMC9574152 DOI: 10.4103/idoj.idoj_139_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/04/2022] Open
Abstract
Hair loss is one of the most common post-covid symptoms observed during this severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Pro-inflammatory cytokines, direct viral effect on hair follicles, and microthrombi are thought to be the pathogenic factors considered. Information regarding time of onset and severity is similar to other infection-induced acute telogen effluvium. It is reasonable to think that the evolution and prognosis are similar, and therefore, even without any specific treatment, full recovery of lost hair is expected.
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28
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Hussain N, Agarwala P, Iqbal K, Omar HMS, Jangid G, Patel V, Rathore SS, Kumari C, Velasquez‐Botero F, López GAB, Vishwakarma Y, Nipu AP, Ahmed NK. A systematic review of acute telogen effluvium, a harrowing post‐COVID‐19 manifestation. J Med Virol 2021; 94:1391-1401. [DOI: 10.1002/jmv.27534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Nabeel Hussain
- Saba University School of Medicine The Bottom The Netherlands
| | | | - Kinza Iqbal
- Department of Internal Medicine Dow Medical College, Dow University of Health Sciences Karachi Pakistan
| | | | - Gurusha Jangid
- Dr. Sampurnanand Medical College Jodhpur Rajasthan India
| | - Vraj Patel
- Smt NHL Municipal Medical College Ahmedabad Gujarat India
| | | | | | | | | | | | | | - Noman Khurshid Ahmed
- Department of Internal Medicine Dow Medical College, Dow University of Health Sciences Karachi Pakistan
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29
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Shome D, Kapoor R, Surana M, Vadera S, Shah R. Efficacy of QR678 Neo ® hair growth factor formulation for the treatment of hair loss in Covid-19-induced persistent Telogen Effluvium-A prospective, clinical, single-blind study. J Cosmet Dermatol 2021; 21:16-23. [PMID: 34875139 DOI: 10.1111/jocd.14626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Telogen Effluvium (TE) in a post-Covid-19 patient causes excessive shedding of hair. No definite treatment is available till now. Past studies demonstrates that QR678Neo® has shown promising results in various types of Alopecia. AIM In this study, we aim to establish efficacy of QR678 Neo® hair growth factor formulation administration in Covid-19-induced persistent TE for treatment of hair loss and for hair regrowth. MATERIAL & METHOD Twenty adult patients (all females) presenting with persistent TE starting few weeks after recovery from Covid-19 infection, and continuing beyond 6 months were included for the study. A 1.5 mL solution of QR678 Neo® hair growth factor formulation was administered in the scalp per session. A total of 8 sessions (one session every 4 weeks) were done. The results were assessed at the baseline, after 4thsession, and 1 month after 8th session. RESULTS Most of the patients showed significant reduction in hair fall; 89% patients showed excellent hair growth. Global photographic assessment score showed marked improvement, which maintained even post therapy. Videomicroscopic assessment showed increase in the hair count (mean =29.32) after 8th session, that further improved even post therapy. The subjective assessment scores for overall hair growth, appearance of hair, reduction in visibility of the scalp, and hair loss were 4, 4.5, 4.25, and 5, respectively. CONCLUSION Management of Covid-19-induced persistent Telogen Effluvium has been unclear and futile so far. Intra-dermal administration of QR678 Neo® hair growth factor formulation in the scalp, reduces hair fall, improves hair regrowth, and increases the hair density.
