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Schreiber CS, Wiesweg I, Stanelle-Bertram S, Beck S, Kouassi NM, Schaumburg B, Gabriel G, Richter F, Käufer C. Sex-specific biphasic alpha-synuclein response and alterations of interneurons in a COVID-19 hamster model. EBioMedicine 2024; 105:105191. [PMID: 38865747 PMCID: PMC11293593 DOI: 10.1016/j.ebiom.2024.105191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/02/2024] [Accepted: 05/25/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) frequently leads to neurological complications after recovery from acute infection, with higher prevalence in women. However, mechanisms by which SARS-CoV-2 disrupts brain function remain unclear and treatment strategies are lacking. We previously demonstrated neuroinflammation in the olfactory bulb of intranasally infected hamsters, followed by alpha-synuclein and tau accumulation in cortex, thus mirroring pathogenesis of neurodegenerative diseases such as Parkinson's or Alzheimer's disease. METHODS To uncover the sex-specific spatiotemporal profiles of neuroinflammation and neuronal dysfunction following intranasal SARS-CoV-2 infection, we quantified microglia cell density, alpha-synuclein immunoreactivity and inhibitory interneurons in cortical regions, limbic system and basal ganglia at acute and late post-recovery time points. FINDINGS Unexpectedly, microglia cell density and alpha-synuclein immunoreactivity decreased at 6 days post-infection, then rebounded to overt accumulation at 21 days post-infection. This biphasic response was most pronounced in amygdala and striatum, regions affected early in Parkinson's disease. Several brain regions showed altered densities of parvalbumin and calretinin interneurons which are involved in cognition and motor control. Of note, females appeared more affected. INTERPRETATION Our results demonstrate that SARS-CoV-2 profoundly disrupts brain homeostasis without neuroinvasion, via neuroinflammatory and protein regulation mechanisms that persist beyond viral clearance. The regional patterns and sex differences are in line with neurological deficits observed after SARS-CoV-2 infection. FUNDING Federal Ministry of Health, Germany (BMG; ZMV I 1-2520COR501 to G.G.), Federal Ministry of Education and Research, Germany (BMBF; 03COV06B to G.G.), Ministry of Science and Culture of Lower Saxony in Germany (14-76403-184, to G.G. and F.R.).
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Affiliation(s)
- Cara Sophie Schreiber
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany
| | - Ivo Wiesweg
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Sebastian Beck
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Nancy Mounogou Kouassi
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Berfin Schaumburg
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Gülsah Gabriel
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, Hamburg, Germany; Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Franziska Richter
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany.
| | - Christopher Käufer
- Department of Pharmacology, Toxicology, and Pharmacy; University of Veterinary Medicine Hannover, Hannover, Germany; Center for Systems Neuroscience Hannover (ZSN), Germany.
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Jiao T, Huang Y, Sun H, Yang L. Research progress of post-acute sequelae after SARS-CoV-2 infection. Cell Death Dis 2024; 15:257. [PMID: 38605011 PMCID: PMC11009241 DOI: 10.1038/s41419-024-06642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
SARS-CoV-2 has spread rapidly worldwide and infected hundreds of millions of people worldwide. With the increasing number of COVID-19 patients discharged from hospitals, the emergence of its associated complications, sequelae, has become a new global health crisis secondary to acute infection. For the time being, such complications and sequelae are collectively called "Post-acute sequelae after SARS-CoV-2 infection (PASC)", also referred to as "long COVID" syndrome. Similar to the acute infection period of COVID-19, there is also heterogeneity in PASC. This article reviews the various long-term complications and sequelae observed in multiple organ systems caused by COVID-19, pathophysiological mechanisms, diagnosis, and treatment of PASC, aiming to raise awareness of PASC and optimize management strategies.
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Affiliation(s)
- Taiwei Jiao
- Department of Gastroenterology and Endoscopy, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Yuling Huang
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China
| | - Haiyan Sun
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, 110001, P.R. China.
| | - Lina Yang
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China.
- Department of International Physical Examination Center, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, P.R. China.
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Yu M, Zhang C, Wan S, Lu Y, Wang Y, Liu T, Wang H, Chen W, Liu Y. NEW PREDICTIVE BIOMARKERS FOR SCREENING COVID-19 PATIENTS WITH RHABDOMYOLYSIS IN COMBINATION WITH CYSTATIN C. Shock 2024; 61:549-556. [PMID: 38010067 DOI: 10.1097/shk.0000000000002258] [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
ABSTRACT Purpose: Cystatin C (CysC) has been linked to the prognosis of corona virus disease 2019 (COVID-19). The study aims to investigate a predictor correlated with CysC screening for poor prognosis in COVID-19 patients combined with skeletal muscle (SKM) impairment and rhabdomyolysis (RM). Methods: A single-center retrospective cohort analysis was carried out. Demographic information, clinical data, laboratory test results, and clinical outcome data were gathered and analyzed. Results: According to the inclusion and exclusion criteria, 382 patients were included in this study. The subjects were divided into three groups based on CysC tertiles. Multivariate analysis revealed that SaO 2 (hazard ratio [HR], 0.946; 95% confidence interval [CI], 0.906-0.987; P = 0.011), CysC (HR, 2.124; 95% CI, 1.223-3.689; P = 0.008), aspartate aminotransferase (AST) (HR, 1.009; 95% CI, 1.000-1.018; P = 0.041), and hypersensitive C-reactive protein (HR, 1.005; 95% CI, 1.000-1.010; P = 0.045) were significantly associated with survivals. The area under curve (AUC) in the model characterized by RM incidence was 0.819 (0.698-0.941), as shown by CysC receiver operating characteristic curves. LDH*CysC and AST*CysC had better predictive values than CysC and the best prediction for RM, with an AUC of 0.880 (0.796,0.964) for LDH*CysC ( P < 0.05, vs CysC) and 0.925 (0.878,0.972) for AST*CysC ( P < 0.05, vs CysC). Conclusion: CysC is an essential evaluation indicator for COVID-19 patients' prognosis. AST*CysC and LDH*CysC have superior predictive value to CysC for SKM, RM, and death, and optimal classification for RM.
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Affiliation(s)
- Mengyang Yu
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Chengying Zhang
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Sitong Wan
- Department of Nutrition and Health, Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food Quality, China Agricultural University, Beijing, China
| | - Yang Lu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Yufei Wang
- Clinical Laboratory Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Ting Liu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Huimin Wang
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Wei Chen
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
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Brogna C, Montano L, Zanolin ME, Bisaccia DR, Ciammetti G, Viduto V, Fabrowski M, Baig AM, Gerlach J, Gennaro I, Bignardi E, Brogna B, Frongillo A, Cristoni S, Piscopo M. A retrospective cohort study on early antibiotic use in vaccinated and unvaccinated COVID-19 patients. J Med Virol 2024; 96:e29507. [PMID: 38504586 DOI: 10.1002/jmv.29507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024]
Abstract
The bacteriophage behavior of SARS-CoV-2 during the acute and post-COVID-19 phases appears to be an important factor in the development of the disease. The early use of antibiotics seems to be crucial to inhibit disease progression-to prevent viral replication in the gut microbiome, and control toxicological production from the human microbiome. To study the impact of specific antibiotics on recovery from COVID-19 and long COVID (LC) taking into account: vaccination status, comorbidities, SARS-CoV-2 wave, time of initiation of antibiotic therapy and concomitant use of corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). A total of 211 COVID-19 patients were included in the study: of which 59 were vaccinated with mRNA vaccines against SARS-CoV-2 while 152 were unvaccinated. Patients were enrolled in three waves: from September 2020 to October 2022, corresponding to the emergence of the pre-Delta, Delta, and Omicron variants of the SARS-CoV-2 virus. The three criteria for enrolling patients were: oropharyngeal swab positivity or fecal findings; moderate symptoms with antibiotic intake; and measurement of blood oxygen saturation during the period of illness. The use of antibiotic combinations, such as amoxicillin with clavulanic acid (875 + 125 mg tablets, every 12 h) plus rifaximin (400 mg tablets every 12 h), as first choice, as suggested from the previous data, or azithromycin (500 mg tablets every 24 h), plus rifaximin as above, allows healthcare professionals to focus on the gut microbiome and its implications in COVID-19 disease during patient care. The primary outcome measured in this study was the estimated average treatment effect, which quantified the difference in mean recovery between patients receiving antibiotics and those not receiving antibiotics at 3 and 9 days after the start of treatment. In the analysis, both vaccinated and unvaccinated groups had a median illness duration of 7 days (interquartile range [IQR] 6-9 days for each; recovery crude hazard ratio [HR] = 0.94, p = 0.700). The median illness duration for the pre-Delta and Delta waves was 8 days (IQR 7-10 days), while it was shorter, 6.5 days, for Omicron (IQR 6-8 days; recovery crude HR = 1.71, p < 0.001). These results were confirmed by multivariate analysis. Patients with comorbidities had a significantly longer disease duration: median 8 days (IQR 7-10 days) compared to 7 days (IQR 6-8 days) for those without comorbidities (crude HR = 0.75, p = 0.038), but this result was not confirmed in multivariate analysis as statistical significance was lost. Early initiation of antibiotic therapy resulted in a significantly shorter recovery time (crude HR = 4.74, p < 0.001). Concomitant use of NSAIDs did not reduce disease duration and in multivariate analysis prolonged the disease (p = 0.041). A subgroup of 42 patients receiving corticosteroids for a median of 3 days (IQR 3-6 days) had a longer recovery time (median 9 days, IQR 8-10 days) compared to others (median 7 days, IQR 6-8 days; crude HR = 0.542, p < 0.001), as confirmed also by the adjusted HR. In this study, a statistically significant reduction in recovery time was observed among patients who received early antibiotic treatment. Early initiation of antibiotics played a crucial role in maintaining higher levels of blood oxygen saturation. In addition, it is worth noting that a significant number of patients who received antibiotics in the first 3 days and for a duration of 7 days, during the acute phase did not develop LC.
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Affiliation(s)
- Carlo Brogna
- Craniomed Group Srl. Research Facility, Bresso, Italy
| | - Luigi Montano
- Andrology Unit and Service of Lifestyle Medicine in Uro-Andrology, Local Health Authority (ASL), Salerno, Italy
| | | | | | - Gianluca Ciammetti
- Otorhinolaryngology Unit, Hospital Ferdinando Veneziale Isernia, Regional Health Authority of Molise, Italy
| | | | - Mark Fabrowski
- Department of Emergency Medicine, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Abdul M Baig
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Iapicca Gennaro
- Pineta Grande Hospital Group, Department of Urology, Santa Rita Clinic, Atripalda, Italy
| | | | - Barbara Brogna
- Department of Radiology, Moscati Hospital, Avellino, Italy
| | | | | | - Marina Piscopo
- Department of Biology, University of Naples Federico II, Naples, Italy
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Yang XY, Liu T, Jiang SC, Zhang ZW, Fu YF, Li ZL, Hu J, Yuan S. Antibodies against SARS-CoV-2 non-structural protein 3 cross-react with human muscle cells and neuroglial cells. Vaccine 2024; 42:1259-1267. [PMID: 38281898 DOI: 10.1016/j.vaccine.2024.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/23/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
Coronavirus Disease 2019 (COVID-19) vaccines protect the public and limit viral spread. However, inactivated viral vaccines use the whole virus particle, which contains many non-capsid proteins that may cause adverse immune responses. A report has found that the ADP-ribose-binding domains of SARS-CoV-2 non-structural protein 3 (NSP3) and human poly(ADP-ribose) polymerase family member 14 (PARP14) share a significant degree of homology. Here, we further show that antibodies against 2019 novel SARS-like coronavirus (SARS-CoV-2) NSP3 can bind human PARP14 protein. However, when G159R + G162R mutations were introduced into NSP3, the antibody titer against human PARP14 decreased 14-fold. Antibodies against SARS-CoV-2 NSP3 can cross-react with human skeletal muscle cells and astrocytes, but not human embryonic kidney 293T cells. However, when G159R + G162R mutations were introduced into NSP3, the cross-reaction was largely inhibited. The results imply that COVID-19 patients with high antibody titers against NSP3 may have high risks of muscular and/or neurological complications. And the possible strategies to improve the safety of inactivated viral vaccines are also discussed.
