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Singh MM, Sharma H, Bhatnagar N, Borle AL, Rao S, Mishra S, Singh G, Singh T, Kapoor M, Kumar N. Burden of Long COVID-19 in a Cohort of Recovered COVID-19 Patients in Delhi, India. Cureus 2024; 16:e60652. [PMID: 38899267 PMCID: PMC11185991 DOI: 10.7759/cureus.60652] [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: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The long COVID phase is characterized by signs and symptoms persisting for at least three months after recovery from acute COVID-19 illness. There is limited data on comprehensive long-term clinical follow-up of COVID-19 patients. AIMS This study aims to explore the burden and symptomatology of long COVID syndrome and its association with various health parameters. SETTINGS AND DESIGN This prospective observational study was conducted in Delhi from May 2022 to March 2023. METHODS AND MATERIAL A total of 553 adult patients who had recovered from COVID-19 were enrolled in the study. A sociodemographic and clinical profile was obtained using validated questionnaires, along with an evaluation of biochemical parameters to assess the associated factors. STATISTICAL ANALYSIS USED Chi-square test, unpaired t-test, and bivariate regression analysis were applied using Statistical Product and Service Solutions (SPSS, version 28; IBM SPSS Statistics for Windows, Armonk, NY). A p value of <0.05 was considered significant. RESULTS A total of 252 patients (45.6%) had long COVID syndrome, which was significantly associated with the presence of any pre-existing comorbidity (OR=1.46 (1.02-2.09); p=0.039), previous history of hypertension (OR=1.82 (1.07-3.09); p=0.027), and vaccination against COVID-19 (OR=1.392 (1.171-1.656); p=0.003). The most common symptoms reported were persistent fatigue (33.3%) and persistent dry cough (28.5%). Patients with long COVID syndrome are also reported to have poorer sleep quality. Biochemical findings showed abnormal T lymphocytes (9.3%) and raised HbA1c (11.9%). CONCLUSIONS Multiple risk factors and symptoms associated with long COVID syndrome were identified in this study. Research efforts and knowledge regarding the pattern of illness will aid in long-term monitoring and development of interventional strategies and guidelines for the care of recovered COVID-19 patients.
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Affiliation(s)
- Mongjam M Singh
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Hitakshi Sharma
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Nidhi Bhatnagar
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | | | - Shivani Rao
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Suruchi Mishra
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Gurmeet Singh
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Tanya Singh
- Community Medicine, Maulana Azad Medical College, New Delhi, IND
| | - Mahima Kapoor
- Psychiatry, Maulana Azad Medical College, New Delhi, IND
| | - Naresh Kumar
- Pulmonary Medicine, Maulana Azad Medical College, New Delhi, IND
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Rivera-Cavazos A, Luviano-García JA, Garza-Silva A, Morales-Rodríguez DP, Kuri-Ayache M, Sanz-Sánchez MÁ, Santos-Macías JE, Romero-Ibarguengoitia ME, González-Cantú A. Analyzing the Interplay between COVID-19 Viral Load, Inflammatory Markers, and Lymphocyte Subpopulations on the Development of Long COVID. Microorganisms 2023; 11:2241. [PMID: 37764085 PMCID: PMC10536598 DOI: 10.3390/microorganisms11092241] [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: 07/25/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
The global impact of the SARS-CoV-2 infection has been substantial, affecting millions of people. Long COVID, characterized by persistent or recurrent symptoms after acute infection, has been reported in over 40% of patients. Risk factors include age and female gender, and various mechanisms, including chronic inflammation and viral persistence, have been implicated in long COVID's pathogenesis. However, there are scarce studies in which multiple inflammatory markers and viral load are analyzed simultaneously in acute infection to determine how they predict for long COVID at long-term follow-up. This study explores the association between long COVID and inflammatory markers, viral load, and lymphocyte subpopulation during acute infection in hospitalized patients to better understand the risk factors of this disease. This longitudinal retrospective study was conducted in patients hospitalized with COVID-19 in northern Mexico. Inflammatory parameters, viral load, and lymphocyte subpopulation during the acute infection phase were analyzed, and long COVID symptoms were followed up depending on severity and persistence (weekly or monthly) and assessed 1.5 years after the acute infection. This study analyzed 79 patients, among them, 41.8% presented long COVID symptoms, with fatigue being the most common (45.5%). Patients with long COVID had higher lymphocyte levels during hospitalization, and NK cell subpopulation levels were also associated with long COVID. ICU admission during acute COVID-19 was also linked to the development of long COVID symptoms.
