Health-Related Quality of Life for Jordanian-Recovered Individuals During Post-COVID-19 Era: A Cross-Sectional Study

Aim

This study aims to determine health-related quality of life (HRQoL) that includes the physical and mental health of recovered patients of COVID-19 and examines the significant impact of variables such as period of infection, sample demographics characteristics, hospitalization past, and chronic disease past and the other variables on HRQoL of COVID-19-recovered patients.

Methods

An exploratory, community-based, cross-sectional research layout was adopted, using an electronic self-reporting survey disseminated online to recovered COVID-19 patients in Jordan. Targeted COVID-19 patients were individuals who were 18 years old or above. They had a documented background of COVID-19 illness, as stated in the following inclusion requirements: Those who had not been formally proven to have been afflicted by COVID-19 were excluded.

Results

The mean of the physical well-being of study participants during COVID-19 was M=68.00 (SD=6.95), representing medium physical well-being status. The mean of psychological well-being of study participants during COVID-19 was M=60.20 (SD=8.85), representing medium physical health. Multiple regression showed that female recovered patients who are not working, with a low level of income, married women, and who getting COVID-19 more than once are having lower health-related quality of life compared to other recovered patients.

Conclusion

The HRQoL of COVID-19 patients was significantly impacted, independent of the period since hospitalization or rehabilitation. Policymakers and health workers should research strong ways to enhance the HRQoL of COVID-19 patients as soon as possible. Elderly patients and those who have been infected more than one time and being hospitalized have a greater probability of decreased HRQoL after infection.

Traumatic experiences and PTSD symptoms in substance use disorder: A comparison of recovered versus current users

Introduction: The aim of this study was to investigate the prevalence of traumatic experiences and symptoms of posttraumatic stress disorder (PTSD) in treatment-seeking individuals with ongoing substance use disorder (SUD) compared to individuals who have recovered from SUD. Methods: Patients with SUD recruited from the STAYER study (N = 114) underwent an examination of alcohol and drug use, childhood trauma, negative life events and PTSD symptomatology. In this study, only participants with 12-month concurrent polysubstance use was included. Using historical data from the STAYER study, alcohol and drug trajectories were dichotomised as (1) current SUD (current SUD) or (2) recovered from substance use disorder (recovered SUD). Crosstabs and chi-tests were used to measure differences between groups. Results: Childhood maltreatment, traumatic experiences later in life and symptoms of concurrent PTSD were highly prevalent in the study population. We found no significant difference between the current and recovered SUD groups. Recovered women reported a lower prevalence of physical neglect (p = 0.031), but a higher prevalence of multiple lifetime traumas (p = 0.019) compared to women with current SUD. Both women with current SUD and recovered women reported a significantly higher prevalence of sexual aggression than men (p < 0.001 and p < 0.001, respectively). In addition, men who have recovered from SUD reported a lower prevalence of PTSD symptoms over cut-off 38 (p = 0.017), of re-experiencing (p = 0.036) and of avoidance (p = 0.015), compared to recovered women. Conclusion: Reported trauma did not differ between persons with current SUD and those who had recovered from SUD. Gender differences discovered in this study indicate the importance of developing individualised and gender-specific treatment models for comorbid PTSD/SUD.

An Update on Protective Effectiveness of Immune Responses After Recovery From COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exhibits variable immunity responses among hosts based on symptom severity. Whether immunity in recovered individuals is effective for avoiding reinfection is poorly understood. Determination of immune memory status against SARS-CoV-2 helps identify reinfection risk and vaccine efficacy. Hence, after recovery from COVID-19, evaluation of protective effectiveness and durable immunity of prior disease could be significant. Recent reports described the dynamics of SARS-CoV-2 -specific humoral and cellular responses for more than six months in convalescent SARS-CoV-2 individuals. Given the current evidence, NK cell subpopulations, especially the memory-like NK cell subset, indicate a significant role in determining COVID-19 severity. Still, the information on the long-term NK cell immunity conferred by SARS-CoV-2 infection is scant. The evidence from vaccine clinical trials and observational studies indicates that hybrid natural/vaccine immunity to SARS-CoV-2 seems to be notably potent protection. We suggested the combination of plasma therapy from recovered donors and vaccination could be effective. This focused review aims to update the current information regarding immune correlates of COVID-19 recovery to understand better the probability of reinfection in COVID-19 infected cases that may serve as guides for ongoing vaccine strategy improvement.