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Affiliation(s)
- Debraj Shome
- Department of Facial Plastic Surgery & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Rinky Kapoor
- Department of Dermatology, Cosmetic Dermatology & Dermato-Surgery, The Esthetic Clinics, Mumbai, India
| | - Monika Surana
- Department of Facial Plastic Surgery & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Sapna Vadera
- Department of Facial Plastic Surgery & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
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Starace M, Iorizzo M, Sechi A, Alessandrini AM, Carpanese M, Bruni F, Vara G, Apalla Z, Asz-Sigall D, Barruscotti S, Camacho F, Doche I, Estrada BD, Dhurat R, Gavazzoni MF, Grimalt R, Harries M, Ioannidis D, McMichael A, Melo DF, Oliveira R, Ovcharenko Y, Pirmez R, Ramot Y, Rudnicka L, Shapiro J, Silyuk T, Sinclair R, Tosti A, Vano-Galvan S, Piraccini BM. Trichodynia and telogen effluvium in COVID-19 patients: Results of an international expert opinion survey on diagnosis and management. JAAD Int 2021; 5:11-18. [PMID: 34368790 PMCID: PMC8328568 DOI: 10.1016/j.jdin.2021.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious telogen effluvium and trichodynia have also been reported. OBJECTIVE To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to the other signs and symptoms of the disease. METHODS Patients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms were questioned about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms. RESULTS Data from 128 patients were collected. Telogen effluvium was observed in 66.3% of the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more. LIMITATIONS The recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities. CONCLUSION The severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset (<4 weeks) and late-onset (>12 weeks) telogen effluvium.
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Affiliation(s)
- Michela Starace
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matilde Iorizzo
- Private Dermatology Practice, Lugano/Bellinzona, Switzerland
| | - Andrea Sechi
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Aurora Maria Alessandrini
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Miriam Carpanese
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bruni
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giulio Vara
- Radiology Unit, Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
| | - Zoe Apalla
- Second Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Stefania Barruscotti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francisco Camacho
- University of Seville, Medical-Surgical Dermatology Department, University Hospital, Seville, Spain
| | - Isabella Doche
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruna Duque Estrada
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Prof. Rubem D Azulay, Rio de Janeiro, Brazil
| | - Rachita Dhurat
- Department of Dermatology, LTM Medical College & Hospital Sion, Mumbai, India
| | | | - Ramon Grimalt
- Facultat de Medicina i Ciencies de la Salut, UIC-Barcelona, Universitat Internacional de Catalunya, Sant Cugat del `Valles, Barcelona, Spain
| | - Matthew Harries
- Department of Dermatology, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Dimitrios Ioannidis
- Department of Dermatology-Venereology, Aristotle University Medical School, Hospital for Skin and Venereal Diseases, Thessaloniki, Greece
| | - Amy McMichael
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel Fernandes Melo
- Department of Dermatology, University of State of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - Rui Oliveira
- Trichology Unit, Dermatology Center CUF Descobertas Hospital, Lisbon, Portugal
| | - Yuliya Ovcharenko
- Department of General and Clinical Immunology and Allergology, V.N. Karazin Kharkiv National University Medical School, Kharkiv, Ukraine
| | - Rodrigo Pirmez
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Prof. Rubem D Azulay, Rio de Janeiro, Brazil
| | - Yuval Ramot
- Department of Dermatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, New York
| | - Tatiana Silyuk
- Hair Treatment and Transplantation Center, Private Practice, Saint Petersburg, Russia
| | | | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Sergio Vano-Galvan
- Dermatology Department, Ramon y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | - Bianca Maria Piraccini
- Dermatology-IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Post-COVID-19 Sydrome and Decrease in Health-Related Quality of Life in Kidney Transplant Recipients after SARS-COV-2 Infection-A Cohort Longitudinal Study from the North of Poland. J Clin Med 2021; 10:jcm10215205. [PMID: 34768725 PMCID: PMC8584685 DOI: 10.3390/jcm10215205] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: Patients after SARS-CoV-2 infection frequently face “Post-COVID-19 Syndrome”, defined by symptoms that develop during or after COVID-19, continue for more than 12 weeks, and are not explained by an alternative diagnosis. We aimed to evaluate the presence of post-COVID-19 syndrome and its predictors in kidney transplant recipients (KTR) 6 months after the disease. Materials and Methods: A total of 67 KTR (38 m) with a mean age of 53.6 ± 14 years, 7.3 ± 6.4 years post-transplant were included in the cohort longitudinal study. Thirty-nine (58.2%) of them were hospitalized, but not one required invasive ventilation therapy. They were interviewed 6 months after being infected, with a series of standardized questionnaires: a self-reported symptoms questionnaire, the modified British Medical Research Council (mMRC) dyspnea scale, EQ-5D-5L questionnaire, and EQ-VAS scale. Results: Post-COVID-19 syndrome was diagnosed in 70.1% of KTR and 26.9% of them reported at least three persistent symptoms. The most common symptoms were fatigue (43.3%), hair loss (31.3%), memory impairment (11.9%), muscle aches, and headaches (11.9%). Dyspnea with an mMRC scale grade of at least 1 was reported by 34.3% patients vs. 14.9% before infection; 47.8% stated that they still feel worse than before the disease. Mean EQ-VAS scores were 64.83 vs. 73.34 before infection. The persistent symptoms are more frequent in older patients and those with greater comorbidity. Conclusions: Persistent symptoms of post-COVID-19 syndrome are present in the majority of KTR, which highlights the need for long-term follow-up as well as diagnostic and rehabilitation programs.