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Affiliation(s)
- Andrea Rivera-Cavazos
- Vicerrectoría de Ciencias de la Salud, Escuela de Medicina, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo León, Mexico; (A.R.-C.)
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico;
| | - José Antonio Luviano-García
- Vicerrectoría de Ciencias de la Salud, Escuela de Medicina, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo León, Mexico; (A.R.-C.)
- Internal Medicine Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico
| | - Arnulfo Garza-Silva
- Vicerrectoría de Ciencias de la Salud, Escuela de Medicina, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo León, Mexico; (A.R.-C.)
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico;
| | - Devany Paola Morales-Rodríguez
- Vicerrectoría de Ciencias de la Salud, Escuela de Medicina, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo León, Mexico; (A.R.-C.)
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico;
| | - Mauricio Kuri-Ayache
- Cardiology Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico
| | - Miguel Ángel Sanz-Sánchez
- Vicerrectoría de Ciencias de la Salud, Escuela de Medicina, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo León, Mexico; (A.R.-C.)
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico;
| | - Juan Enrique Santos-Macías
- Vicerrectoría de Ciencias de la Salud, Escuela de Medicina, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo León, Mexico; (A.R.-C.)
- Internal Medicine Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico
| | - Maria Elena Romero-Ibarguengoitia
- Vicerrectoría de Ciencias de la Salud, Escuela de Medicina, Universidad de Monterrey, San Pedro Garza García 66238, Nuevo León, Mexico; (A.R.-C.)
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico;
| | - Arnulfo González-Cantú
- Research Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico;
- Internal Medicine Department, Hospital Clínica Nova de Monterrey, San Nicolás de los Garza 66450, Nuevo León, Mexico
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3
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Nongpiur A, Barman B, Syiem K, Mawiong AM, Anand N, Nune A. A cross-sectional study of the mental health burden among COVID-19 survivors. Indian J Psychiatry 2023; 65:661-666. [PMID: 37485412 PMCID: PMC10358821 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_105_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on mental health, including stress, anxiety, and depression. This study aimed to assess the incidence and severity of mental health issues among individuals diagnosed with COVID-19 infection. Methods A semi-structured proforma for socio-demographic and clinical parameters was used to collect cross-sectional hospital-based data of subjects who tested positive for COVID-19 infection. The Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS) were used to assess the presence of physical, psychological, and cognitive symptoms. The presence of anxiety, depression, and stress was based on the cut-off scores for HADS-A (≥8), HADS-D (≥8), and PSS (≥14), respectively. Results A total of 101 patients comprising 39 (38.6%) males were recruited. Compared to nuclear families, we observed that patients living in joint families had significantly greater severity scores for fatigue [MFIS (p = 0.04)], anxiety [HADS-A (p = 0.004)], depression [HADS-D (p = 0.004)], and stress [PSS (p = 0.02)]. Based on the cut-off scores, we found that 44 (43.6%) patient had anxiety, 41 (40.6%) had depressive, and 72 (71.3%) had moderate to high stress symptoms, respectively. We also observed significantly greater fatigue and anxiety scores, that is, MFIS (p = 0.008) and HADS-A (p = 0.03) in those who received oxygen therapy compared to those who did not. The subjects who received corticosteroids were older (p = 0.01) and had significantly higher stress scores [PSS (p < 0.001)]. The study showed that patients who were assessed more than 3 months post-COVID-19 infection had higher fatigue and depression scores; however, the difference did not reach statistical significance (MFIS P = 0.058; HADS P = 0.059). Conclusion Our study confirms that COVID-19 infection can cause various adverse mental health issues. Mitigating the hazardous effects of COVID-19 pandemic on mental health should be a top priority for public health to prevent long-term complications.