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Affiliation(s)
- Xin-Yue Yang
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China
| | - Ting Liu
- Sichuan Kelun Pharmaceutical Comp. Ltd., Chengdu 610071, China
| | - Si-Cong Jiang
- Haisco Pharmaceutical Group Comp. Ltd., Chengdu 611138, China
| | - Zhong-Wei Zhang
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China
| | - Yu-Fan Fu
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China
| | - Zi-Lin Li
- Department of Cardiovascular Surgery, Xijing Hospital, Medical University of the Air Force, Xi'an 710032, China
| | - Jing Hu
- School of Medicine, Northwest University, Xi'an 710069, China
| | - Shu Yuan
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China.
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da Silva LNM, Filho AGO, Guimarães JB. Musculoskeletal manifestations of COVID-19. Skeletal Radiol 2023:10.1007/s00256-023-04549-4. [PMID: 38117308 DOI: 10.1007/s00256-023-04549-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
During the COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected millions of people worldwide, with acute respiratory distress syndrome (ARDS) being the most common severe condition of pulmonary involvement. Despite its involvement in the lungs, SARS-CoV-2 causes multiple extrapulmonary manifestations, including manifestations in the musculoskeletal system. Several cases involving bone, joint, muscle, neurovascular and soft tissues were reported shortly after pandemic onset. Even after the acute infection has resolved, many patients experience persistent symptoms and a decrease in quality of life, a condition known as post-COVID syndrome or long COVID. COVID-19 vaccines have been widely available since December 2020, preventing millions of deaths during the pandemic. However, adverse reactions, including those involving the musculoskeletal system, have been reported in the literature. Therefore, the primary goal of this article is to review the main imaging findings of SARS-CoV-2 involvement in the musculoskeletal system, including acute, subacute, chronic and postvaccination manifestations.
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Affiliation(s)
- Lucas N M da Silva
- Department of Musculoskeletal Radiology, Grupo Fleury, Sao Paulo, Brazil
| | | | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Grupo Fleury, Sao Paulo, Brazil.
- Department of Radiology, Universidade Federal de Sao Paulo, UNIFESP-EPM, Sao Paulo, Brazil.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
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7
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Sathu S, Kumar R, Maley DK, Eppakayala S, Kashyap A, NynaSindhu A, Madhu Latha K, Lakkireddy M. Increased Frequency of Low Back Pain in Recent Times: Does the Answer Lie in COVID-19? Cureus 2023; 15:e50021. [PMID: 38186417 PMCID: PMC10767474 DOI: 10.7759/cureus.50021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background The COVID-19 pandemic has impacted many people's activities of daily living and health. It has also created economic burdens and caused mental turmoil across the world. Musculoskeletal symptoms, especially low back pain, have been observed in subjects of post-COVID-19 infection and post-vaccination. Aim In this study, we aimed to investigate the relationship between low back pain and COVID-19 infection and vaccination, as well as associated factors and characteristics. Methods We conducted a questionnaire-based cross-sectional observational study at All India Institute of Medical Science (AIIMS) Bibinagar between September 2021 and March 2022. We collected data from individuals through physical and Google Forms (Google, Mountain View, California). Results We included a total of 535 individuals in the study: 274 (51.2%) were previously positive for COVID-19 infection (group A), and 261 (48.8%) were vaccinated against COVID-19 without a history of COVID-19 infection (group B). Each group was divided into two categories based on whether they had low back pain before COVID-19 infection or vaccination. In group A, 90.1% of individuals experienced an aggravation of low back pain after COVID-19 infection, which was found to be significant (p<0.001). In group B, there was an insignificant increase in low back pain following COVID-19 vaccination (p=0.275). The study also revealed a significant association between comorbidities and low back pain in both groups (p<0.001). Additionally, several differences were observed between the two groups, including duration (p<0.001), severity (p=0.012), and intensity (p<0.001) of low back pain, usage of a back support or brace (p=0.043), and intake of vitamin D (p=0.002). Conclusion Low back pain is an ignored feature of one of the musculoskeletal symptoms of COVID-19 and was aggravated by COVID-19 infection in our patients compared to those who received the vaccination. The findings of this study have implications for raising awareness, improving management and rehabilitation, and guiding future research in this area.
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Affiliation(s)
- Sreedhar Sathu
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Ravi Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Rajkot, Rajkot, IND
| | - Deepak K Maley
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Srikanth Eppakayala
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Adinarayana Kashyap
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Akula NynaSindhu
- Department of General Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Karra Madhu Latha
- Department of Biochemistry, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Maheshwar Lakkireddy
- Department of Orthopedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
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Carrasco-Garrido P, Palacios-Ceña D, Hernández-Barrera V, Jiménez-Trujillo I, Gallardo-Pino C, Fernández-de-las-Peñas C. Patterns of Opioid and Non-Opioid Analgesic Consumption in Patients with Post-COVID-19 Conditions. J Clin Med 2023; 12:6586. [PMID: 37892724 PMCID: PMC10607000 DOI: 10.3390/jcm12206586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Pain is a major health issue for healthcare systems, and access to pain treatment is a fundamental human right. Pain is a common symptom experienced in the post-COVID phase by a significant percentage of patients. This study describes the prevalence and associated factors associated with the use of opioid and non-opioid analgesics in subjects with post-COVID-19 condition. Sociodemographic data, post-COVID symptoms, health profile, and opioid and non-opioid analgesic consumption were collected in 390 subjects with post-COVID-19 condition. We analyzed the independent effect of all variables on opioid/non-opioid analgesic consumption by using logistic multivariate regressions. The prevalence of opioid and non-opioid analgesic consumption was 24.1% and 82.3%, respectively. Tramadol (17.18%) and codeine (7.95%) were the most commonly used opioid analgesics, and Paracetamol (70%) and ibuprofen (45.4%) were the most commonly used non-opioid analgesics. Females were more likely to consume non-opioid analgesics (aOR2.20, 95%CI 1.15, 4.22) than males. Marital status of married/partner vs. single (aOR2.96; 95% CI 1.43, 6.12), monthly income < EUR 1000 VS. > EUR 2000 (aOR3.81; 95% CI 1.37, 10.61), number of post-COVID symptoms < 5 (aOR2.64, 95%CI 1.18, 5.87), and anxiolytics consumption (aOR 1.85, 95%CI 1.05, 3.25) were associated with a greater likelihood of opioid analgesic consumption. Age > 55 years (aOR3.30, 95%CI 1.34, 8.09) and anxiolytics consumption (aOR2.61, 95%CI 1.36, 4.98) were associated with a greater likelihood of non-opioid analgesic consumption. Opioid analgesic consumption was highly associated (aOR 3.41, 95%CI 1.27, 6.11) with non-opioid analgesic consumption. The prevalence of opioid analgesic and non-opioid analgesic consumption in individuals with post-COVID-19 condition was 24.1% and 82.3%. Females with post-COVID-19 condition showed higher non-opioid analgesic consumption than men. Predictors of opioid consumption were marital status, lower monthly income, number of post-COVID symptoms, and anxiolytic consumption. Older age and anxiolytic consumption were predictors of non-opioid consumption.
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Affiliation(s)
- Pilar Carrasco-Garrido
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Avenida Atenas s/n, Alcorcon, 28922 Madrid, Spain; (V.H.-B.); (I.J.-T.); (C.G.-P.)
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. Atenas s/n. Alcorcón, 28922 Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Universidad Rey Juan Carlos, Avenida Atenas s/n, Alcorcon, 28922 Madrid, Spain; (D.P.-C.); (C.F.-d.-l.-P.)
| | - Valentín Hernández-Barrera
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Avenida Atenas s/n, Alcorcon, 28922 Madrid, Spain; (V.H.-B.); (I.J.-T.); (C.G.-P.)
| | - Isabel Jiménez-Trujillo
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Avenida Atenas s/n, Alcorcon, 28922 Madrid, Spain; (V.H.-B.); (I.J.-T.); (C.G.-P.)
| | - Carmen Gallardo-Pino
- Department of Medical Specialties and Public Health, Health Sciences Faculty, Universidad Rey Juan Carlos, Avenida Atenas s/n, Alcorcon, 28922 Madrid, Spain; (V.H.-B.); (I.J.-T.); (C.G.-P.)
| | - Cesar Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Health Sciences Faculty, Universidad Rey Juan Carlos, Avenida Atenas s/n, Alcorcon, 28922 Madrid, Spain; (D.P.-C.); (C.F.-d.-l.-P.)
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de Oliveira Soares Junior A, Dos Santos Afonso M, Vieira YP, Rocha JQS, Dumith S, Neves RG, da Silva CN, Duro SMS, de Oliveira Saes M. Musculoskeletal pain during and after SARS-CoV-2 infection and healthcare utilization: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:685. [PMID: 37644443 PMCID: PMC10463908 DOI: 10.1186/s12891-023-06794-z] [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: 03/01/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated the reorganization of health services to cater to the needs of individuals affected by the virus. OBJECTIVE This study aimed to examine the association between musculoskeletal pain during and after SARS-CoV-2 infection and the utilization of health services among adults in southern Brazil. METHODS: A cross-sectional study was conducted with individuals aged 18 years and older, who were diagnosed with COVID-19 between December 2020 and March 2021. Questionnaires were electronically collected using tablets through the REDCap platform via phone calls. The health service utilization outcomes assessed included Primary Health Care, general practitioners, private emergency care, and specialized services. The exposure variable was the presence of musculoskeletal pain during and after SARS-CoV-2 infection in different regions, such as cervical, upper limbs, thoracic, lumbar, and lower limbs. Poisson regression analysis was employed to assess the relationship between health service utilization during and after SARS-CoV-2 infection and musculoskeletal pain during and after the infection with SARS-CoV-2 among adults in southern Brazil. Data were analyzed using the Stata 16.1 statistical package. RESULTS: A total of 2,919 individuals were interviewed. Overall, individuals with musculoskeletal pain were found to utilize health services approximately 15 percentage points higher when compared to those without musculoskeletal pain. In adjusted analysis, individuals who reported musculoskeletal pain during and after SARS-CoV-2 infection were up to twice as likely to use health services. Among them, the emergency care unit was the most frequently used service, particularly in those with pain in the lower limbs (RP=2.19, 95% CI 1.66-2.87) and thoracic region (RP=2.04, 95% CI 1.47-2.84). Notably, the highest magnitudes of association were observed with emergency care units, specialist doctors, and specialized services, especially neurologists, who were two to three times more likely to be sought, followed by pulmonologists. CONCLUSION: Health service utilization was significantly associated with musculoskeletal pain during and after SARS-CoV-2 infection. All regions, except for the cervical region, showed a correlation with the use of Primary Health Care. The thoracic region featured an association with pulmonologists and emergency room utilization. Additionally, health services like emergency care units, specialist doctors, and specialized services, including cardiologists and neurologists, were commonly utilized across all regions in southern Brazil.
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Affiliation(s)
| | | | | | | | - Samuel Dumith
- Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
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10
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Hodifa Y, Khalayli N, Hodaifa A, Kudsi M. Remitting seronegative symmetrical synovitis with pitting edema syndrome postsecond COVID-19 vaccination: a case report. Ann Med Surg (Lond) 2023; 85:4118-4120. [PMID: 37554915 PMCID: PMC10406070 DOI: 10.1097/ms9.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Coronavirus disease 19 (COVID-19) has become the most serious public health crisis of our generation, and vaccines are effective in preventing its infection. Remitting seronegative symmetrical synovitis with pitting edema is an idiopathic rare benign syndrome, but it could be secondary to aautoimmune diseases. Here, the authors reported the first case of this syndrome's development after COVID-19 vaccination. CASE PRESENTATION A 52-year-old woman presented with hand edema, arthralgia, and morning stiffness, after receiving the second dose of m RNA COVID-19 vaccination. Examination revealed edema in the dorsum of both hands and symmetrical tenderness of the shoulders, elbows, wrists, knees, and ankles. Blood test results were normal except for elevated levels of C-reactive protein. The immune profile and the tuberculin test were also negative. A hand radiograph showed soft tissue edema. Ultrasonography of the extremities has shown tenosynovitis. Remitting seronegative symmetrical synovitis with pitting edema syndrome was diagnosed according to the diagnostic criteria. She was treated with 30 mg/day prednisolone, with a complete disappearance of edema and arthralgia after 10 days, and the C-reactive protein level was decreased. CLINICAL DISCUSSION Vaccines are still the most effective and protective method against COVID-19 infection, but it may trigger an immunological response. Remitting seronegative symmetrical synovitis with pitting edema (or sometimes RS 3 PE) is a rare nonunderstood syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of hands and/or feet, and a negative serum rheumatoid factor, with an excellent prognosis to treatment with steroid. Usually occurred in the old aged population, young patients' cases were mentioned. As the authors did not find any data about our subject, this is the first case of this syndrome development after the second dose of COVID-19 vaccination. CONCLUSION The occurrence of acute symmetrical seronegative polysynovitis with extremities edema, in the elderly, should guide toward the diagnosis of this syndrome.