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Aksoy H, Yıldırım UM, Ergen P, Gürel MS. COVID-19 induced telogen effluvium. Dermatol Ther 2021; 34:e15175. [PMID: 34708909 PMCID: PMC8646871 DOI: 10.1111/dth.15175] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/22/2021] [Indexed: 01/04/2023]
Abstract
COVID‐19 is a febrile, infectious illness that has previously been associated with telogen effluvium (TE). However, to date, no study has been conducted to determine the incidence of TE in those who have had COVID‐19. To assess the frequency of TE in post‐COVID‐19 patients and the correlation between the development of TE and the severity of COVID‐19, to understand whether emotional stress or medications are responsible for the development of TE. Totally 204 patients with a history of SARS‐CoV‐2 infection in the last 3 months were included in the study. The diagnosis of TE was made by history of excessive hair shedding, hair pull test, diffuse or bitemporal thinning, and absence of anisotrichosis in trichoscopy. Patients who did not have any TE cause other than COVID‐19 and whose hair loss started after COVID‐19 were considered as “COVID‐19 associated TE (CATE).” We found TE in 75 (36.7%) cases and androgenetic alopecia (AGA) in 85 (41.7%) cases. CATE was present in 27.9% of cases and developed on average 53.76 (± 23.772) days after COVID‐19 real‐time reverse transcription polymerase chain reaction (RT‐PCR) positivity. The proportion of patients with CATE was numerically higher in hospitalized patients compared to outpatients (31.7% vs. 24.3%; p = 0.238); and significantly higher in women compared to men (42.3% vs. 6.2%; p < 0.001), in patients with hypertension compared to those without hypertension (40.4% vs. 23.1%; p = 0.014), and in patients who had respiratory symptoms compared to those who had not (31.7% vs. 14.0%; p = 0.021). The patients with and without CATE were similar in terms of stress level and usage of COVID‐19 medications. Patients with AGA had a higher rate of hospitalization (69.4% vs. 35.3%; p < 0.001) and a higher incidence of fever (69.4% vs. 54.6%; p = 0.033) during COVID‐19, compared to those without. TE developed in approximately one‐quarter of people who have had COVID‐19, and our study is the first to detect it. The time to onset of CATE, which was 7–8 weeks after the SARS‐CoV‐2 RT‐PCR positivity, was not much different from post‐infectious TE. Patients with severe COVID‐19 seem to be more prone to develop TE. The presence of AGA is associated with a more severe COVID‐19. During the pandemic, clinicians should consider a previous SARS‐CoV‐2 infection in patients presenting with hair loss.