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Affiliation(s)
- Arvind Nongpiur
- Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS) Guwahati, Assam, India
| | - Kimberly Syiem
- Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - Andreecia Mn Mawiong
- Meghalaya Institute of Mental health and Neurosciences (MIMHANS), Meghalaya, India
| | - Naveen Anand
- Manasa Nursing Home (Neuro and Psychiatric Care Center), Shivamogga, Karnataka, India
| | - Arvind Nune
- Southport and Ormskirk NHS Trust, Southport, UK
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Sen P, R N, Nune A, Day J, Joshi M, Agarwal V, Aggarwal R, Gupta L. Post-COVID-19 condition in patients with autoimmune rheumatic diseases: the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. THE LANCET. RHEUMATOLOGY 2023; 5:e247-e250. [PMID: 37124550 PMCID: PMC10124998 DOI: 10.1016/s2665-9913(23)00066-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
| | - Naveen R
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Arvind Nune
- Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton WV10 0QP, UK
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Poole-Wright K, Guennouni I, Sterry O, Evans RA, Gaughran F, Chalder T. Fatigue outcomes following COVID-19: a systematic review and meta-analysis. BMJ Open 2023; 13:e063969. [PMID: 37185637 PMCID: PMC10151247 DOI: 10.1136/bmjopen-2022-063969] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 03/06/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES Fatigue is a pervasive clinical symptom in coronaviruses and may continue beyond the acute phase, lasting for several months or years. This systematic review and meta-analysis aimed to incorporate the current evidence for postinfection fatigue among survivors of SARS-CoV-2 and investigate associated factors. METHODS Embase, PsyINFO, Medline, CINAHL, CDSR, Open Grey, BioRxiv and MedRxiv were systematically searched from January 2019 to December 2021. Eligible records included all study designs in English. Outcomes were fatigue or vitality in adults with a confirmed diagnosis of SARS-CoV-2 measured at >30 days post infection. Non-confirmed cases were excluded. JBI risk of bias was assessed by three reviewers. Random effects model was used for the pooled proportion with 95% CIs. A mixed effects meta-regression of 35 prospective articles calculated change in fatigue overtime. Subgroup analyses explored specific group characteristics of study methodology. Heterogeneity was assessed using Cochran's Q and I2 statistic. Egger's tests for publication bias. RESULTS Database searches returned 14 262 records. Following deduplication and screening, 178 records were identified. 147 (n=48 466 participants) were included for the meta-analyses. Pooled prevalence was 41% (95% CI: 37% to 45%, k=147, I2=98%). Fatigue significantly reduced over time (-0.057, 95% CI: -107 to -0.008, k=35, I2=99.3%, p=0.05). A higher proportion of fatigue was found in studies using a valid scale (51%, 95% CI: 43% to 58%, k=36, I2=96.2%, p=0.004). No significant difference was found for fatigue by study design (p=0.272). Egger's test indicated publication bias for all analyses except valid scales. Quality assessments indicated 4% at low risk of bias, 78% at moderate risk and 18% at high risk. Frequently reported associations were female gender, age, physical functioning, breathlessness and psychological distress. CONCLUSION This study revealed that a significant proportion of survivors experienced fatigue following SARS-CoV-2 and their fatigue reduced overtime. Non-modifiable factors and psychological morbidity may contribute to ongoing fatigue and impede recovery. PROSPERO REGISTRATION NUMBER CRD42020201247.
