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Alghamdi F, Owen R, Ashton REM, Obotiba AD, Meertens RM, Hyde E, Faghy MA, Knapp KM, Rogers P, Strain WD. Post-acute COVID syndrome (long COVID): What should radiographers know and the potential impact for imaging services. Radiography (Lond) 2022; 28 Suppl 1:S93-S99. [PMID: 36109264 PMCID: PMC9468096 DOI: 10.1016/j.radi.2022.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Abstract
Objectives The COVID-19 pandemic caused an unprecedented health crisis resulting in over 6 million deaths worldwide, a figure, which continues to grow. In addition to the excess mortality, there are individuals who recovered from the acute stages, but suffered long-term changes in their health post COVID-19, commonly referred to as long COVID. It is estimated there are currently 1.8 million long COVID sufferers by May 2022 in the UK alone. The aim of this narrative literature review is to explore the signs, symptoms and diagnosis of long COVID and the potential impact on imaging services. Key findings Long COVID is estimated to occur in 9.5% of those with two doses of vaccination and 14.6% if those with a single dose or no vaccination. Long COVID is defined by ongoing symptoms lasting for 12 or more weeks post acute infection. Symptoms are associated with reductions in the quality of daily life and may involve multisystem manifestations or present as a single symptom. Conclusion The full impact of long COVID on imaging services is yet to be realised, but there is likely to be significant increased demand for imaging, particularly in CT for the assessment of lung disease. Educators will need to include aspects related to long COVID pathophysiology and imaging presentations in curricula, underpinned by the rapidly evolving evidence base. Implications for practice Symptoms relating to long COVID are likely to become a common reason for imaging, with a particular burden on Computed Tomography services. Planning, education and updating protocols in line with a rapidly emerging evidence base is going to be essential.
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Affiliation(s)
- F Alghamdi
- College of Medicine and Health, University of Exeter, Exeter, UK.
| | - R Owen
- Human Sciences Research Centre, University of Derby, Derby, UK
| | - R E M Ashton
- Human Sciences Research Centre, University of Derby, Derby, UK
| | - A D Obotiba
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - R M Meertens
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - E Hyde
- College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - M A Faghy
- Human Sciences Research Centre, University of Derby, Derby, UK
| | - K M Knapp
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - P Rogers
- Medical Imaging, Royal Devon and Exeter NHS Foundation Trust, UK
| | - W D Strain
- College of Medicine and Health, University of Exeter, Exeter, UK
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Nejatian MM, Sobhi S, Sanchez BN, Linn K, Manning L, Soh SC, Hiew J, Ritter JC, Yeap BB, Hamilton EJ. Reduction in femoral neck and total hip bone mineral density following hospitalisation for diabetes-related foot ulceration. Sci Rep 2021; 11:22742. [PMID: 34815495 PMCID: PMC8611081 DOI: 10.1038/s41598-021-02233-y] [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: 04/23/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
Management of diabetes-related foot ulceration (DFU) includes pressure offloading resulting in a period of reduced activity. The metabolic effects of this are unknown. This study aims to investigate changes in bone mineral density (BMD) and body composition 12 weeks after hospitalisation for DFU. A longitudinal, prospective, observational study of 22 people hospitalised for DFU was conducted. Total body, lumbar spine, hip and forearm BMD, and total lean and fat mass were measured by dual-energy X-ray absorptiometry (DXA) during and 12 weeks after hospitalisation for DFU. Significant losses in total hip BMD of the ipsilateral limb (- 1.7%, p < 0.001), total hip BMD of the contralateral limb (- 1.4%, p = 0.005), femoral neck BMD of the ipsilateral limb (- 2.8%, p < 0.001) and femoral neck BMD of the contralateral limb (- 2.2%, p = 0.008) were observed after 12 weeks. Lumbar spine and forearm BMD were unchanged. HbA1c improved from 75 mmol/mol (9.2%) to 64 mmol/mol (8.0%) (p = 0.002). No significant changes to lean and fat mass were demonstrated. Total hip and femoral neck BMD decreased bilaterally 12 weeks after hospitalisation for DFU. Future research is required to confirm the persistence and clinical implications of these losses.