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Affiliation(s)
| | | | | | - Maysoun Kudsi
- Rheumatology, Faculty of Medicine, Damascus University, Damascus, Syria Arab Republic
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11
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Ousseiran ZH, Fares Y, Chamoun WT. Neurological manifestations of COVID-19: a systematic review and detailed comprehension. Int J Neurosci 2023; 133:754-769. [PMID: 34433369 PMCID: PMC8506813 DOI: 10.1080/00207454.2021.1973000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 08/16/2021] [Indexed: 12/13/2022]
Abstract
The current pandemic caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is accompanied with a rapid increase of reports and papers detailing its neurological effects and symptoms. The virus infection causes respiratory illness named by the world health organization as corona virus 19 (COVID-19).This systematic review aims to study and summarize the different neurological manifestations of this virus. All articles published and indexed via Pubmed, Medline and Google Scholar databases between January 1st 2020 and February 28th 2021 that reported neurological symptoms of SARS-CoV-2 are reviewed following the Preferred Reporting Items for Systemic review and Meta-Analysis (PRISMA) guidelines.We included data from 113 articles: eight prospective studies, 25 retrospective studies and the rest were case reports/series. COVID-19 can present with central nervous system manifestations, such as headache, encephalitis and encephalopathy, peripheral nervous system manifestations, such as anosmia, ageusia and Guillian Barre syndrome, and skeletal muscle manifestations, such as myalgia and myasthenia gravis. Our systematic review showed that COVID-19 can be manifested by a wide spectrum of neurological symptoms reported either in the early stage or within the course of the disease. However, a detailed comprehension of these manifestations is required and more studies are needed in order to improve our scientific knowledge and to develop preventive and therapeutic measures to control this pandemic.
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Affiliation(s)
- Zeina Hassan Ousseiran
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Wafaa Takash Chamoun
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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12
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Alnamlah OS, Almarwani MM. Musculoskeletal pain post-COVID-19 in patients undergoing physical therapy in Saudi Arabia: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:507. [PMID: 37344796 DOI: 10.1186/s12891-023-06647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The COVID-19 (coronavirus disease 2019) pandemic has posed a challenge to the physical therapy service. In addition to pandemic-associated treatment interference, many recovered COVID-19 patients developed new or worsening musculoskeletal pain as a sequela of COVID-19, which has been shown to affect the musculoskeletal system. The objective of the study was to examine musculoskeletal pain post-COVID-19 in patients undergoing physical therapy in Saudi Arabia. METHODS The design of the study was a cross-sectional study. We approached patients attending physical therapy clinics who had COVID-19. Data were collected through an electronic survey consisting of multiple-choice questions related to sociodemographic data and pain. Pain severity was rated on a 10-point numerical rating scale. RESULTS A total of 85 recovered COVID-19 patients participated in this study, 30 had musculoskeletal pain prior to getting COVID-19, while 55 acquired it after. The most affected sites for musculoskeletal pain were the lower back and shoulder. Mean pain levels reported increased from 4.48 ± 2.54 pre-COVID-19 to 6.92 ± 8.06 post-COVID-19 (mean difference, 1.61 ± 2.61; t = 5.68; p < 0.0001). Mean pain scores did not associate significantly with demographic or clinical factors. Patient responses skewed toward increased pain as well as decreased activity levels after being infected with COVID-19 versus pre-COVID-19 (all p < 0.0001). CONCLUSIONS Recovered COVID-19 patients reported increased pain intensity and frequency, together with reduced activity levels, relative to pre-COVID-19 levels, without effects of sociodemographic or clinical characteristics.
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Affiliation(s)
- Ohoud S Alnamlah
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Maha M Almarwani
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia.
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13
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Pattanaik A, Bhandarkar B S, Lodha L, Marate S. SARS-CoV-2 and the nervous system: current perspectives. Arch Virol 2023; 168:171. [PMID: 37261613 DOI: 10.1007/s00705-023-05801-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/15/2023] [Indexed: 06/02/2023]
Abstract
SARS-CoV-2 infection frequently causes neurological impairment in both adults and children. Recent publications have described significant aspects of the viral pathophysiology associated with neurological dysfunction. In theory, neurological manifestations following SARS-CoV-2 infection may be caused directly by the effects of the virus infecting the brain or indirectly by the local and systemic immune responses against the virus. Neurological manifestations can occur during the acute phase as well as in the post-acute phase of the infection. In this review, we discuss recent literature describing the association of nervous system disorders with COVID-19.
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Affiliation(s)
- Amrita Pattanaik
- Manipal Institute of Virology, Manipal Academy of Higher Education (MAHE), PIN-576104, Manipal, Karnataka, India.
| | - Sushma Bhandarkar B
- Manipal Institute of Virology, Manipal Academy of Higher Education (MAHE), PIN-576104, Manipal, Karnataka, India
| | - Lonika Lodha
- Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), PIN-560029, Bengaluru, Karnataka, India
| | - Srilatha Marate
- Manipal Institute of Virology, Manipal Academy of Higher Education (MAHE), PIN-576104, Manipal, Karnataka, India
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14
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Park JM, Woo W, Lee SC, Park S, Yon DK, Lee SW, Smith L, Koyanagi A, Shin JI, Kim YW. Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence. Neuroepidemiology 2023; 57:129-147. [PMID: 37044073 DOI: 10.1159/000530536] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19), a global pandemic, has infected approximately 10% of the world's population. This comprehensive review aimed to determine the prevalence of various neurological disorders in COVID-19 without overlapping meta-analysis errors. METHODS We searched for meta-analyses on neurological disorders following COVID-19 published up to March 14, 2023. We obtained 1,184 studies, of which 44 meta-analyses involving 9,228,588 COVID-19 patients were finally included. After confirming the forest plot of each study and removing overlapping individual studies, a re-meta-analysis was performed using the random-effects model. RESULTS The summarized combined prevalence of each neurological disorder is as follows: stroke 3.39% (95% confidence interval, 1.50-5.27), dementia 6.41% (1.36-11.46), multiple sclerosis 4.00% (2.50-5.00), epilepsy 5.36% (-0.60-11.32), Parkinson's disease 0.67% (-1.11-2.45), encephalitis 0.66% (-0.44-1.77), and Guillain-Barré syndrome 3.83% (-0.13-7.80). In addition, the mortality risk of patients with comorbidities of COVID-19 is as follows: stroke OR 1.63 (1.23-2.03), epilepsy OR 1.71 (1.00-2.42), dementia OR 1.90 (1.31-2.48), Parkinson's disease OR 3.94 (-2.12-10.01). CONCLUSION Our results show that the prevalence and mortality risk may increase in some neurological diseases during the COVID-19 pandemic. Future studies should elucidate the precise mechanisms for the link between COVID-19 and neurological diseases, determine which patient characteristics predispose them to neurological diseases, and consider potential global patient management.
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Affiliation(s)
- Jong Mi Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
- Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, ISCIII, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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15
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Sahin BE, Celikbilek A, Kocak Y, Koysuren A, Hizmali L. Associations of the neutrophil/lymphocyte ratio, monocyte/ lymphocyte ratio, and platelet/lymphocyte ratio with COVID-19 disease severity in patients with neurological symptoms: A cross-sectional monocentric study. J Neurosci Rural Pract 2023; 14:224-229. [PMID: 37181197 PMCID: PMC10174155 DOI: 10.25259/jnrp_6_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives Data are limited regarding the relationship of neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/ lymphocyte ratio (PLR) with neurological symptoms (NS) in COVID-19 patients. This study is the first to assess the utility of the NLR, MLR, and PLR for predicting COVID-19 severity in infected patients with NS. Materials and Methods Consecutive 192 PCR-positive COVID-19 patients with NS were included in this cross-sectional and prospective study. The patients were classified into the non-severe and severe groups. We analyzed routinely complete blood count in these groups in terms of COVID-19 disease severity. Results Advanced age, a higher body mass index, and comorbidities were significantly more common in the severe group (P < 0.001). Among the NS, anosmia (P = 0.001) and memory loss (P = 0.041) were significantly more common in the non-severe group. In the severe group, the lymphocytes and monocyte counts and the hemoglobin level were significantly lower, while the neutrophil count, NLR, and PLR were significantly higher (all P < 0.001). In the multivariate model, advanced age and a higher neutrophil count were independently associated with severe disease (both P < 0.001) but the NLR and PLR were not (both P > 0.05). Conclusion We found positive associations of COVID-19 severity with the NLR and PLR in infected patients with NS. Further research is required to shed more light on the role of neurological involvement in disease prognosis and outcomes.
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Affiliation(s)
- Burc Esra Sahin
- Department of Neurology, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Asuman Celikbilek
- Department of Neurology, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Yusuf Kocak
- Department of Neurology, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Aydan Koysuren
- Department of Neurology, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Lokman Hizmali
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
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16
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Türken A, Çapar H. Vaccine hesitancy in patients with COVID-19 who have back pain. Osong Public Health Res Perspect 2023; 14:100-109. [PMID: 37183330 PMCID: PMC10211457 DOI: 10.24171/j.phrp.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVES Musculoskeletal pain is among the most common symptoms in patients diagnosed with coronavirus disease 2019 (COVID-19), and it has placed a significant burden on health worldwide during the pandemic. This study explored vaccine hesitancy and associated factors in patients with positive COVID-19 polymerase chain reaction test results who were hospitalized and had back pain. METHODS A cross-sectional study was conducted among 170 hospitalized COVID-19 patients over 18 years of age. Data were analyzed using descriptive statistics with IBM SPSS ver. 25.0. RESULTS COVID-19 patients who were married considered COVID-19 vaccinations riskier than unmarried COVID-19 patients. Patients who had not been vaccinated expressed higher levels of distrust towards COVID-19 vaccines than patients who had been vaccinated. Participants had relatively little hesitation toward the Sinovac vaccine. High vaccine confidence was found in all participants regardless of vaccination status. Those who had not received the COVID-19 vaccine reported higher risk perceptions than those who had received at least 1 dose of any COVID-19 vaccine. CONCLUSION Measurements of the hesitancy of vaccinated and non-vaccinated patients or members of society towards vaccines can be an important parameter for health authorities to find solutions.
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Affiliation(s)
- Askeri Türken
- Department of Physical Medicine and Rehabilitation, Gazi Yaşargil Education and Research Hospital, University of Health Sciences, Diyarbakır, Turkey
| | - Haşim Çapar
- Department of Health Management, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
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17
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Romero DE, Muzy J, Maia LR, Almeida WDSD, Silva DRPD, Malta DC, Souza Junior PRBD. Factors associated with the incidence and worsening of back pain during the first wave of COVID-19 in Brazil. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023283.13042022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Abstract The article aims to estimate the incidence and worsening of back pain (BP) during the first wave of COVID-19 in Brazil, as well as to investigate demographic, socioeconomic factors and associated changes in living conditions. ConVid - Behavior Research, applied between April and May 2020, was used as data source. The number and distribution of respondents who developed BP and those who had a worsening of the preexisting problem, their 95% confidence intervals and Pearson’s Chi-square test were estimated. The odds ratio of developing BP or worsening a preexisting problem was also estimated using multiple logistic regression models. Pre-existing BP was reported by 33.9% (95%CI 32.5-35.3) of respondents and more than half (54.4%; 95%CI 51.9-56.9) had worsened. The cumulative incidence of BP in the first wave of the pandemic was 40.9% (95%CI 39.2-42.7). Being a woman, the perceived increase in housework and the frequent feeling of sadness or depression were associated with both outcomes. Socioeconomic factors were not associated with any of outcome. The high incidence and worsening of BP during the first wave reveal the need for studies in more recent periods, given the long duration of the pandemic.
