More than 50 long-term effects of COVID-19: a systematic review and meta-analysis

The potential of metal-organic framework MIL-101(Al)-NH2 in the forefront of antiviral protection of cells via interaction with SARS-CoV-2 spike RBD protein and their antibacterial action mediated with hypericin and photodynamic treatment

The global pandemic of SARS-CoV-2 has highlighted the necessity for innovative therapeutic solutions. This research presents a new formulation utilising the metal-organic framework MIL-101(Al)-NH2, which is loaded with hypericin, aimed at addressing viral and bacterial challenges. Hypericin, recognised for its antiviral and antibacterial efficacy, was encapsulated to mitigate its hydrophobicity, improve bioavailability, and utilise its photodynamic characteristics. The MIL-101(Al)-NH2 Hyp complex was synthesised, characterised, and evaluated for its biological applications for the first time. The main objective of this study was to demonstrate the multimodal potential of such a construct, in particular the effect on SARS-CoV-2 protein levels and its interaction with cells. Both in vitro and in vivo experiments demonstrated the effective transport of hypericin to cells that express ACE2 receptors, thereby mimicking mechanisms of viral entry. In addition, hypericin found in the mitochondria showed selective phototoxicity when activated by light, leading to a decrease in the metabolic activity of glioblastoma cells. Importantly, the complex also showed antibacterial efficacy by selectively targeting Gram-positive Staphylococcus epidermidis compared to Gram-negative Escherichia coli under photodynamic therapy (PDT) conditions. To our knowledge, this study was the first to demonstrate the interaction between hypericin, MIL-101(Al)-NH2 and the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein, which inhibits cellular uptake and colocalises with ACE2-expressing cells. Therefore, the dual functionality of the complex - targeting the viral RBD and the antibacterial effect via PDT - emphasises its potential to mitigate complications of viral infections, such as secondary bacterial infections. In summary, these results suggest that MIL-101(Al)-NH2 Hyp is a promising multifunctional therapeutic agent for antiviral and antibacterial applications, potentially contributing to the improvement of COVID-19 treatment protocols and the treatment of co-infections.

Socioeconomic disparities in long COVID diagnosis among ethnic minorities in Denmark

BACKGROUND

Low socioeconomic status has been demonstrated as a risk factor for COVID-19 severity and mortality. However, whether socioeconomic disparities also influence the risk of long COVID diagnosis among ethnic minorities compared to the native majority population remains unclear.

METHODS

We conducted a nationwide register-based cohort study in Denmark, including individuals with a first-time COVID-19 diagnosis between January 2020 and August 2022. The risk of long COVID diagnosis among ethnic groups (defined by country of birth) was compared according to socioeconomic status.

RESULTS

Among 2 287 175 COVID-19 cases, 4579 were diagnosed with long COVID. The risk of long COVID diagnosis did not significantly differ by income or educational attainment for most ethnic groups. However, among low-income individuals, migrants had a higher risk of long COVID than native Danes, particularly Eastern Europeans (HRadjusted 1.45, 95 % CI [1.25,1.70], p < 0.001), Southeast Asians (HRadjusted 2.08, 95 % CI [1.32,3.28], p = 0.002), Middle Easterners (HRadjusted 1.65, 95 % CI [1.31,2.07], p < 0.001), and North Africans (HRadjusted 1.68, 95 % CI [1.24,2.27], p < 0.001). Additionally, migrant workers (Eastern European, Middle Eastern, and South Asian) in occupational sectors such as "economy, business, and administration", "operator, driver and transportation service", "sales and customer service", "general office and secretarial service" and "education" had a higher long COVID risk than native Danish workers in the same workplaces.

IMPLICATIONS

These findings highlight the need to address ethnic disparities in long COVID, particularly among migrants with low income. Workplace interventions and policies targeting work-related vulnerabilities could help reduce the disproportionate burden of long COVID among migrant workers.

Use of Complementary Medicine Among US Adults with Post-COVID-19: Results from the 2022 National Health Interview Survey

OBJECTIVE

The aim of this study was to investigate the prevalence and type of complementary medicine (CM) use as well as potential factors related to CM use in a representative sample of US adults with self-reported post-COVID-19.

METHODS

This secondary data analysis was based on data from the 2022 National Health Interview Survey 2022 about presence of post-COVID-19 symptoms and CM use in a representative adult sample (weighted n = 89,437,918).

RESULTS

Our estimates indicate that 19.7% of those who reported having a symptomatic SARS-CoV-2 infection experienced post-COVID-19 symptoms, and 46.2% of those reported using any type of CM in the last 12 months. Specifically, post-COVID-19 respondents most often used mind-body medicine (32.0%), followed by massage (16.1%), chiropractic (14.4%), acupuncture (3.4%), naturopathy (2.2%), and art or music therapy (2.1%). Reporting post-COVID-19 was associated with an increased likelihood of using any CM in the last 12 months (adjusted odds ratio [AOR] 1.18; 95% confidence interval [CI]. 1.03-1.34; P = .014) and specifically, to visit an art or music therapist (AOR 2.56; 95% CI, 1.58-4.41; P < .001). The overall use of any CM was more likely among post-COVID-19 respondents under 65 years old, females, those with an ethnic background other than Hispanic, African-American, Asian, or non-Hispanic Whites, having a higher educational level, living in large metropolitan areas, and having private health insurance.