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Affiliation(s)
- Marcel M Nejatian
- Medical School, The University of Western Australia, Perth, Australia
| | - Salar Sobhi
- Medical School, The University of Western Australia, Perth, Australia
| | - Blake N Sanchez
- Medical School, The University of Western Australia, Perth, Australia
| | - Kathryn Linn
- Department of Nuclear Medicine, Fiona Stanley Hospital, Perth, Australia
| | - Laurens Manning
- Medical School, The University of Western Australia, Perth, Australia.,Infectious Diseases Department, Fiona Stanley Hospital, Perth, Australia.,Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Perth, Australia
| | - Shuen-Chyn Soh
- Medical School, The University of Western Australia, Perth, Australia
| | - Jonathan Hiew
- Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Perth, Australia.,Department of Podiatry, Fiona Stanley Hospital, Perth, Australia
| | - J Carsten Ritter
- Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Perth, Australia.,Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia, Perth, Australia.,Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Perth, Australia.,Department of Endocrinology and Diabetes, Fiona Stanley Hospital, CD-09, 11 Robin Warren Drive, Murdoch, Perth, 6150, Australia
| | - Emma J Hamilton
- Medical School, The University of Western Australia, Perth, Australia. .,Multidisciplinary Diabetes Foot Unit, Fiona Stanley Hospital, Perth, Australia. .,Department of Endocrinology and Diabetes, Fiona Stanley Hospital, CD-09, 11 Robin Warren Drive, Murdoch, Perth, 6150, Australia.
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Hopkins SJ, Toms AD, Brown M, Appleboam A, Knapp KM. Disuse osteopenia following leg fracture in postmenopausal women: Implications for HIP fracture risk and fracture liaison services. Radiography (Lond) 2018; 24:151-158. [PMID: 29605113 DOI: 10.1016/j.radi.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Disuse osteopenia is a known consequence of reduced weight-bearing and has been demonstrated at the hip following leg injury but has not been specifically studied in postmenopausal women. METHOD Bilateral DXA (GE Lunar Prodigy) bone mineral density (BMD) measurements were taken at the neck of femur (NOF), total hip region (TH) and lumbar spine in postmenopausal female groups comprising controls (N = 43), new leg fractures (#<3wks) (N = 9), and participants who had sustained a leg fracture more than one year previously (#>1yr) (N = 24). #>1yr were assessed at a single visit and the remaining groups at intervals over twelve months. Weight-bearing, function, 3-day pedometer readings, and pain levels were also recorded. RESULTS The #<3wks demonstrated significant (p < 0.05) losses in ipsilateral TH BMD at 6 weeks from baseline 0.927 ± 0.137 g/cm2, to 0.916 ± 0.151 g/cm2 improving to 0.946 ± 0.135 g/cm2 (n.s) at 12 months following gradual return to normal function and weight-bearing activity. The #>1yr scored significantly below controls in almost all key physical and functional outcomes demonstrating a long-term deficit in hip bone density on the ipsilateral side. CONCLUSION The clinical significance of post-fracture reduction in hip BMD is a potential increased risk of hip fracture for a variable period that may be mitigated after return to normal function and weight-bearing. Improvement at 12 months in #<3wks is not consistent with #>1yr results indicating that long-term impairment in function and bone health may persist for some leg fracture patients. Unilateral bone loss could have implications for Fracture Liaison Services when assessing the requirement for medication post fracture.
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Affiliation(s)
| | - A D Toms
- Royal Devon and Exeter Hospital, UK
| | - M Brown
- Royal Devon and Exeter Hospital, UK
| | | | - K M Knapp
- University of Exeter Medical School, UK
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