A Prediction Model for High Risk of Positive RT-PCR Test Results in COVID-19 Patients Discharged From Wuhan Leishenshan Hospital, China

Several recent studies have reported that a few patients had positive SARS-CoV-2 RNA tests after hospital discharge. The high-risk factors associated with these patients remain to be identified. A total of 463 patients with COVID-19 discharged from Leishenshan Hospital in Wuhan, China, between February 8 and March 8, 2020 were initially enrolled, and 351 patients with at least 2 weeks of follow-up were finally included. Seventeen of the 351 discharged patients had positive tests for SARS-CoV-2 RNA. Based on clinical characteristics and mathematical modeling, patients with shorter hospital stays and less oxygen desaturation were at higher risk of SARS-CoV-2 RNA reoccurrence after discharge. Notably, traditional Chinese medicine treatment offered extensive benefits to reduce risk. Particular attention should be paid to those patients with high risk, and traditional Chinese medicine should be advocated.

Memory B cells targeting SARS-CoV-2 spike protein and their dependence on CD4+ T cell help

Memory B cells seem to be more durable than antibodies and thus crucial for the long-term immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here we investigate SARS-CoV-2 spike-specific memory B cells and their dependence on CD4⁺ T cell help in different settings of coronavirus disease 2019 (COVID-19). Compared with severely ill individuals, those who recovered from mild COVID-19 develop fewer but functionally superior spike-specific memory B cells. Generation and affinity maturation of these cells is best associated with IL-21⁺CD4⁺ T cells in recovered individuals and CD40L⁺CD4⁺ T cells in severely ill individuals. The increased activation and exhaustion of memory B cells observed during COVID-19 correlates with CD4⁺ T cell functions. Intriguingly, CD4⁺ T cells recognizing membrane protein show a stronger association with spike-specific memory B cells than those recognizing spike or nucleocapsid proteins. Overall, we identify CD4⁺ T cell subsets associated with the generation of B cell memory during SARS-CoV-2 infection.

Risk factors for redetectable positivity in recovered COVID-19 children

OBJECTIVE

To identify the risk factors for redetectable positivity (RP), and to provide a basis for prevention and control of coronavirus disease-2019 (COVID-19) in children.

METHODS

A retrospective study was performed on all pediatric patients diagnosed with COVID-19. RP was defined as the positive result of real-time reverse transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after symptom resolution and discharge. Children were defined as being less than 18 years old.

RESULTS

Fourteen out of 38 (36.8%) pediatric patients exhibited RP. Compared with the non-RP group (n = 24), the RP group (n = 14) had more family cluster infections, relatively higher white blood cell (WBC) count and longer plasma prothrombin time (PT), while age and gender were insignificant. T lymphocyte subclassification was observed at five-time points: the first test after admission, 2 weeks, and 1, 2, and 3 months after discharge. The RP group had a higher percentage and count of CD8+ T lymphocytes and lower CD4+/CD8+ ratio at 2 weeks, while a lower percentage and count of CD4+ T lymphocytes and lower CD4+/CD8+ ratio at 2 months. The positive rate of nasopharyngeal swabs by RT-PCR was higher during the onset, while that of anal swabs was higher during the recovery of COVID-19.

CONCLUSIONS

Family cluster infection, higher WBC count, and longer PT are the early risk factors for RP in recovered COVID-19 children. The dynamic changes in number and ratio of CD4+ and CD8+ T lymphocytes may be involved in prolonged SARS-CoV-2 clearance. Nasopharyngeal swabs sampling during the onset and anal swabs sampling during the recovery may improve the positivity rate of RT-PCR.

Coronavirus disease-19 spread in the Eastern Mediterranean Region, updates and prediction of disease progression in Kingdom of Saudi Arabia, Iran, and Pakistan

OBJECTIVES

The present study is considered the first study that aims to estimate the spread of coronavirus disease (COVID)-19 pandemic in the Eastern Mediterranean Region and to predict the pattern of spread among Kingdom of Saudi Arabia (KSA) in comparison to Iran and Pakistan.

METHODS

Data during the period from January 29, 2020, till April 14, 2020, were extracted from 76 WHO situational reports and from the Worldometer website. Numbers of populations in each country were considered during data analysis. Susceptible, infectious, recovered, and deaths (SIRD) model and smoothing spline regression model were used to predict the number of cases in each country.

RESULTS

SIRD model in KSA yielded β = 2e-0.6, γ = 0.006, and μ = 0.00038 and R0= 0.00029. It is expected that by the 1st of May 2020, that number of cumulative infected cases would rise to 16848 in KSA and to 11,825 in Pakistan while in Iran, it is expected that the number mostly will be 100485. Moreover, the basic reproduction number R0 is expected to decrease by time progression.

CONCLUSION

The cumulative infected cases are expected to grow exponentially. Although R0 is expected to be decreased, the quarantine measures should be maintained or even enhanced.