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Affiliation(s)
- Kim Poole-Wright
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | | | - Olivia Sterry
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Fiona Gaughran
- Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Trudie Chalder
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Yan MZ, Yang M, Lai CL. Post-COVID-19 Syndrome Comprehensive Assessment: From Clinical Diagnosis to Imaging and Biochemical-Guided Diagnosis and Management. Viruses 2023; 15:v15020533. [PMID: 36851746 PMCID: PMC9964207 DOI: 10.3390/v15020533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/04/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
The COVID-19 outbreak was first reported in 2019, causing massive morbidity and mortality. The majority of the COVID-19 patients survived and developed Post-COVID-19 Syndrome (PC19S) of varying severity. Currently, the diagnosis of PC19S is achieved through history and symptomatology that cannot be explained by an alternative diagnosis. However, the heavy reliance on subjective reporting is prone to reporting errors. Besides, there is no unified diagnostic assessment tool to classify the clinical severity of patients. This leads to significant difficulties when managing patients in terms of public resource utilization, clinical progression monitorization and rehabilitation plan formulation. This narrative review aims to review current evidence of diagnosis based on triple assessment: clinical symptomatology, biochemical analysis and imaging evidence. Further assessment tools can be developed based on triple assessment to monitor patient's clinical progression, prognosis and intervals of monitoring. It also highlights the high-risk features of patients for closer and earlier monitoring. Rehabilitation programs and related clinical trials are evaluated; however, most of them focus on cardiorespiratory fitness and psychiatric presentations such as anxiety and depression. Further research is required to establish an objective and comprehensive assessment tool to facilitate clinical management and rehabilitation plans.
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Affiliation(s)
- Michael Zhipeng Yan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- Correspondence: (M.Z.Y.); (C.-L.L.)
| | - Ming Yang
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China
| | - Ching-Lung Lai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- Correspondence: (M.Z.Y.); (C.-L.L.)
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T Sathyapalan D, V Nair C, Moni M, Edathadathil F, A A, Prasanna P, Pushpa Raghavan R, Jayant A. Incidence and characterisation of post-COVID-19 symptoms in hospitalized COVID-19 survivors: A single centre, prospective observational cohort study to recognize the syndemic connotations in India. JMIR Form Res 2023; 7:e40028. [PMID: 36920842 PMCID: PMC10131721 DOI: 10.2196/40028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Long COVID or post-COVID-19 syndrome is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to pre pandemic states, post-COVID-19 state tends to be less recognised from low middle income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of the COVID 19, it is important to characterise post-COVID-19 syndrome. OBJECTIVE We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February 2021 to July 2021 from a tertiary care centre in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in non-ICU and ICU patients, assessing the persistence, severity and characteristics of post-COVID-19 manifestations and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. METHODS 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after informed written consent. The cohort included 50 patients requiring Intensive care unit and 70 patients with non-intensive care. The follow-up was conducted on the second and sixth week after discharge with a structured questionnaire. The questionnaire was filled by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow up at 6 weeks. RESULTS : Mean age of the cohort was 55 years and 55% were males. Only (5%) of the cohort had taken the first dose of COVID-19 vaccination.58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. 60.8% (n=73) of patients had at least one persistent symptom at sixth week of discharge. 50 (41.7%) patients required intensive care during their inpatient stay. Presence of persistent symptoms at 6 weeks was not associated with severity of illness, age or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8% followed by dyspnoea (20%) and weight loss (16.7%). Female sex (OR 2.4, 95% CI: 1.03-5.58, P=.04) and steroid administration during hospital stay (OR: 4.43; 95% CI: 1.9-10.28, P=.001), were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. CONCLUSIONS 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 week's post- discharge from hospital. Incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate and severe COVID-19 severity categories. Female sex and steroid administration during hospital stay were identified as predictors of persistence of post-COVID-19 symptoms at 6 weeks. CLINICALTRIAL