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18
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Romero DE, Muzy J, Maia LR, Almeida WDSD, Silva DRPD, Malta DC, Souza Junior PRBD. Factors associated with the incidence and worsening of back pain during the first wave of COVID-19 in Brazil. CIENCIA & SAUDE COLETIVA 2023; 28:771-784. [PMID: 36888861 DOI: 10.1590/1413-81232023283.13042022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/15/2022] [Indexed: 03/08/2023] Open
Abstract
The article aims to estimate the incidence and worsening of back pain (BP) during the first wave of COVID-19 in Brazil, as well as to investigate demographic, socioeconomic factors and associated changes in living conditions. ConVid - Behavior Research, applied between April and May 2020, was used as data source. The number and distribution of respondents who developed BP and those who had a worsening of the preexisting problem, their 95% confidence intervals and Pearson's Chi-square test were estimated. The odds ratio of developing BP or worsening a preexisting problem was also estimated using multiple logistic regression models. Pre-existing BP was reported by 33.9% (95%CI 32.5-35.3) of respondents and more than half (54.4%; 95%CI 51.9-56.9) had worsened. The cumulative incidence of BP in the first wave of the pandemic was 40.9% (95%CI 39.2-42.7). Being a woman, the perceived increase in housework and the frequent feeling of sadness or depression were associated with both outcomes. Socioeconomic factors were not associated with any of outcome. The high incidence and worsening of BP during the first wave reveal the need for studies in more recent periods, given the long duration of the pandemic.
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Affiliation(s)
- Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | - Jessica Muzy
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | - Leo Ramos Maia
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | | | | | - Paulo Roberto Borges de Souza Junior
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
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19
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Evcik D. Musculoskeletal involvement: COVID-19 and post COVID 19. Turk J Phys Med Rehabil 2023; 69:1-7. [PMID: 37201006 PMCID: PMC10186015 DOI: 10.5606/tftrd.2023.12521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 05/20/2023] Open
Abstract
The worldwide pandemic of coronavirus disease 2019 (COVID-19) was known to predominantly affect the lungs, but it was realized that COVID-19 had a large variety of clinical involvement. Cardiovascular, gastrointestinal, neurological, and musculoskeletal systems are involved by direct or indirect mechanisms with various manifestations. The musculoskeletal involvement can manifest during COVID-19 infection, due to medications used for the treatment of COVID-19, and in the post/long COVID-19 syndrome. The major symptoms are fatigue, myalgia/arthralgia, back pain, low back pain, and chest pain. During the last two years, musculoskeletal involvement increased, but no clear consensus was obtained about the pathogenesis. However, there is valuable data that supports the hypothesis of angiotensinconverting enzyme 2, inflammation, hypoxia, and muscle catabolism. Additionally, medications that were used for treatment also have musculoskeletal adverse effects, such as corticosteroid-induced myopathy and osteoporosis. Therefore, while deciding the drugs, priorities and benefits should be taken into consideration. Symptoms that begin three months from the onset of the COVID-19 infection, continue for at least two months, and cannot be explained by another diagnosis is accepted as post/long COVID-19 syndrome. Prior symptoms may persist and fluctuate, or new symptoms may manifest. In addition, there must be at least one symptom of infection. Most common musculoskeletal symptoms are myalgia, arthralgia, fatigue, back pain, muscle weakness, sarcopenia, impaired exercise capacity, and physical performance. In addition, the female sex, obesity, elderly patients, hospitalization, prolonged immobility, having mechanical ventilation, not having vaccination, and comorbid disorders can be accepted as clinical predictors for post/long COVID-19 syndrome. Musculoskeletal pain is also a major problem and tends to be in chronic form. There is no consensus on the mechanism, but inflammation and angiotensin-converting enzyme 2 seem to play an important role. Localized and generalized pain may occur after COVID-19, and general pain is at least as common as localized pain. An accurate diagnosis allows physicians to initiate pain management and proper rehabilitation programs.
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Affiliation(s)
- Deniz Evcik
- Department of Physical Medicine and Rehabilitation, Ankara Private Güven Hospital, Ankara, Türkiye
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20
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Fialho MFP, Brum ES, Oliveira SM. Could the fibromyalgia syndrome be triggered or enhanced by COVID-19? Inflammopharmacology 2023; 31:633-651. [PMID: 36849853 PMCID: PMC9970139 DOI: 10.1007/s10787-023-01160-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
Fibromyalgia (FM) is a complex disease with an uncertain aetiology and intricate pathophysiology. Although its genesis is not fully explained, potential environmental factors, such as viral infections might trigger FM or worsen patients' clinical outcomes. The SARS-CoV-2 virus may affect central and peripheral nervous systems, leading to musculoskeletal, neurological, and psychological disturbances. These symptoms might persist at least 12 months beyond the recovery, often referred to as post-COVID syndrome, which resembles FM syndrome. In this sense, we argued the potential consequences of COVID-19 exclusively on FM syndrome. First, we have described post-COVID syndrome and its painful symptoms. Afterwards, we argued whether FM syndrome could be triggered or enhanced by COVID-19 infection or by numerous and persistent stressors imposed daily by the pandemic setting (isolation, uncertainty, depression, mental stress, generalized anxiety, and fear of the virus). In addition, we have demonstrated similarities between pathophysiological mechanisms and cardinal symptoms of FM and COVID-19, speculating that SARS-CoV-2 might represent a critical mediator of FM or an exacerbator of its symptoms once both syndromes share similar mechanisms and complaints. Therefore, pharmacologic and non-pharmacological approaches commonly used to treat FM could serve as strategic therapies to attenuate painful and neurological manifestations of post-COVID syndrome. Although it is still theoretical, clinicians and researchers should be alert of patients who develop symptoms similar to FM or those who had their FM symptoms increased post-COVID to manage them better.
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Affiliation(s)
- Maria Fernanda Pessano Fialho
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Evelyne Silva Brum
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
- Department of Biochemistry and Molecular Biology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
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21
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Exploring the trajectory curve of long-term musculoskeletal post-COVID pain symptoms in hospitalized COVID-19 survivors: a multicenter study. Pain 2023; 164:413-420. [PMID: 35930390 DOI: 10.1097/j.pain.0000000000002718] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/07/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT This multicenter cohort study investigated the prevalence of musculoskeletal post-COVID pain during the first year after the infection with mosaic plots and an exponential bar plot model and its associated risk factors. Patients hospitalized because of COVID-19 in 5 hospitals of Madrid (Spain) were scheduled for a telephone interview at 2 follow-up periods after hospitalization for collecting data about musculoskeletal post-COVID pain. Hospitalization and clinical data were collected from hospital medical records. From 2000 patients initially recruited, 1593 (44.6% women, age: 61 ± 15 years) were assessed at T0 (hospital admission), T1 (mean: 8.0 ± 1.5 months after discharge), and T2 (mean: 13.2 ± 1.5 months after discharge). The prevalence of musculoskeletal pain (myalgia) was 30.3% (n = 483) at T0, increased to 43.4% (n = 692) at T1, and decreased to 37.8% (n = 603) at T2. The trajectory curve revealed a decreasing prevalence trend of musculoskeletal post-COVID pain the following years after hospitalization. According to the presence of pre-existing pain symptoms, the prevalence of new-onset post-COVID pain was 75.9%. Female sex (odds ratio [OR] 1.593, 95% confidence interval [CI] 1.148-2.211), history of musculoskeletal pain (OR 1.591, 95% CI 1.211-2.07), the presence of myalgia (OR 1.371, 95% CI 1.032-1.821) or headache (OR 2.278, 95% CI 1.622-3.199) at hospitalization, the days of hospitalization (OR 1.013, 95% CI 1.000-1.025), and the presence of post-COVID pain at T1 (OR 11.02, 95% CI 8.493-14.305) were factors associated with musculoskeletal post-COVID pain 1 year after hospitalization. In conclusion, musculoskeletal post-COVID pain remains highly prevalent 1 year after hospitalization. Female sex, previous history of pain symptoms, pain symptoms at onset, and days at hospital were factors associated with musculoskeletal post-COVID pain 1 year after hospitalization.
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22
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Adar S, Konya PŞ, Akçin Aİ, Dündar Ü, Demirtürk N. Evaluation and follow-up of pain, fatigue, and quality of life in COVID-19 patients. Osong Public Health Res Perspect 2023; 14:40-50. [PMID: 36944344 DOI: 10.24171/j.phrp.2022.0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/28/2022] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVES We evaluated pain, fatigue, anxiety, depression, and quality of life in patients hospitalized for coronavirus disease 2019 (COVID-19) and observed them over a period of 3 months. We also investigated the relationship of these symptoms to age, sex, disease severity, and levels of anxiety and depression. METHODS The study included 100 confirmed COVID-19 patients (i.e., positive on a polymerase chain reaction test) between the ages of 18 and 75 years. Pain (visual analog scale [VAS]), fatigue (fatigue severity scale), anxiety, and depression (hospital anxiety and depression scales) were evaluated on the first day of hospitalization and at 1-month and 3-month follow-ups. The short form-12 questionnaire was used to measure quality of life at the 1-month and 3-month followups. RESULTS No differences were found in pain, fatigue, anxiety levels, depression levels, and quality of life according to disease severity. High VAS scores at hospital admission were related to continued pain at the 3-month follow-up (odds ratio [OR], 1.067; p<0.001). High VAS (OR, 1.072; p=0.003) and anxiety levels (OR, 1.360; p=0.007) were related to severe fatigue at the 3-month evaluation. CONCLUSIONS Pain, fatigue, anxiety, and depression appear to be long-term sequelae of COVID-19 and can affect quality of life. High VAS and anxiety levels were found to be associated with long-term fatigue.
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Affiliation(s)
- Sevda Adar
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Petek Şarlak Konya
- Department of Infectious Diseases and Clinical Microbiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ali İzzet Akçin
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ümit Dündar
- Department of Physical Medicine and Rehabilitation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Neşe Demirtürk
- Department of Infectious Diseases and Clinical Microbiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Ahmadpour D, Kristoffersson A, Fredrikson M, Huang-Link Y, Eriksson A, Iacobaeus E, Landtblom AM, Haghighi S. Inventory study of an early pandemic COVID-19 cohort in South-Eastern Sweden, focusing on neurological manifestations. PLoS One 2023; 18:e0280376. [PMID: 36638113 PMCID: PMC9838851 DOI: 10.1371/journal.pone.0280376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Neurological manifestations in patients with COVID-19 have been reported previously as outcomes of the infection. The purpose of current study was to investigate the occurrence of neurological signs and symptoms in COVID-19 patients, in the county of Östergötland in southeastern Sweden. METHODS This is a retrospective, observational cohort study. Data were collected between March 2020 and June 2020. Information was extracted from medical records by a trained research assistant and physician and all data were validated by a senior neurologist. RESULTS Seventy-four percent of patients developed at least one neurological symptom during the acute phase of the infection. Headache (43%) was the most common neurological symptom, followed by anosmia and/or ageusia (33%), confusion (28%), hallucinations (17%), dizziness (16%), sleep disorders in terms of insomnia and OSAS (Obstructive Sleep Apnea) (9%), myopathy and neuropathy (8%) and numbness and tingling (5%). Patients treated in the ICU had a higher male presentation (73%). Several risk factors in terms of co-morbidities, were identified. Hypertension (54.5%), depression and anxiety (51%), sleep disorders in terms of insomnia and OSAS (30%), cardiovascular morbidity (28%), autoimmune diseases (25%), chronic lung diseases (24%) and diabetes mellitus type 2 (23%) founded as possible risk factors. CONCLUSION Neurological symptoms were found in the vast majority (74%) of the patients. Accordingly, attention to neurological, mental and sleep disturbances is warranted with involvement of neurological expertise, in order to avoid further complications and long-term neurological effect of COVID-19. Furthermore, risk factors for more severe COVID-19, in terms of possible co-morbidities that identified in this study should get appropriate attention to optimizing treatment strategies in COVID-19 patients.