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Affiliation(s)
- Hasan Aksoy
- Department of Dermatology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
| | - Umut Mert Yıldırım
- Department of Dermatology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
| | - Mehmet Salih Gürel
- Department of Dermatology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
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Rezende HD, Iglesias GA, Lázaro BPBD, Morais RVDA, Dinato SLM, Dias MFRG. A comment on psychological distress and women's hair loss related to the COVID-19 pandemic. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1083-1084. [PMID: 34669849 DOI: 10.1590/1806-9282.20210606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Hudson Dutra Rezende
- Centro Universitário Lusíada, Departamento de Dermatologia - Santos (SP), Brazil
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Abstract
With a practice dedicated to hair restoration and hair loss management, the authors have seen a large number of patients presenting with increased hair fall in the last 18 months. Hair fall after a stressfull event such as infections with febrile episodes is known. However, the latent period between the infective episode and hair fall has been shorter after COVID-19 infection than before. This review attempts to look at various pathways responsible for hair fall and if this differs from the conventional hair fall seen after any infection. It also tries to understand if the infection with the SARS-CoV-2 virus has a direct impact on the hair follicle leading to hair fall.
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Affiliation(s)
- Sandeep Suresh Sattur
- Hairrevive-Centre for Hair Restoration & Skin Rejuvenation, Santacruz West, Mumbai, Maharashtra, India
| | - Indu Sandeep Sattur
- Hairrevive-Centre for Hair Restoration & Skin Rejuvenation, Santacruz West, Mumbai, Maharashtra, India
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35
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Thurnher MM, Reith W, Thurnher AP, Rommer P. [Long COVID: long-term symptoms and morphological/radiological correlates]. Radiologe 2021; 61:915-922. [PMID: 34554270 PMCID: PMC8459338 DOI: 10.1007/s00117-021-00910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neurologic, pulmonary, cardiac and gastrointestinal functional disorders can persist in the post-acute phase and constitute a long COVID syndrome, also known as post-acute sequelae of SARS-CoV‑2 infection (PASC). Some patients develop persistent and debilitating symptoms despite a relatively mild illness at onset and they are known as COVID-19 long haulers. OBJECTIVE Presentation of symptoms, signs and biomarkers present in patients previously affected by COVID-19 and discussion of possible underlying mechanisms and consequences. METHODS Existing literature and reported cases as well as expert opinions are analyzed and discussed. RESULTS Long COVID affects survivors of COVID-19 at all levels of disease severity, even in mild to moderate cases and younger adults who did not require respiratory support, hospitalization or intensive care. A challenging aspect is that many long haulers never had laboratory confirmation of COVID-19, raising skepticism that the persistent symptoms have a physiological basis. On the other hand, some symptoms seen in post-acute COVID-19 may occur as a consequence of critical illness or as a side effect of treatment. CONCLUSION Given that COVID-19 is a new disease, it is not possible to determine how long these effects will last. Long-term monitoring of post-acute COVID-19 symptoms and screening for frequent comorbid conditions are essential.
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Affiliation(s)
- Majda M Thurnher
- Universitätsklinik für Radiologie und Nuklearmedizin, Allgemeines Krankenhaus Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Wolfgang Reith
- Diagnostische Neuroradiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | | | - Paulus Rommer
- Allgemeines Krankenhaus Wien, Universitätsklinik für Neurologie, Wien, Österreich
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More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep 2021; 11:16144. [PMID: 34373540 PMCID: PMC8352980 DOI: 10.1038/s41598-021-95565-8] [Citation(s) in RCA: 1117] [Impact Index Per Article: 372.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/20/2021] [Indexed: 01/07/2023] Open
Abstract
COVID-19 can involve persistence, sequelae, and other medical complications that last weeks to months after initial recovery. This systematic review and meta-analysis aims to identify studies assessing the long-term effects of COVID-19. LitCOVID and Embase were searched to identify articles with original data published before the 1st of January 2021, with a minimum of 100 patients. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were followed. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included (age 17–87 years). The included studies defined long-COVID as ranging from 14 to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.