Levels of Acceptance and Forgiveness Reported by Patients With BPD and Personality-Disordered Comparison Subjects Over 20 Years of Prospective Follow-Up

This study had two objectives: to determine the levels of acceptance and forgiveness reported by patients with borderline personality disorder (BPD) and personality-disordered comparison subjects and by recovered versus non-recovered patients with BPD over 20 years of prospective follow-up. Levels of acceptance and forgiveness were reassessed every 2 years. Patients with BPD reported levels of these states that were approximately 70% lower than comparison subjects at baseline. These states increased significantly over time for patients with BPD but not for comparison subjects. Recovered patients with BPD reported approximately three times the levels of these states than non-recovered patients with BPD. These levels increased for both groups over time; one state (accepting of myself) increased at a significantly steeper rate for recovered patients with BPD. These results suggest that patients with BPD report becoming more accepting and forgiving over time. Additionally, recovery status is significantly associated with increasing time in these states.

Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain)

OBJECTIVES

The aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%-49%) and the effect of 1-year change in LVEF in this group.

SETTING

Multicentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units.

PARTICIPANTS

Fourteen per cent (n=504) of the 3580 patients included had HFmrEF.

INTERVENTIONS

Baseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes.

RESULTS

Median follow-up was 3.66 (1.69-6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%-49% and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027) and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively).

CONCLUSIONS

Patients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1 year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.

Persistent body image disturbance following recovery from eating disorders

OBJECTIVE

Individuals with an eating disorder experience the rubber hand illusion (RHI) significantly more strongly than healthy controls on both perceptual (proprioceptive drift) and subjective (self-report embodiment questionnaire) measures. This heightened sensitivity to visual information about the body, and/or reduced somatosensory information processing about the body, suggest an increased malleability of the bodily self. The aim of the present study was to explore whether this is a state phenomenon or a persisting individual trait that outlasts the period of acute eating disorder.

METHOD

The RHI and self-report measures of eating disorder psychopathology (EDI-3 subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; DASS-21; and the Self-Objectification Questionnaire) were administered to 78 individuals with an eating disorder, 28 individuals recovered from an eating disorder, and 61 healthy controls.

RESULTS

Proprioceptive drift in recovered individuals was intermediate between the acutely ill and HC groups. Subjective report of the strength of the illusion in recovered individuals was similar to acutely ill individuals.

DISCUSSION

These results suggest that increased malleability of the bodily self persists, at least partially, following recovery and may be a trait phenomenon in people with eating disorders. Those with a lifetime history of an eating disorder may have heightened sensitivity to visual information about the body and reduced somatosensory information processing of the body.

Emotional facial expression in women recovered from anorexia nervosa

BACKGROUND

Recent models of anorexia nervosa (AN) have emphasised the importance of social and emotional difficulties as maintenance factors of the disorder, however, empirical data are limited. The aim of this study was to examine whether altered emotional facial expression, previously observed in people currently ill with anorexia nervosa, is limited to the ill state or present in people recovered from the illness.

METHODS

The sample consisted of 123 participants [49 AN, 21 recovered AN (RecAN) and 53 healthy controls (HC)]. Participants watched three films clips (amusing, neutral, sad) whilst their facial expressions were recorded and completed the positive and negative affect scale (PANAS) to record subjective experience. Facial expressions were subsequently coded for frequency of positive and negative expression and frequency of looking away.

RESULTS

In response to the amusing clip, AN participants showed significantly less positive expression than both HC and RecAN groups and both AN and RecAN showed more negative expression than HC with no difference between groups in looking away.In response to the sad clip there was no difference between groups in positive expression, but current AN participants showed significantly less negative expression than HC and looked away from the stimuli more than RecAN or HC.In terms of their subjective emotional experience, patients with current AN reported less positive emotion in response to both the amusing and the sad film clip. There was no difference between groups in subjective negative experience.

CONCLUSIONS

Alterations in facial expression are present in people currently ill with AN contributing to the social difficulties found in AN and potentially exacerbating resistance to treatment. Some alterations in facial expression are found in women with a past history of AN but not to the same extent as those shown in the currently ill group. Future studies need to use a wider range of stimuli involving different emotions to corroborate findings.

Gender differences in the developmental course of depression

BACKGROUND

There is ample evidence for female preponderance of major depressive disorder (MDD) in adolescence and adulthood. This study examined gender differences in the developmental course (i.e., incidence, duration, number of depressive episodes, and recovery rates) of MDD in non-referred adolescents and young adults.

METHODS

Data from the Oregon Adolescent Depression Project were used to examine gender differences in the developmental course of MDD. Gender differences in the onset, duration, number of depressive episode and rate of recovery from MDD were examined in a population-based sample of the same individuals (participants: N=773) during adolescence (age 14 to 17) and at age 30.

RESULTS

Compared to males, females have higher incidence rates of MDD and had a more chronic course. Difference in duration of depressive episodes is marginally significant between male and female, with females having longer episodes. Lower onset age correlates significantly with more number of episodes in both genders; however, lower onset age predicts a worse course of depression only in females.

LIMITATIONS

The sample was from a single region of the country and consisted mostly of White adolescents.

CONCLUSIONS

Childhood depression may be a more serious risk factor for girls than for boys.