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Affiliation(s)
- Doryaneh Ahmadpour
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Medical Specialists, Institute of Neurology, Motala Hospital, Motala, Sweden
| | - Anna Kristoffersson
- Department of Medical Specialists, Institute of Neurology, Motala Hospital, Motala, Sweden
| | | | - Yumin Huang-Link
- Department of Neurology, Linköping University Hospital, Linköping, Sweden
| | - Anne Eriksson
- Department of Medical Specialists, Institute of Medicine, Motala Hospital, Motala, Sweden
| | - Ellen Iacobaeus
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Anne-Marie Landtblom
- Department of Neurology, Linköping University Hospital, Linköping, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sara Haghighi
- Department of Medical Specialists, Institute of Neurology, Motala Hospital, Motala, Sweden
- Department of Neurology, Linköping University Hospital, Linköping, Sweden
- * E-mail:
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24
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Hannum ME, Koch RJ, Ramirez VA, Marks SS, Toskala AK, Herriman RD, Lin C, Joseph PV, Reed DR. Taste loss as a distinct symptom of COVID-19: a systematic review and meta-analysis. Chem Senses 2023; 48:bjad043. [PMID: 38100383 DOI: 10.1093/chemse/bjad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Chemosensory scientists have been skeptical that reports of COVID-19 taste loss are genuine, in part because before COVID-19 taste loss was rare and often confused with smell loss. Therefore, to establish the predicted prevalence rate of taste loss in COVID-19 patients, we conducted a systematic review and meta-analysis of 376 papers published in 2020-2021, with 235 meeting all inclusion criteria. Drawing on previous studies and guided by early meta-analyses, we explored how methodological differences (direct vs. self-report measures) may affect these estimates. We hypothesized that direct measures of taste are at least as sensitive as those obtained by self-report and that the preponderance of evidence confirms taste loss is a symptom of COVID-19. The meta-analysis showed that, among 138,015 COVID-19-positive patients, 36.62% reported taste dysfunction (95% confidence interval: 33.02%-40.39%), and the prevalence estimates were slightly but not significantly higher from studies using direct (n = 15) versus self-report (n = 220) methodologies (Q = 1.73, df = 1, P = 0.1889). Generally, males reported lower rates of taste loss than did females, and taste loss was highest among middle-aged adults. Thus, taste loss is likely a bona fide symptom of COVID-19, meriting further research into the most appropriate direct methods to measure it and its underlying mechanisms.
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Affiliation(s)
- Mackenzie E Hannum
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Riley J Koch
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Vicente A Ramirez
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
- Department of Public Health, University of California Merced, Merced, CA 95348, USA
| | - Sarah S Marks
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Aurora K Toskala
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Riley D Herriman
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Cailu Lin
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Paule V Joseph
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- Division of Intramural Research, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Danielle R Reed
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
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25
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Dannecker E, Clements S, Schultz E, Derrick B, Keleh SA, Golzy M. Relationships Among Musculoskeletal Symptoms, Self-Rated Health, and Work Locations in Studies of Computer Work or Coronavirus Diagnosis. J Occup Environ Med 2022; 64:1059-1066. [PMID: 35901216 PMCID: PMC9722324 DOI: 10.1097/jom.0000000000002649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To clarify work location's association with musculoskeletal symptoms. METHODS Study 1 surveyed 246 working adults who usually felt pain, in general, and increased pain from computer work. Study 2 surveyed a nationally representative sample of 1084 working adults. RESULTS In study 1, 32.5% of the participants sought treatment for their increased pain from computer work. Education differed by work location. When education was considered, there were no significant work location differences in pain intensity, pain interference, or self-rated health. In study 2, COVID-19 diagnoses, education, and gender differed by work location. Age and work location explained self-rated health. Self-rated health was associated with musculoskeletal ache. Work location did not significantly predict musculoskeletal ache. CONCLUSION Working at home was associated with fewer COVID-19 diagnoses and higher self-rated health than working at employers' locations.
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26
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dos Santos AAC, Rodrigues LE, Alecrim-Zeza AL, de Araújo Ferreira L, Trettel CDS, Gimenes GM, da Silva AF, Sousa-Filho CPB, Serdan TDA, Levada-Pires AC, Hatanaka E, Borges FT, de Barros MP, Cury-Boaventura MF, Bertolini GL, Cassolla P, Marzuca-Nassr GN, Vitzel KF, Pithon-Curi TC, Masi LN, Curi R, Gorjao R, Hirabara SM. Molecular and cellular mechanisms involved in tissue-specific metabolic modulation by SARS-CoV-2. Front Microbiol 2022; 13:1037467. [PMID: 36439786 PMCID: PMC9684198 DOI: 10.3389/fmicb.2022.1037467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/26/2022] [Indexed: 09/09/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is triggered by the SARS-CoV-2, which is able to infect and cause dysfunction not only in lungs, but also in multiple organs, including central nervous system, skeletal muscle, kidneys, heart, liver, and intestine. Several metabolic disturbances are associated with cell damage or tissue injury, but the mechanisms involved are not yet fully elucidated. Some potential mechanisms involved in the COVID-19-induced tissue dysfunction are proposed, such as: (a) High expression and levels of proinflammatory cytokines, including TNF-α IL-6, IL-1β, INF-α and INF-β, increasing the systemic and tissue inflammatory state; (b) Induction of oxidative stress due to redox imbalance, resulting in cell injury or death induced by elevated production of reactive oxygen species; and (c) Deregulation of the renin-angiotensin-aldosterone system, exacerbating the inflammatory and oxidative stress responses. In this review, we discuss the main metabolic disturbances observed in different target tissues of SARS-CoV-2 and the potential mechanisms involved in these changes associated with the tissue dysfunction.
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Affiliation(s)
| | - Luiz Eduardo Rodrigues
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Amanda Lins Alecrim-Zeza
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Liliane de Araújo Ferreira
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Caio dos Santos Trettel
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Gabriela Mandú Gimenes
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Adelson Fernandes da Silva
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | | | - Tamires Duarte Afonso Serdan
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
- Department of Molecular Pathobiology, University of New York, New York, NY, United States
| | - Adriana Cristina Levada-Pires
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Elaine Hatanaka
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Fernanda Teixeira Borges
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
- Divisão de Nefrologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Paes de Barros
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Maria Fernanda Cury-Boaventura
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Gisele Lopes Bertolini
- Department of Physiological Sciences, Biological Science Center, State University of Londrina, Londrina, PR, Brazil
| | - Priscila Cassolla
- Department of Physiological Sciences, Biological Science Center, State University of Londrina, Londrina, PR, Brazil
| | | | - Kaio Fernando Vitzel
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand
| | - Tania Cristina Pithon-Curi
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Laureane Nunes Masi
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Rui Curi
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
- Instituto Butantan, São Paulo, Brazil
| | - Renata Gorjao
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
| | - Sandro Massao Hirabara
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, São Paulo, Brazil
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27
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Gagnier JJ, Bergmans RS, Clauw DJ. Musculoskeletal Components of Post-Acute Sequelae of SARS-CoV-2 Infections. JBJS Rev 2022; 10:01874474-202211000-00009. [PMID: 36524670 DOI: 10.2106/jbjs.rvw.22.00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
➢ Musculoskeletal (MSK) sequelae of severe acute respiratory syndrome coronavirus 2 infections seem to be common. ➢ Mechanisms of such effects are becoming clear. ➢ There is a complex interplay of biopsychosocial effects associated with MSK symptoms after acute coronavirus disease 2019. ➢ Additional research should focus on completely describing the breadth of these MSK sequelae and related psychosocial symptoms.
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Affiliation(s)
- Joel J Gagnier
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Rachel S Bergmans
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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28
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Haykal MA, Menkes DL. The Clinical Neurophysiology of COVID-19- Direct Infection, Long-Term Sequelae and Para-Immunization responses: A literature review. Clin Neurophysiol Pract 2022; 8:3-11. [PMID: 36275861 PMCID: PMC9574576 DOI: 10.1016/j.cnp.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic resulting from the SARS-CoV-2 virus is in its third year. There is continuously evolving information regarding its pathophysiology and its effects on the nervous system. Clinical neurophysiology techniques are commonly employed to assess for neuroanatomical localization and/or defining the spectrum of neurological illness. There is an evolving body of literature delineating the effects of the SARS-CoV-2 virus on the nervous system as well as para-immunization responses to vaccination against this virus. This review focuses on the use of neurophysiological diagnostic modalities in the evaluation of potential acute and long-term neurological complications in patients that experience direct infection with SARS-CoV-2 and analyzes those reports of para-immunization responses to vaccination against the SARS-CoV-2 virus. The neurophysiological modalities to be discussed include electroencephalography (EEG), evoked potentials (EPs), nerve conduction studies and electromyography (EMG/NCV), autonomic function tests, transcranial magnetic stimulation (TMS) and Transcranial Doppler ultrasound (TCD).
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29
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Tharwat S, Shabana NM, Nassar MK. Lifting the Mask on Musculoskeletal Manifestations of COVID-19: Results of an Interview-Based Study. Open Access Rheumatol 2022; 14:211-220. [PMID: 36217355 PMCID: PMC9547602 DOI: 10.2147/oarrr.s376289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background Coronavirus disease of 2019 (COVID-19) is considered a multi-system disease that might present with or develop complications during the acute phase of illness. The aim of this study was to describe the characteristics of musculoskeletal (MSK) manifestations in patients with COVID-19 infection and investigate their clinical correlations. Methods This study was carried out on 110 patients with a history of RT-PCR confirmed COVID-19 infection. They completed a questionnaire that covered detailed information on their sociodemographic characteristics, clinical data of COVID-19 infection in addition to MSK discomfort form based on the Nordic MSK Questionnaire. Results The mean age of the patients was 37.7 years (SD 12.9), 72.7% were females. The majority of patients (90.9%) reported MSK symptoms that occur during or shortly after the acute attack of COVID-19 infection. The median duration of onset of MSK symptoms was 2 days from the first day of COVID-19 infection (min-max: 0–45 days) with a median duration of MSK symptoms of 7 days. Myalgia was the main complaint (85.5%) followed by arthralgia 90 (81.8%). However, swollen joints were reported in only 9 patients (8.2%). According to the body areas, maximum number of patients felt pain at the lower back (60%), followed by neck (39.1%), and upper back (32.5%) followed by right and left shoulder (20.9%). Patients with MSK manifestations were associated higher severity of COVID-19 infection (p < 0.001), prolonged duration of COVID-19 symptoms (p < 0.001) and higher prevalence of fatigue (p < 0.001). Conclusion MSK manifestations are common in COVID-19 patients and related to disease severity, duration and fatigue.
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Affiliation(s)
- Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Mansoura University, Mansoura, Egypt,Correspondence: Samar Tharwat, Mansoura University Hospital, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt, Tel +20 1091784143, Fax +2 50 2202834, Email
| | - Noran Mohamed Shabana
- Mansoura Manchester Programme for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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30
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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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31
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Prevalence of Musculoskeletal Post-COVID Pain in Hospitalized COVID-19 Survivors Depending on Infection with the Historical, Alpha or Delta SARS-CoV-2 Variant. Biomedicines 2022; 10:biomedicines10081951. [PMID: 36009498 PMCID: PMC9406216 DOI: 10.3390/biomedicines10081951] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
We compared the prevalence of musculoskeletal post-COVID pain between previously hospitalized COVID-19 survivors infected with the historical, Alpha or Delta SARS-CoV-2 variant. Data about musculoskeletal post-COVID pain were systematically collected through a telephone interview involving 201 patients who had survived the historical variant, 211 who had survived the Alpha variant and 202 who had survived the Delta variant six months after hospital discharge. Participants were recruited from non-vaccinated individuals hospitalized due to SARS-CoV-2 infection in one hospital of Madrid (Spain) during three different waves of the pandemic (historical, Alpha or Delta variant). Hospitalization and clinical data were collected from hospital medical records. In addition, anxiety/depressive levels and sleep quality were also assessed. The prevalence of musculoskeletal post-COVID pain was higher (p = 0.003) in patients infected with the historical variant (47.7%) than in those infected with the Alpha (38.3%) or Delta (41%) variants. A significantly (p = 0.002) higher proportion of individuals infected with the historical variant reported generalized pain (20.5%) when compared with those infected with the other variants. The prevalence of new-onset post-COVID musculoskeletal pain reached 80.1%, 75.2% and 79.5% of patients infected with the historical, Alpha or Delta variants, respectively. No specific risk factors for developing post-COVID pain were identified depending on the SARS-CoV-2 variant. In conclusion, this study found that musculoskeletal post-COVID pain is highly prevalent in COVID-19 survivors six months after hospital discharge, with the highest prevalence and most generalized pain symptoms in individuals infected with the historical variant. Approximately 50% developed “de novo” post-COVID musculoskeletal pain symptoms.