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Fahriani M, Ilmawan M, Fajar JK, Maliga HA, Frediansyah A, Masyeni S, Yusuf H, Nainu F, Rosiello F, Sirinam S, Keam S, Ophinni Y. Persistence of long COVID symptoms in COVID-19 survivors worldwide and its potential pathogenesis - A systematic review and meta-analysis. NARRA J 2021; 1:e36. [PMID: 38449463 PMCID: PMC10914031 DOI: 10.52225/narraj.v1i2.36] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/03/2021] [Indexed: 10/16/2023]
Abstract
The study sought to determine the prevalence of persistent long COVID symptoms such as anxiety, depression, dizziness, chest pain, sleep difficulty, palpitations, weight loss, and hair loss among coronavirus disease 2019 (COVID-19) survivors worldwide and to discuss the potential pathogeneses. Potential studies were searched in three databases (PubMed, Scopus, and Web of Science) as of January 30, 2021. Data on study characteristics, patient characteristics during the follow-up, the number of patients with persistent long COVID symptoms and total COVID-19 survivors were collected according to PRISMA guidelines. To assess the quality of studies, the Newcastle-Ottawa scale was used. The estimated prevalence of each long COVID symptom and the association between COVID-19 severity and the occurrence of prolonged symptoms was assessed, if appropriate. The global prevalence of prolonged anxiety was 15.76% (95%CI: 6.36%, 25.15%). Chest pain persisted in 10.36% (239/3,224) of COVID-19 patients (95%CI: 4.92%, 15.80%). Prolonged depression was found in 24 of 548 COVID-19 survivors with an estimated prevalence of 4.32% (95%CI: 2.62%, 6.03%) and dizziness was presented in 4.83% (118/2,219, 95%CI: 1.50%, 8.16%) after recovery. Hair loss was complained by 527 of 2,251 recovered patients (cumulative prevalence of 24.76%, 95%CI: 19.60%, 29.91%), while weight loss was identified in 37 cases among 452 COVID-19 survivors (8.19%, 95%CI: 5.66%, 10.71%). Prolonged palpitation was experienced by 19.38% (211/1,926) survivors with 95%CI: 2.40%, 41.16%. Sleep difficulty was found in 541 of 2,622 COVID-19 survivors (17.87%, 95%CI: 7.55%, 28.20%). The association between COVID-19 severity and the occurrence of persistent long COVID symptoms was not analyzed due to the lack of data. In conclusion, persistent psychological symptoms are frequently reported among COVID-19 survivors. Follow-up studies with a longer duration and larger population are warranted to assess the extent of prolonged symptoms and the quality of life of COVID-19 survivors. Despite various potential pathogeneses that have been hypothesized, a definitive mechanism is yet to be addressed. PROSPERO registration: CRD42021247172.
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Affiliation(s)
- Marhami Fahriani
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Muhammad Ilmawan
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, Indonesia
| | - Jonny K. Fajar
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, Indonesia
| | - Helnida A. Maliga
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, Indonesia
| | - Andri Frediansyah
- Research Division for Natural Product Technology (BPTBA), Indonesian Institute of Sciences (LIPI), Wonosari, Indonesia
| | - Sri Masyeni
- Department of Internal Medicine, Faculty of Medicine and Health Sciences Universitas Warmadewa, Denpasar, Bali, Indonesia
- Department of Internal Medicine, Sanjiwani Hospital, Denpasar, Bali, Indonesia
| | - Hanifah Yusuf
- Department of Pharmacology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Francesco Rosiello
- Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy
| | - Salin Sirinam
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Synat Keam
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Youdiil Ophinni
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Harvard University, Cambridge, MA, USA
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Rossi A, Magri F, Sernicola A, Michelini S, Caro G, Muscianese M, Di Fraia M, Chello C, Fortuna MC, Grieco T. Telogen Effluvium after SARS-CoV-2 Infection: A Series of Cases and Possible Pathogenetic Mechanisms. Skin Appendage Disord 2021; 21:1-5. [PMID: 34373830 PMCID: PMC8339054 DOI: 10.1159/000517223] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/28/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Physicians have largely studied the cutaneous involvement of coronavirus disease 2019 (COVID-19), but only few reports have focused on telogen effluvium (TE) as a possible sequela of COVID-19. We assessed 14 cases of hair loss occurring after SARS-CoV-2 infection using trichoscopy and trichogram to investigate patterns related to COVID-19. Furthermore, we discussed possible mechanisms involved in COVID-19 TE. CASE PRESENTATION Fourteen individuals were referred to our post-COVID-19 dermatology office complaining acute hair loss after SARS-CoV-2 infection. Clinical evaluation included pull test, trichoscopy, and trichogram. CO-VID-19 TE occurred after a median of 2 months (range 1-3 months) following SARS-CoV-2 infection. The median duration of hair loss was 5 months (range 1-6 months). Trichoscopy showed variable but typical TE patterns. Trichogram showed different telogen/anagen ratio depending on the interval between onset of hair loss and trichological visit. DISCUSSION/CONCLUSION Our cases showed TE between 1 and 3 months after the onset of SARS-CoV-2 infection, thus earlier than classic TE. Trichoscopic features and trichogram showed no variations from classic TE. Different pathogenetic mechanisms including pro-inflammatory cytokines and direct viral damage on the hair follicle can be hypothesized; further studies on a larger sample are needed to better understand this condition.