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Affiliation(s)
- Dipu T Sathyapalan
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Chithira V Nair
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Merlin Moni
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Fabia Edathadathil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Appukuttan A
- Division of Infectious Disease, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | - Preetha Prasanna
- Department of Medical Administration, Amrita Institute of Medical Science and Research Centre, Kochi, IN
| | | | - Aveek Jayant
- Department of Anaesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, IN
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Takakura K, Suka M, Kajihara M, Koido S. Clinical features, therapeutic outcomes, and recovery period of long COVID. J Med Virol 2023; 95:e28316. [PMID: 36412057 PMCID: PMC10108287 DOI: 10.1002/jmv.28316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022]
Abstract
To characterize the clinical features of long COVID, 286 patients who received care in our outpatient clinic for long COVID from May to December 2021 were surveyed. The recovery periods of each symptom and the key factors contributing to early recovery were statistically analysed. The median age of the patients was 35.8 years, with 137 men and 149 women. The median number of symptoms was 2.8. The most frequent symptoms were respiratory manifestations (52.1%), followed by fatigue (51.4%). Respiratory symptoms, fatigue, and headache/arthralgia were major complaints in the initial phase, whereas hair loss was a major complaint in the late phase, suggesting that the chief complaint of patients with long COVID may vary temporally. The best treatment outcome was observed for pulmonary symptoms, and hair loss had the worst outcome. COVID-19 severity, the number of manifestations, and the delay in starting treatment exerted a negative effect on the recovery period of long COVID. In addition, the smoking habit was an independent risk factor for slowing the recovery period from long COVID. This study provides insights into the clinical course of each manifestation and therapeutic options with a more certain future of long COVID to meet the unmet medical needs.
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Affiliation(s)
- Kazuki Takakura
- Department of Internal Medicine, UnMed Clinic Motomachi, Yokohama, Kanagawa, Japan
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Mikio Kajihara
- Department of Internal Medicine, Kajihara Clinic, Hiratsuka, Kanagawa, Japan
| | - Shigeo Koido
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University Kashiwa Hospital, Chiba, Japan
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Mohammad KO, Lin A, Rodriguez JBC. Cardiac Manifestations of Post-Acute COVID-19 Infection. Curr Cardiol Rep 2022; 24:1775-1783. [PMID: 36322364 PMCID: PMC9628458 DOI: 10.1007/s11886-022-01793-3] [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] [Accepted: 10/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW There is emerging evidence that the post-acute and chronic phases of COVID-19 infection are associated with various significant cardiovascular sequelae. RECENT FINDINGS Long COVID has been shown to be associated with multiple cardiovascular sequelae including direct myocardial injury, arrhythmias, and cardiomyopathies. Hypotheses on the mechanism of myocardial injury include direct viral infiltration and autoimmune dysregulation. Long COVID is associated with persistent cardiac ischemia in patients with no previous history of coronary disease, atrial and ventricular arrhythmias, and the development of new-onset heart failure in previously healthy patients. Onset of long COVID may be related to severity of the initial SARS-CoV2 infection. Cardiac MRI is a valuable tool in assessing myocarditis and the development of cardiomyopathies in the setting of long COVID. Both patients with and without pre-existing cardiovascular disease are at risk of developing myocardial injury in the setting of long COVID. Future studies will elucidate both cardiovascular mortality and cardiac rehabilitation in the post-acute and chronic phases of COVID-19.