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32
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Brown RB. Non-Specific Low Back Pain, Dietary Salt Intake, and Posterior Lumbar Subcutaneous Edema. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159158. [PMID: 35954516 PMCID: PMC9368517 DOI: 10.3390/ijerph19159158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 12/10/2022]
Abstract
Low back pain is the world’s leading disability, but the etiology of the majority of low back pain is non-specific with no known cause. Moreover, overuse of opioids to treat low back pain is a widespread problem. This paper proposes that non-specific low back pain may be associated with excessive intake of dietary salt, potentially mediated by posterior lumbar subcutaneous edema. In addition to pain, symptoms of edema include swelling, tightness, and stiff joints, which are common complaints of people with low back pain, along with restricted lumbar range of motion and impaired mobility. Many global populations consume excess sodium chloride, which can lead to fluid overload in hypervolemia, and cause swelling and temporary weight gain associated with low back pain. Numerous conditions comorbid with low back pain are also potentially mediated by excessive salt intake, including migraine headache, hypertension, cardiovascular disease, venous thromboembolism, liver disease, respiratory disorders, chronic kidney disease, pregnancy complications, and multiple sclerosis. Novel approaches to identify and prevent the cause of non-specific low back pain have potential to reduce disability worldwide by reducing low back pain prevalence. More research is needed to confirm the involvement of dietary salt and posterior lumbar subcutaneous edema in non-specific low back pain.
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Affiliation(s)
- Ronald B Brown
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Ozduran E, Büyükçoban S. Evaluating the readability, quality and reliability of online patient education materials on post-covid pain. PeerJ 2022; 10:e13686. [PMID: 35880220 PMCID: PMC9308460 DOI: 10.7717/peerj.13686] [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: 03/21/2022] [Accepted: 06/15/2022] [Indexed: 01/17/2023] Open
Abstract
Background The use of the Internet to access healthcare-related information is increasing day by day. However, there are concerns regarding the reliability and comprehensibility of this information. This study aimed to investigate the readability, reliability, and quality of Internet-based patient educational materials (PEM) related to "post-COVID-19 pain." Methods One-hundred websites that fit the purposes of the study were identified by searching for the terms "post-COVID-19 pain" and "pain after COVID-19" using the Google search engine on February 24, 2022. The website readability was assessed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning FOG (GFOG). The reliability, quality, and popularity of the websites were assessed using the JAMA score, DISCERN score/Health on the Net Foundation code of conduct, and Alexa, respectively. Results Upon investigation of the textual contents, the mean FRES was 51.40 ± 10.65 (difficult), the mean FKGL and SMOG were 10.93 ± 2.17 and 9.83 ± 1.66 years, respectively, and the mean GFOG was 13.14 ± 2.16 (very difficult). Furthermore, 24.5% of the websites were highly reliable according to JAMA scores, 8% were of high quality according to GQS values, and 10% were HONcode-compliant. There was a statistically significant difference between the website types and reliability (p = 0.003) and quality scores (p = 0.002). Conclusion The readability level of PEM on post-COVID-19 pain was considerably higher than grade 6 educational level, as recommended by the National Institutes of Health, and had low reliability and poor quality. We suggest that Internet-based PEM should have a certain degree of readability that is in accordance with the educational level of the general public and feature reliable content.
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Affiliation(s)
- Erkan Ozduran
- Department of Physical Medicine and Rehabilitation, Algology, Dokuz Eylül University, Izmir, Turkey
| | - Sibel Büyükçoban
- Department of Anesthesiology and Reanimation, Dokuz Eylül University, Izmir, Turkey
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Korres G, Kitsos DK, Kaski D, Tsogka A, Giannopoulos S, Giannopapas V, Sideris G, Tyrellis G, Voumvourakis K. The Prevalence of Dizziness and Vertigo in COVID-19 Patients: A Systematic Review. Brain Sci 2022; 12:brainsci12070948. [PMID: 35884754 PMCID: PMC9313303 DOI: 10.3390/brainsci12070948] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022] Open
Abstract
Clinical manifestations of COVID-19 include symptoms of vertigo and dizziness, which is rather unsurprising, since SARS-CoV-2 neurotropism may inflict a broad spectrum of neuropathic effects. The widespread nature of central and peripheral audiovestibular pathways suggests that there may be several probable pathophysiological mechanisms. The cytokine storm, CNS infiltration of the virus through ACE 2 receptors, and other systemic factors can be responsible for the significant number of COVID-19 patients reported to experience symptoms of vertigo and dizziness. In this paper, we present a systematic review of clinical studies reporting the detection of dizziness and vertigo as clinical manifestations of COVID-19 and discuss their etiopathogenesis.
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Affiliation(s)
- George Korres
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
- Correspondence:
| | - Dimitrios K. Kitsos
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, University College London, 33 Queen Square, London WC1N 3BG, UK;
| | - Anthi Tsogka
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Vasileios Giannopapas
- 2nd Department of Neurology, Laboratory of Neuromuscular & Cardiovascular Study of Motion (LANECASM), Attikon University Hospital, 124 62 Athens, Greece;
| | - Giorgos Sideris
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
| | - Giorgos Tyrellis
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
| | - Konstantine Voumvourakis
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
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35
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Fernández‐de‐las‐Peñas C, Parás‐Bravo P, Ferrer‐Pargada D, Cancela‐Cilleruelo I, Rodríguez‐Jiménez J, Nijs J, Arendt‐Nielsen L, Herrero‐Montes M. Sensitization symptoms are associated with psychological and cognitive variables in COVID-19 survivors exhibiting post-COVID pain. Pain Pract 2022; 23:23-31. [PMID: 35757896 PMCID: PMC9350126 DOI: 10.1111/papr.13146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the association between demographic, clinical, psychological, cognitive, and health-related variables and the Central Sensitization Inventory (CSI) in previously hospitalized COVID-19 survivors exhibiting "de novo" post-COVID pain. METHODS Seventy-seven (n = 77) COVID-19 survivors with "de novo" post-COVID pain completed demographic (age, height, and weight), clinical (duration and intensity of the pain), psychological (depressive/anxiety levels and sleep quality), cognitive (catastrophizing and kinesiophobia levels), and health-related quality of life variables as well as the CSI. A multivariable correlation analysis was conducted to determine the association between variables, and a stepwise multiple linear regression model was performed to identify CSI predictors. RESULTS Patients were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Twenty-six (33.7%) individuals showed indications of sensitization-associated symptoms (CSI score ≥40 points). The CSI score was positively associated with pain intensity (r: 0.371), anxiety (r: 0.784), depressive (r: 0.709), catastrophizing (r: 0.620), and kinesiophobia (r: 0.359) levels (all, p < 0.001). The stepwise regression analysis revealed that 60.2% of CSI was explained by anxiety levels and pain intensity. CONCLUSION This study found that psychological and cognitive variables were associated with the CSI score in previously hospitalized COVID-19 survivors with "de novo" post-COVID pain. Anxiety levels and the intensity of pain symptoms were independently associated with CSI score suggesting a significant overlap with psychological construct. The "de novo" post-COVID pain association with CSI may indicate changes in the pain processing important for managing the pain.
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Affiliation(s)
- César Fernández‐de‐las‐Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and RehabilitationUniversidad Rey Juan Carlos (URJC)MadridSpain,Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMIAalborg UniversityAalborgDenmark
| | - Paula Parás‐Bravo
- Departamento de EnfermeríaUniversidad de CantabriaSantanderSpain,Grupo de Investigación en EnfermeríaInstituto de Investigación Sanitaria Valdecilla (IDIVAL)SantanderSpain
| | - Diego Ferrer‐Pargada
- Servicio de NeumologíaHospital Universitario Marqués de ValdecillaCantabriaSpain
| | - Ignacio Cancela‐Cilleruelo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and RehabilitationUniversidad Rey Juan Carlos (URJC)MadridSpain
| | - Jorge Rodríguez‐Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and RehabilitationUniversidad Rey Juan Carlos (URJC)MadridSpain
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & PhysiotherapyVrije Universiteit BrusselBrusselsBelgium,Department of Physical Medicine and PhysiotherapyUniversity Hospital BrusselsBrusselsBelgium,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Lars Arendt‐Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMIAalborg UniversityAalborgDenmark,Department of Medical Gastroenterology, Mech‐SenseAalborg University HospitalAalborgDenmark
| | - Manuel Herrero‐Montes
- Departamento de EnfermeríaUniversidad de CantabriaSantanderSpain,Grupo de Investigación en EnfermeríaInstituto de Investigación Sanitaria Valdecilla (IDIVAL)SantanderSpain
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36
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Meidaninikjeh S, Sabouni N, Taheri M, Borjkhani M, Bengar S, Majidi Zolbanin N, Khalili A, Jafari R. SARS-CoV-2 and Guillain-Barré Syndrome: Lessons from Viral Infections. Viral Immunol 2022; 35:404-417. [PMID: 35766944 DOI: 10.1089/vim.2021.0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the COVID-19 pandemic. COVID-19 has a broad clinical spectrum from asymptomatic patients to multiorgan dysfunction and septic shock. Most of the common symptoms of COVID-19 are classified as respiratory disorders, but some reports show neurological involvements. During the COVID-19 pandemic, a case series of neurological complications, such as Guillain-Barré syndrome (GBS), were reported. GBS is a neuroimmune disorder with acute inflammatory radicular polyneuropathy in different parts of the peripheral nerve. Some studies have reported GBS as an inflammatory neuropathy related to various viral infections, such as cytomegalovirus (CMV), Epstein-Barr Virus (EBV), herpes simplex virus (HSV), human immunodeficiency virus (HIV), influenza, and Zika virus. There are some immunomodulation approaches for the management of GBS. Studies have evaluated the effects of the various therapeutic approaches, including intravenous immunoglobulin (IVIG), plasma exchange (PE), complement inhibitors, and corticosteroids to regulate overactivation of immune responses during GBS in experimental and clinical studies. In this regard, the possible association between GBS and SARS-CoV-2 infection during the outbreak of the current pandemic and also the mentioned therapeutic approaches were reviewed.