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Affiliation(s)
| | | | - Alvise Sernicola
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Savaş Şen Z, Polat M, Öz FN, Tanir G. Hair Loss as a Late Complication of Multisystem Inflammatory Syndrome in Children. Pediatr Infect Dis J 2021; 40:e251-e252. [PMID: 33633001 DOI: 10.1097/inf.0000000000003115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Zeynep Savaş Şen
- Department of Pediatric Infectious Disease, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Clinical course of alopecia after COVID-19. Int J Infect Dis 2021; 107:255-256. [PMID: 33962081 PMCID: PMC9613849 DOI: 10.1016/j.ijid.2021.04.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
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Cline A, Jacobs AK, Fonseca M, Wu J, Asrani F, Safai B, Glick S, McLellan BN, McMichael AJ, Marmon S. Race, ethnicity, and comorbidities are critical factors in the diagnosis of telogen effluvium during the COVID-19 pandemic. J Am Acad Dermatol 2021; 85:209-211. [PMID: 33839211 PMCID: PMC8027097 DOI: 10.1016/j.jaad.2021.03.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Abigail Cline
- Metropolitan Medical Center, Department of Dermatology, New York, New York; Coney Island Medical Center, Department of Dermatology, Brooklyn, New York
| | | | - Maira Fonseca
- Lincoln Medical Center, Department of Dermatology, Bronx, New York
| | - Julia Wu
- Elmhurst Medical Center, Department of Dermatology, Queens, New York
| | - Falguni Asrani
- Woodhull Medical Center, Department of Dermatology, Brooklyn, New York; Cumberland Medical Center, Department of Dermatology, Brooklyn, New York
| | - Bijan Safai
- Metropolitan Medical Center, Department of Dermatology, New York, New York
| | - Sharon Glick
- Kings County Medical Center, Department of Dermatology and Pediatrics, Brooklyn, New York
| | - Beth N McLellan
- Jacobi Medical Center, Division of Dermatology, Bronx, New York
| | - Amy J McMichael
- Wake Forest School of Medicine, Department of Dermatology, Winston-Salem, North Carolina
| | - Shoshana Marmon
- Coney Island Medical Center, Department of Dermatology, Brooklyn, New York; Woodhull Medical Center, Department of Dermatology, Brooklyn, New York; Cumberland Medical Center, Department of Dermatology, Brooklyn, New York.
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Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A, Villapol S. More Than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-Analysis. RESEARCH SQUARE 2021:rs.3.rs-266574. [PMID: 33688642 PMCID: PMC7941645 DOI: 10.21203/rs.3.rs-266574/v1] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. Methods . LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. All articles with original data for detecting long-term COVID-19 published before 1 st of January 2021 and with a minimum of 100 patients were included. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. Heterogeneity was assessed using I 2 statistics. This systematic review followed Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines, although the study protocol was not registered. Results. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. The follow-up time ranged from 14 to 110 days post-viral infection. The age of the study participants ranged between 17 and 87 years. It was estimated that 80% (95% CI 65-92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). All meta-analyses showed medium (n=2) to high heterogeneity (n=13). Conclusions . In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, the severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.