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Affiliation(s)
- Khan O. Mohammad
- Department of Internal Medicine, Dell Medical School at The University of Texas, 1500 Red River St., Austin, TX 78701 USA
| | - Andrew Lin
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, CA USA
| | - Jose B. Cruz Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, CA USA
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Kell DB, Pretorius E. The potential role of ischaemia-reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications. Biochem J 2022; 479:1653-1708. [PMID: 36043493 PMCID: PMC9484810 DOI: 10.1042/bcj20220154] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
Ischaemia-reperfusion (I-R) injury, initiated via bursts of reactive oxygen species produced during the reoxygenation phase following hypoxia, is well known in a variety of acute circumstances. We argue here that I-R injury also underpins elements of the pathology of a variety of chronic, inflammatory diseases, including rheumatoid arthritis, ME/CFS and, our chief focus and most proximally, Long COVID. Ischaemia may be initiated via fibrin amyloid microclot blockage of capillaries, for instance as exercise is started; reperfusion is a necessary corollary when it finishes. We rehearse the mechanistic evidence for these occurrences here, in terms of their manifestation as oxidative stress, hyperinflammation, mast cell activation, the production of marker metabolites and related activities. Such microclot-based phenomena can explain both the breathlessness/fatigue and the post-exertional malaise that may be observed in these conditions, as well as many other observables. The recognition of these processes implies, mechanistically, that therapeutic benefit is potentially to be had from antioxidants, from anti-inflammatories, from iron chelators, and via suitable, safe fibrinolytics, and/or anti-clotting agents. We review the considerable existing evidence that is consistent with this, and with the biochemical mechanisms involved.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, U.K
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kemitorvet 200, 2800 Kgs Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland 7602, South Africa
| | - Etheresia Pretorius
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, U.K
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland 7602, South Africa
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Spanos M, Shachar S, Sweeney T, Lehmann HI, Gokulnath P, Li G, Sigal GB, Nagaraj R, Bathala P, Rana F, Shah RV, Routenberg DA, Das S. Elevation of neural injury markers in patients with neurologic sequelae after hospitalization for SARS-CoV-2 infection. iScience 2022; 25:104833. [PMID: 35937088 PMCID: PMC9341164 DOI: 10.1016/j.isci.2022.104833] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with SARS-CoV-2 infection (COVID-19) risk developing long-term neurologic symptoms after infection. Here, we identify biomarkers associated with neurologic sequelae one year after hospitalization for SARS-CoV-2 infection. SARS-CoV-2-positive patients were followed using post-SARS-CoV-2 online questionnaires and virtual visits. Hospitalized adults from the pre-SARS-CoV-2 era served as historical controls. 40% of hospitalized patients develop neurological sequelae in the year after recovery from acute COVID-19 infection. Age, disease severity, and COVID-19 infection itself was associated with additional risk for neurological sequelae in our cohorts. Glial fibrillary astrocytic protein (GFAP) and neurofilament light chain (NF-L) were significantly elevated in SARS-CoV-2 infection. After adjusting for age, sex, and disease severity, GFAP and NF-L remained significantly associated with longer term neurological symptoms in patients with SARS-CoV-2 infection. GFAP and NF-L warrant exploration as biomarkers for long-term neurologic complications after SARS-CoV-2 infection.
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Affiliation(s)
- Michail Spanos
- Cardiovascular Research Center, 185 Cambridge Street, Simches 3 Massachusetts General Hospital, Boston, MA, USA
| | - Sigal Shachar
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | - Thadryan Sweeney
- Cardiovascular Research Center, 185 Cambridge Street, Simches 3 Massachusetts General Hospital, Boston, MA, USA
| | - H. Immo Lehmann
- Cardiovascular Research Center, 185 Cambridge Street, Simches 3 Massachusetts General Hospital, Boston, MA, USA
| | - Priyanka Gokulnath
- Cardiovascular Research Center, 185 Cambridge Street, Simches 3 Massachusetts General Hospital, Boston, MA, USA
| | - Guoping Li
- Cardiovascular Research Center, 185 Cambridge Street, Simches 3 Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Farhan Rana
- Cardiovascular Research Center, 185 Cambridge Street, Simches 3 Massachusetts General Hospital, Boston, MA, USA
| | - Ravi V. Shah
- Cardiovascular Research Center, 185 Cambridge Street, Simches 3 Massachusetts General Hospital, Boston, MA, USA
| | | | - Saumya Das
- Cardiovascular Research Center, 185 Cambridge Street, Simches 3 Massachusetts General Hospital, Boston, MA, USA
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Nune A, Iyengar KP, Barman B, Manzo C. Post-COVID-19 Condition and İts Recognition in Low- and Middle-income Countries: Working Notes from the United Kingdom Experience. Balkan Med J 2022; 39:303-304. [PMID: 35873791 PMCID: PMC9326947 DOI: 10.4274/balkanmedj.galenos.2022.2022-5-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Letters to the Editor. J R Coll Physicians Edinb 2022; 52:80-85. [DOI: 10.1177/14782715221089063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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