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Affiliation(s)
- Sepideh Meidaninikjeh
- Department of Microbiology, Faculty of Biological Sciences, Alzahra University, Tehran, Iran.,Cancer Biomedical Center (CBC) Research Institute, Tehran, Iran
| | - Nasim Sabouni
- Department of Immunology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdie Taheri
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdis Borjkhani
- Bioprocess Engineering Department, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
| | - Sajad Bengar
- Department of Microbiology, Faculty of Science, Shahre Ghods Branch, Islamic Azad University, Shahre Ghods, Tehran, Iran
| | - Naime Majidi Zolbanin
- Experimental and Applied Pharmaceutical Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Ahmad Khalili
- Cancer Biomedical Center (CBC) Research Institute, Tehran, Iran
| | - Reza Jafari
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
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37
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Singh B, Lant S, Cividini S, Cattrall JWS, Goodwin LC, Benjamin L, Michael BD, Khawaja A, Matos ADMB, Alkeridy W, Pilotto A, Lahiri D, Rawlinson R, Mhlanga S, Lopez EC, Sargent BF, Somasundaran A, Tamborska A, Webb G, Younas K, Al Sami Y, Babu H, Banks T, Cavallieri F, Cohen M, Davies E, Dhar S, Fajardo Modol A, Farooq H, Harte J, Hey S, Joseph A, Karthikappallil D, Kassahun D, Lipunga G, Mason R, Minton T, Mond G, Poxon J, Rabas S, Soothill G, Zedde M, Yenkoyan K, Brew B, Contini E, Cysique L, Zhang X, Maggi P, van Pesch V, Lechien J, Saussez S, Heyse A, Brito Ferreira ML, Soares CN, Elicer I, Eugenín-von Bernhardi L, Ñancupil Reyes W, Yin R, Azab MA, Abd-Allah F, Elkady A, Escalard S, Corvol JC, Delorme C, Tattevin P, Bigaut K, Lorenz N, Hornuss D, Hosp J, Rieg S, Wagner D, Knier B, Lingor P, Winkler AS, Sharifi-Razavi A, Moein ST, SeyedAlinaghi S, JamaliMoghadamSiahkali S, Morassi M, Padovani A, Giunta M, Libri I, Beretta S, Ravaglia S, Foschi M, Calabresi P, Primiano G, Servidei S, Biagio Mercuri N, Liguori C, Pierantozzi M, Sarmati L, Boso F, Garazzino S, Mariotto S, Patrick KN, Costache O, Pincherle A, Klok FA, Meza R, Cabreira V, Valdoleiros SR, Oliveira V, Kaimovsky I, Guekht A, Koh J, Fernández Díaz E, Barrios-López JM, Guijarro-Castro C, Beltrán-Corbellini Á, Martínez-Poles J, Diezma-Martín AM, Morales-Casado MI, García García S, Breville G, Coen M, Uginet M, Bernard-Valnet R, Du Pasquier R, Kaya Y, Abdelnour LH, Rice C, Morrison H, Defres S, Huda S, Enright N, Hassell J, D’Anna L, Benger M, Sztriha L, Raith E, Chinthapalli K, Nortley R, Paterson R, Chandratheva A, Werring DJ, Dervisevic S, Harkness K, Pinto A, Jillella D, Beach S, Gunasekaran K, Rocha Ferreira Da Silva I, Nalleballe K, Santoro J, Scullen T, Kahn L, Kim CY, Thakur KT, Jain R, Umapathi T, Nicholson TR, Sejvar JJ, Hodel EM, Tudur Smith C, Solomon T. Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis. PLoS One 2022; 17:e0263595. [PMID: 35653330 PMCID: PMC9162376 DOI: 10.1371/journal.pone.0263595] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
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Affiliation(s)
- Bhagteshwar Singh
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Suzannah Lant
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan W. S. Cattrall
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Lynsey C. Goodwin
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Laura Benjamin
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Benedict D. Michael
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Ayaz Khawaja
- Department of Neurology, Wayne State University, Detroit, Michigan, United States of America
| | | | - Walid Alkeridy
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Durjoy Lahiri
- Bangur Institute of Neurosciences, Institute of Post-Graduate Medical Education and Research, Kolkata, India
| | - Rebecca Rawlinson
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sithembinkosi Mhlanga
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Evelyn C. Lopez
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Brendan F. Sargent
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Anushri Somasundaran
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arina Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Glynn Webb
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Komal Younas
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Yaqub Al Sami
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Heavenna Babu
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Tristan Banks
- Department of Infection, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matthew Cohen
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Emma Davies
- Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Shalley Dhar
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anna Fajardo Modol
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Hamzah Farooq
- Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Jeffrey Harte
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Samuel Hey
- Department of Infectious Diseases & Tropical Medicine, North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Albert Joseph
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Dileep Karthikappallil
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Kassahun
- Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom of Great Britain and Northern Ireland
| | - Gareth Lipunga
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rachel Mason
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Minton
- Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Gabrielle Mond
- North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Joseph Poxon
- Epsom and St Helier University Hospitals NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Sophie Rabas
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Germander Soothill
- Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Konstantin Yenkoyan
- Yerevan State Medical University named after Mkhitar Heratsi, Neuroscience Laboratory, Cobrain Center, Yerevan, Armenia
| | - Bruce Brew
- St Vincent’s Hospital, Sydney, Australia
| | | | | | - Xin Zhang
- St Vincent’s Hospital, Sydney, Australia
| | - Pietro Maggi
- Saint-Luc University Hospital, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | - Rong Yin
- The 940th Hospital of Joint Logistic Support Force of the People’s Liberation Army, Lanzhou, China
| | | | | | | | | | | | | | | | - Kévin Bigaut
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Norbert Lorenz
- Children’s Hospital, Dresden Municipal Hospital Teaching Hospital TUD, Dresden, Germany
| | - Daniel Hornuss
- Medical Center University of Freiburg, Freiburg, Germany
| | - Jonas Hosp
- Medical Center University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Medical Center University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Medical Center University of Freiburg, Freiburg, Germany
| | - Benjamin Knier
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Paul Lingor
- Department of Neurology, Technical University of Munich, Munich, Germany
| | | | | | - Shima T. Moein
- Institute for Research in Fundamental Sciences (IPM), Tehran, Islamic Republic of Iran
| | | | | | - Mauro Morassi
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | | | | | - Simone Beretta
- San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | | | - Matteo Foschi
- Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Primiano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | | | | | - Federica Boso
- Healthcare Trust of the Autonomous Region of Trento, Rovereto, Italy
| | - Silvia Garazzino
- Città della Salute e della Scienza di Torino, Regina Margherita Children’s Hospital, Turin, Italy
| | | | | | | | | | | | - Roger Meza
- Hospital Regional Docente de Trujillo, Trujillo, Peru
| | | | | | | | - Igor Kaimovsky
- Buyanov Moscow City Hospital, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry and Buyanov Moscow City Hospital, Moscow, Russian Federation
| | - Jasmine Koh
- National Neuroscience Institute, Singapore, Singapore
| | | | | | | | | | | | | | | | | | | | - Matteo Coen
- Hopitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | | | - Yildiz Kaya
- Acibadem Mehmet Ali Aydinlar University Medical School, Istanbul, Turkey
| | - Loay H. Abdelnour
- Ulster Hospital, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Claire Rice
- University of Bristol and North Bristol NHS Trust, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Hamish Morrison
- Gloucestershire Royal Hospital, Gloucester, United Kingdom of Great Britain and Northern Ireland
| | - Sylviane Defres
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Saif Huda
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Noelle Enright
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Jane Hassell
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Lucio D’Anna
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Matthew Benger
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Laszlo Sztriha
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Eamon Raith
- The National Hospital for Neurology & Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
| | - Krishna Chinthapalli
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Nortley
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Paterson
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Arvind Chandratheva
- University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - David J. Werring
- University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - Samir Dervisevic
- Eastern Pathology Alliance Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - Kirsty Harkness
- Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Ashwin Pinto
- Wessex Neurological Centre, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Dinesh Jillella
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Scott Beach
- Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kulothungan Gunasekaran
- Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, United States of America
| | | | - Krishna Nalleballe
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Jonathan Santoro
- Children’s Hospital Los Angeles and Keck School of Medicine at the University of Southern California, Los Angeles, California, United States of America
| | - Tyler Scullen
- Ochsner Medical Center, New Orleans, Los Angeles, United States of America
| | - Lora Kahn
- Ochsner Medical Center, New Orleans, Los Angeles, United States of America
| | - Carla Y. Kim
- Columbia University Irving Medical Center, New York, New York, United States of America
| | - Kiran T. Thakur
- Columbia University Irving Medical Center, New York, New York, United States of America
| | - Rajan Jain
- New York University Grossman School of Medicine, New York, New York, United States of America
| | | | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - James J. Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eva Maria Hodel
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- * E-mail:
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38
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Pires RE, Reis IGN, Waldolato GS, Pires DD, Bidolegui F, Giordano V. What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review. JBJS Rev 2022; 10:01874474-202206000-00001. [PMID: 35658089 DOI: 10.2106/jbjs.rvw.22.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
» COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. » In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. » Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance. » Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis. » A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.
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Affiliation(s)
- Robinson E Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Igor G N Reis
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo S Waldolato
- Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Diego D Pires
- Cedimagem Medicina Diagnóstica, Grupo Alliar, Juiz de Fora, Brazil
| | - Fernando Bidolegui
- Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, ECICARO, Buenos Aires, Argentin
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
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Keklicek H, Selçuk H, Kurt İ, Ulukaya S, Öztürk G. Individuals with a COVID-19 history exhibit asymmetric gait patterns despite full recovery. J Biomech 2022; 137:111098. [PMID: 35460936 PMCID: PMC9011902 DOI: 10.1016/j.jbiomech.2022.111098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022]
Abstract
COVID-19 is a multisystem infectious disease affecting the body systems. Its neurologic complications include -but are not limited to headache, loss of smell, encephalitis, and cerebrovascular accidents. Even though gait analysis is an objective measure of the neuro-motor system and may provide significant information about the pathophysiology of specific diseases, no studies have investigated the gait characteristics in adults after full recovery from COVID-19. This was a cross-sectional, controlled study that included 12 individuals (mean age, 23.0 ± 4.1 years) with mild-to-moderate COVID-19 history (COVD) and 20 sedentary controls (CONT; mean age, 24.0 ± 3.6 years). Gait was evaluated using inertial sensors on a motorized treadmill. Spatial-temporal gait parameters and gait symmetry were calculated by using at least 512 consecutive steps for each participant. The effect-size analyses were utilized to interpret the impact of the results. Spatial-temporal gait characteristics were comparable between the two groups. The COVD group showed more asymmetrical gait patterns than the CONT group in the double support duration symmetry (p = 0.042), single support duration symmetry (p = 0.006), loading response duration symmetry (p = 0.042), and pre-swing duration symmetry (p = 0.018). The effect size analyses of the differences showed large effects (d = 0.68-0.831). Individuals with a history of mild-to-moderate COVID-19 showed more asymmetrical gait patterns than individuals without a disease history. Regardless of its severity, the multifaceted long-term effects of COVID-19 need to be examined and the scope of clinical follow-up should be detailed.
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Affiliation(s)
- Hilal Keklicek
- Trakya Unversity, Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, Edirne, Turkey,Corresponding author at: Trakya University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Edirne, Turkey
| | - Halit Selçuk
- Trakya Unversity, Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, Edirne, Turkey,Marmara University, Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - İlke Kurt
- Institute of Science, Department of Computational Sciences, Trakya University, 22030, Edirne, Turkey
| | - Sezer Ulukaya
- Faculty of Engineering, Department of Electrical and Electronics Engineering, Trakya University, 22030, Edirne, Turkey
| | - Gülnur Öztürk
- Trakya Unversity, Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, Edirne, Turkey
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40
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Fuller L, Moehle J, Hardin A. Suspected Recurrence of Cranial Neuralgia Following Infection With SARS-CoV-2: A Case Report. Integr Med (Encinitas) 2022; 21:42-46. [PMID: 35702490 PMCID: PMC9173853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
It is understood that patients infected with the COVID-19 virus can present with headache as an initial symptom, but it is unclear if those with a history of cranial neuralgias may have a different initial COVID-19 presentation, or if infections from SARS-CoV-2 virus may cause a recurrence of previous cranial neuralgias. In this review, we report a case of cranial neuralgia recurrence that was preceded by a SARS-CoV-2 exposure. There is currently a lack of literature describing COVID-19 patients with a recurrence of a previous cranial neuralgia, and this case draws attention to potential reactivation of cranial neuralgia symptoms in COVID-19 patients, highlights key components of the pathophysiology of cranial neuralgias, and underscores the potential need to identify previous history of cranial neuralgia to more appropriately navigate management and treatment of neuralgia causing head pain as a consequence of COVID-19 infection.
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Affiliation(s)
| | - Jillian Moehle
- Resident Physician; Institute of Complementary Medicine, Seattle, Washington
| | - Angela Hardin
- Chief Resident Physician, at National University of Natural Medicine, Portland, Oregon
- Corresponding author: Angela Hardin, ND E-mail address:
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41
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Rudroff T, Workman CD, Bryant AD. Potential Factors That Contribute to Post-COVID-19 Fatigue in Women. Brain Sci 2022; 12:brainsci12050556. [PMID: 35624943 PMCID: PMC9139370 DOI: 10.3390/brainsci12050556] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
Mortality of acute coronavirus disease (COVID-19) is higher in men than in women. On the contrary, women experience more long-term consequences of the disease, such as fatigue. In this perspective article, we proposed a model of the potential factors that might contribute to the higher incidence of post-COVID-19 fatigue in women. Specifically, psycho-physiological factors are features that might increase central factors (e.g., inflammation) and result in greater perceptions of fatigue. Furthermore, pre-existing conditions likely play a prominent role. This model offers a framework for researchers and clinicians, and future research is required to validate our proposed model and elucidate all mechanisms of the increased incidence and prevalence of post-COVID-19 fatigue in women.
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Affiliation(s)
- Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Correspondence:
| | - Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
| | - Andrew D. Bryant
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
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42
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dos Santos PK, Sigoli E, Bragança LJ, Cornachione AS. The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection. Front Physiol 2022; 13:813924. [PMID: 35492595 PMCID: PMC9040683 DOI: 10.3389/fphys.2022.813924] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.