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Affiliation(s)
| | | | - Carol Perelman
- National Autonomous University of Mexico: Universidad Nacional Autonoma de Mexico
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Hayran Y, Yorulmaz A, Gür G, Aktaş A. Different hair loss patterns in two pediatric patients with COVID-19-associated multisystem inflammatory syndrome in children. Dermatol Ther 2021; 34:e14820. [PMID: 33506994 PMCID: PMC7995128 DOI: 10.1111/dth.14820] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/23/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Yıldız Hayran
- Department of Dermatology, Ankara City Hospital, Ankara, Turkey
| | - Ahu Yorulmaz
- Department of Dermatology, Ankara City Hospital, Ankara, Turkey
| | - Güneş Gür
- Department of Dermatology, Ankara City Hospital, Ankara, Turkey
| | - Akın Aktaş
- Department of Dermatology, Ankara City Hospital, Ankara, Turkey
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44
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Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo PA, Cuapio A, Villapol S. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.27.21250617. [PMID: 33532785 PMCID: PMC7852236 DOI: 10.1101/2021.01.27.21250617] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. All articles with original data for detecting long-term COVID-19 published before 1st of January 2021 and with a minimum of 100 patients were included. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. Heterogeneity was assessed using I2 statistics. This systematic review followed Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines, although the study protocol was not registered. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. The follow-up time ranged from 14 to 110 days post-viral infection. The age of the study participants ranged between 17 and 87 years. It was estimated that 80% (95% CI 65-92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). All meta-analyses showed medium (n=2) to high heterogeneity (n=13). In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.
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Affiliation(s)
| | - Talia Wegman-Ostrosky
- Instituto Nacional de Cancerología, Subdirección de Investigación básica, Ciudad de México, México
| | - Carol Perelman
- National Autonomous University of Mexico, SOMEDICyT, RedMPC, México
| | | | - Paulina A Rebolledo
- Divison of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Angelica Cuapio
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Sonia Villapol
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Neuroscience in Neurological Surgery, Weill Cornell Medical College, New York, USA
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45
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Olds H, Liu J, Luk K, Lim HW, Ozog D, Rambhatla PV. Telogen effluvium associated with COVID-19 infection. Dermatol Ther 2021; 34:e14761. [PMID: 33405302 PMCID: PMC7883200 DOI: 10.1111/dth.14761] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/30/2020] [Indexed: 01/04/2023]
Abstract
Telogen effluvium (TE) is characterized by diffuse hair shedding 2‐3 months after a stressor, and COVID‐19 infection is potentially one such stressor. Those who were infected with the virus were under immense psychosocial and physiologic stress. We retrospectively reviewed electronic medical records of 552 patients who were evaluated by a Henry Ford Health System dermatologist between February 2020 and September 2020 and had a diagnosis of COVID‐19 infection. Ten patients were identified with TE attributed to COVID‐19 infection and described their presentations as a case series. For the ten patients selected, the mean age was 48.5 years old and 90% were female. Six of the patients were Black, one Middle Eastern, and three White. On average, the hair shedding began 50 days after the first symptom of COVID‐19 infection. About 80% of these patients were treated with antibiotics, systemic corticosteroids, and/or hydroxychloroquine for their COVID‐19 infection and 70% were hospitalized. The presentations of these patients suggest that COVID‐19 infection may be a significant trigger of TE. TE caused by hydroxychloroquine, azithromycin or other medications cannot be ruled out, and the global pandemic itself is a source of psychosocial stress. Further studies will be needed to understand the long‐term prevalence and prognosis of TE associated with COVID‐19 infection.
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Affiliation(s)
- Hailey Olds
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jesse Liu
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kevin Luk
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - David Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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