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Affiliation(s)
- Patty K. dos Santos
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | | | | | - Anabelle S. Cornachione
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
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43
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Shrivastava S, Shrivastava P. Coronavirus disease 2019 infection and neurological manifestations: Points to ponder. ENVIRONMENTAL DISEASE 2022. [DOI: 10.4103/ed.ed_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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44
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Boussaid S, Makhlouf Y, Jammali S, Sahli H, Elleuch M, Rekik S. Association of SARS-COV2 and Lumbar Spine Fractures: Causal or Coincidental? J Clin Densitom 2022; 25:124-126. [PMID: 34920937 PMCID: PMC8616711 DOI: 10.1016/j.jocd.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Soumaya Boussaid
- Rheumatology department, la rabta Hospital, Jabari, Tunisi, Tunisia
| | - Yasmine Makhlouf
- Rheumatology department, la rabta Hospital, Jabari, Tunisi, Tunisia.
| | - Samia Jammali
- Rheumatology department, la rabta Hospital, Jabari, Tunisi, Tunisia
| | - Hela Sahli
- Rheumatology department, la rabta Hospital, Jabari, Tunisi, Tunisia
| | - Mohamed Elleuch
- Rheumatology department, la rabta Hospital, Jabari, Tunisi, Tunisia
| | - Sonia Rekik
- Rheumatology department, la rabta Hospital, Jabari, Tunisi, Tunisia
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45
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Herrero-Montes M, Fernández-de-las-Peñas C, Ferrer-Pargada D, Tello-Mena S, Cancela-Cilleruelo I, Rodríguez-Jiménez J, Palacios-Ceña D, Parás-Bravo P. Prevalence of Neuropathic Component in Post-COVID Pain Symptoms in Previously Hospitalized COVID-19 Survivors. Int J Clin Pract 2022; 2022:3532917. [PMID: 35685491 PMCID: PMC9159239 DOI: 10.1155/2022/3532917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/18/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of neuropathic pain symptoms and to analyze the correlation between neuropathic symptoms with pain-related, psychological, and cognitive variables in COVID-19 survivors exhibiting "de novo" post-COVID pain. METHODS Seventy-seven (n = 77) previously hospitalized COVID-19 survivors presenting with post-COVID pain completed demographic (such as age, height, and weight), pain-related (the duration and intensity of pain), psychological (depressive/anxiety levels), and cognitive (catastrophizing and kinesiophobia) variables. The Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire was also assessed. After conducting multivariable correlation analyses, a stepwise multiple linear regression model was performed to identify S-LANSS predictors. RESULTS Participants were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Nineteen (24.6%) exhibited neuropathic pain symptoms (S-LANSS score≥12 points). The S-LANSS score was positively associated with the duration of post-COVID pain (r: 0.262), anxiety levels (r: 0.275), and kinesiophobia level (r: 0.291) (all, P < 0.05). The stepwise regression analysis revealed that 12.8% of the S-LANSS variance was just explained by kinesiophobia. CONCLUSION This study found that almost 25% of previously hospitalized COVID-19 survivors with "de novo" post-COVID pain reported a neuropathic pain component. The presence of neuropathic pain symptomatology was associated with more anxiety and kinesiophobia, but only kinesiophobia level was significantly associated explaining 12.8% of the variance of the S-LANSS score.
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Affiliation(s)
- Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria, Santander 39008, Spain
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Enfermería, Santander 39008, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid 28922, Spain
| | - Diego Ferrer-Pargada
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander 39008, Spain
| | - Sandra Tello-Mena
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander 39008, Spain
| | - Ignacio Cancela-Cilleruelo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid 28922, Spain
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid 28922, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid 28922, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria, Santander 39008, Spain
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Enfermería, Santander 39008, Spain
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Hannum ME, Koch RJ, Ramirez VA, Marks SS, Toskala AK, Herriman RD, Lin C, Joseph PV, Reed DR. Taste loss as a distinct symptom of COVID-19: a systematic review and meta-analysis. Chem Senses 2022; 47:bjac001. [PMID: 35171979 PMCID: PMC8849313 DOI: 10.1093/chemse/bjac001] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Chemosensory scientists have been skeptical that reports of COVID-19 taste loss are genuine, in part because before COVID-19 taste loss was rare and often confused with smell loss. Therefore, to establish the predicted prevalence rate of taste loss in COVID-19 patients, we conducted a systematic review and meta-analysis of 376 papers published in 2020-2021, with 241 meeting all inclusion criteria. Drawing on previous studies and guided by early meta-analyses, we explored how methodological differences (direct vs. self-report measures) may affect these estimates. We hypothesized that direct measures of taste are at least as sensitive as those obtained by self-report and that the preponderance of evidence confirms taste loss is a symptom of COVID-19. The meta-analysis showed that, among 138,897 COVID-19-positive patients, 39.2% reported taste dysfunction (95% confidence interval: 35.34%-43.12%), and the prevalence estimates were slightly but not significantly higher from studies using direct (n = 18) versus self-report (n = 223) methodologies (Q = 0.57, df = 1, P = 0.45). Generally, males reported lower rates of taste loss than did females, and taste loss was highest among middle-aged adults. Thus, taste loss is likely a bona fide symptom of COVID-19, meriting further research into the most appropriate direct methods to measure it and its underlying mechanisms.
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Affiliation(s)
- Mackenzie E Hannum
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Riley J Koch
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Vicente A Ramirez
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
- Department of Public Health, University of California Merced, Merced, CA 95348, USA
| | - Sarah S Marks
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Aurora K Toskala
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Riley D Herriman
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Cailu Lin
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
| | - Paule V Joseph
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- Division of Intramural Research, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Danielle R Reed
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104, USA
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Desai AD, Lavelle M, Boursiquot BC, Wan EY. Long-term complications of COVID-19. Am J Physiol Cell Physiol 2022; 322:C1-C11. [PMID: 34817268 PMCID: PMC8721906 DOI: 10.1152/ajpcell.00375.2021] [Citation(s) in RCA: 155] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022]
Abstract
SARS-CoV-2 has rapidly spread across the globe and infected hundreds of millions of people worldwide. As our experience with this virus continues to grow, our understanding of both short-term and long-term complications of infection with SARS-CoV-2 continues to grow as well. Just as there is heterogeneity in the acute infectious phase, there is heterogeneity in the long-term complications seen following COVID-19 illness. The purpose of this review article is to present the current literature with regards to the epidemiology, pathophysiology, and proposed management algorithms for the various long-term sequelae that have been observed in each organ system following infection with SARS-CoV-2. We will also consider future directions, with regards to newer variants of the virus and their potential impact on the long-term complications observed.
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Affiliation(s)
- Amar D Desai
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York
| | - Michael Lavelle
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York
| | - Brian C Boursiquot
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York
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48
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Assessment of neck pain, low back pain and disability in patients isolated at home due to mild-COVID-19: a cross-sectional study. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.996523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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49
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Prevalence and risk factors of musculoskeletal pain symptoms as long-term post-COVID sequelae in hospitalized COVID-19 survivors: a multicenter study. Pain 2021; 163:e989-e996. [PMID: 34913880 DOI: 10.1097/j.pain.0000000000002564] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
This study investigated the prevalence of long-term musculoskeletal post-COVID pain and their risk factors in a large cohort of COVID-19 survivors. A multicenter cohort study including patients hospitalised due to COVID-19 in five hospitals of Madrid (Spain) during the first wave of the pandemic was conducted. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview after hospital discharge for collecting data about the musculoskeletal post-COVID pain. Anxiety/depressive levels and sleep quality were likewise assessed. From 2,000 patients recruited, a total of 1,969 (46.4% women, age: 61, SD: 16 years) were assessed on average at 8.4 (SD 1.5) months after discharge. At the time of the study, 887 (45% women) reported musculoskeletal post-COVID pain. According to the presence of previous pain symptoms, the prevalence of "de novo" (new-onset) musculoskeletal post-COVID pain was 74.9%, whereas 25.1% experienced an increase of previous symptoms (exacerbated COVID-related pain). Female gender (OR1.349, 95%CI 1.059-1.720), previous history of musculoskeletal pain (OR1.553, 95%CI 1.271-1.898), the presence of myalgia (OR1.546, 95%CI 1.155-2.070) and headache (1.866, 95%CI 1.349-2.580) as COVID-19 associated onset symptoms, and days at hospital (OR1.013, 95%CI 1.004-1.022) were risk factors associated musculoskeletal post-COVID pain. In conclusion, musculoskeletal post-COVID pain is present in 45.1% of COVID-19 survivors at eight months after hospital discharge with most patients developing "de novo" post-COVID pain. Female gender, history of musculoskeletal pain, presence of myalgias and headache as COVID-19 symptoms at the acute phase, and days at hospital were risk factors associated with musculoskeletal post-COVID pain.
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50
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Misra S, Kolappa K, Prasad M, Radhakrishnan D, Thakur KT, Solomon T, Michael BD, Winkler AS, Beghi E, Guekht A, Pardo CA, Wood GK, Hsiang-Yi Chou S, Fink EL, Schmutzhard E, Kheradmand A, Hoo FK, Kumar A, Das A, Srivastava AK, Agarwal A, Dua T, Prasad K. Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis. Neurology 2021; 97:e2269-e2281. [PMID: 34635561 PMCID: PMC8665434 DOI: 10.1212/wnl.0000000000012930] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES One year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality. METHODS We searched PubMed, Medline, Cochrane library, ClinicalTrials.gov, and EMBASE for studies from December 31, 2019, to December 15, 2020, enrolling consecutive patients with COVID-19 presenting with neurologic manifestations. Risk of bias was examined with the Joanna Briggs Institute scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% confidence intervals (CIs) were calculated for neurologic manifestations. Odds ratio (ORs) and 95% CIs were calculated to determine the association of neurologic manifestations with disease severity and mortality. Presence of heterogeneity was assessed with I 2, meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2. RESULTS Of 2,455 citations, 350 studies were included in this review, providing data on 145,721 patients with COVID-19, 89% of whom were hospitalized. Forty-one neurologic manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurologic symptoms included fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%), and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurologic diagnosis (pooled prevalence 2%). In patients with COVID-19 ≥60 years of age, the pooled prevalence of acute confusion/delirium was 34%, and the presence of any neurologic manifestations in this age group was associated with mortality (OR 1.80, 95% CI 1.11-2.91). DISCUSSION Up to one-third of patients with COVID-19 analyzed in this review experienced at least 1 neurologic manifestation. One in 50 patients experienced stroke. In those >60 years of age, more than one-third had acute confusion/delirium; the presence of neurologic manifestations in this group was associated with nearly a doubling of mortality. Results must be interpreted with the limitations of observational studies and associated bias in mind. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020181867.
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Affiliation(s)
- Shubham Misra
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Kavitha Kolappa
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Manya Prasad
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Divya Radhakrishnan
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Kiran T Thakur
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Tom Solomon
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Benedict Daniel Michael
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Andrea Sylvia Winkler
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Ettore Beghi
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Alla Guekht
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Carlos A Pardo
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Greta Karen Wood
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Sherry Hsiang-Yi Chou
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Ericka L Fink
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Erich Schmutzhard
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Amir Kheradmand
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Fan Kee Hoo
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Amit Kumar
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Animesh Das
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Achal K Srivastava
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Ayush Agarwal
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Tarun Dua
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India
| | - Kameshwar Prasad
- From the Department of Neurology (S.M., D.R., A.K., A.D., A.K.S., A.A.), All India Institute of Medical Sciences, New Delhi, India; Brain Health Unit (K.K., T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Research and Epidemiology (M.P.), Institute of Liver and Biliary Sciences, New Delhi, India; Columbia University Irving Medical Center-New York Presbyterian Hospital (K.T.T.), NY; Institute of Infection, Veterinary and Ecological Sciences (T.S., B.D.M., G.K.W.), University of Liverpool; Department of Neurology (T.S., B.D.M.), Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection (B.D.M.), Liverpool, UK; Center for Global Health (A.S.W.), Department of Neurology, Technical University of Munich, Germany; Centre for Global Health (A.S.W.), Institute of Health and Society, University of Oslo, Norway; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (E.B.), Milan, Italy; Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University (A.G.), Russia; Departments of Neurology and Pathology (C.A.P.), Johns Hopkins University School of Medicine, Baltimore, MD; University of Pittsburgh School of Medicine (S.H.-Y.C.); Department of Critical Care Medicine (E.L.F.), UPMC Children's Hospital of Pittsburgh, PA; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Departments of Neurology and Otolaryngology-Head & Neck Surgery (A.K.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (F.K.H.), Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan; and Rajendra Institute of Medical Sciences (K.P.), Ranchi, Jharkhand, India.
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