CONCLUSIONS

Our findings show a high prevalence of CM use among post-COVID-19 respondents, which highlights the need for further investigations on effectiveness, safety, and possible mechanisms of action.

Comparison of quadriceps muscle strength, functional capacity and fatigue at hospital discharge and after 12 months in COVID-19 hospitalized patients undergoing early rehabilitation: a follow-up study

PURPOSE

To compare quadriceps muscle strength, functional capacity, and fatigue at hospital discharge and after 12 months in hospitalized individuals with coronavirus disease 2019 (COVID-19) who underwent early rehabilitation, and to verify whether quadriceps muscle strength at hospital discharge and functional capacity at 12 months later could be correlated.

METHODS

This was a prospective cohort study. Isometric quadriceps muscle strength, the Short Physical Performance Battery (SPPB), and the Checklist Individual Strength (CIS) scale were assessed at discharge and after 12 months.

RESULTS

Of the 34 individuals, 17 completed the 12-month follow-up. Although the quadriceps muscle strength significantly improved (p = 0.046), 59.0% of individuals stayed below 70% of predicted values. SPPB score also significantly improved (p = 0.001), but some individuals still demonstrated moderate to low performance. CIS scale score did not change. Quadriceps muscle strength at discharge was correlated with the SPPB score 12 months later (r = 0.675; p = 0.006) and explained 45.6% of the variance in SPPB after 12 months (R2=0.456; p = 0.006).

CONCLUSION

Quadriceps muscle strength and SPPB score improved 12 months after hospital discharge due to COVID-19. However, some individuals still present impairments. Moreover, quadriceps muscle strength at discharge explained functional capacity after 12 months. Thus, early rehabilitation is essential for functional improvement.

Psychological symptoms and risk factors associated with long COVID: a study on the Indian cohort

The long-term neurological effects of COVID-19, such as lack of concentration, loss of memory, and anxiety, present major concerns for COVID-19 Recovered Individuals (CRIs). Our study aims at understanding these long-term COVID-19 symptoms (LCS) and associated risk factors among the Indian cohort. In this two-part study, we analyze self-reported symptom information such as fatigue in different life spheres, symptoms experienced in past months, hospitalization status, and sex of Healthy Controls (HCs) and CRIs. In Study 1, we compare the symptoms of 62 CRIs (16 Females; 30.60   ±   10.34 years) with 36 hCs (11 Females; 27.53   ±   7.3 years). Chi-square analysis revealed that both the groups differ significantly from each other in terms of self-reported major symptoms experienced (MSEs) (p < 0.001) and major life spheres being affected by fatigue (MLSA) (p = 0.008). Further, in Study 2, we explore predictive models for these symptoms as reported by 57 of the CRIs (15 Females; 31.28   ±   10.50 years) using logistic regression and receiver operator characteristic (ROCs) information, with unrefreshing sleep, hospitalization status, and sex as the predictors for LCS. Statistical analysis reveals unrefreshing sleep as an important predictor of attention issues (odds ratio (OR) = 6.25, p = 0.003), anxiety issues (OR = 7.75, p = 0.018), and fatigue (OR = 5.83, p = 0.018) but was found non-significant for memory issues (OR = 1.86, p = 0.513) among CRIs. Hospitalization status and sex were not found to significantly affect these reported symptoms.

Physical activity level one year following admission to the intensive care unit for COVID-19

While regular physical activity is associated to multiple health effects, a COVID-19 infection may affect the ability to be physically active, due to muscular, cardiac and pulmonary complications. Therefore, the aim of this study was to describe the physical activity level and to identify factors at baseline that are associated with being physically inactive at one year following intensive care unit (ICU) admission for COVID-19. The dependent variable, being physically inactive, was assessed using the Saltin-Grimby Physical Activity Level Scale and the International Physical Activity Questionnaire Short Form (IPAQ-SF). To identify any predictors, univariable and multivariable logistic regression analyses were performed. A total of 105 (57.7%) and 95 (52.2%) survivors responded to the two scales. Being physically inactive was self-reported by 25.7% and 22.1%, respectively. Using the Saltin-Grimby Physical Activity Level Scale, longer stay at the ICU [odds ratio 1.05 (95% confidence interval (95% CI) 1.02-1.08)] and diabetes mellitus [3.92 (1.30-11.55)] were identified as predictors, while using the IPAQ-SF, longer stay at the ICU [odds ratio 1.04 (95% CI 1.01-1.07)] was the predictor for being physically inactive at one year following COVID-19.

Psychiatric hospitalizations in the Unified Health System: an observational study on hospitalization rates from 2012 to 2023

BACKGROUND

Psychiatric care in Brazil is based on the National Mental Health Policy and is aligned with the guidelines of the Brazilian Unified Health System. It is based on the preeminence of care in the extra-hospital context over the hospital context. Hospital admissions should occur solely when extra-hospital resources prove insufficient for the proper management of the mental health condition.

METHOD

It refers to a time series investigation of a descriptive, ecological, and observational nature. We used publicly available hospital admissions data from the Brazilian Unified Health System's Department of Informatics. The study looked at information on diseases in ICD-10 group V that affected both men and women aged 0 to 80 or older, from 2012 to 2023. The information was analyzed using the statistical software SPSS 20.0, as well as Jointpoint, through permutation tests, with the aim of evaluating the temporal trend of hospitalization and mortality rates. The joinpoint regression model used a log-linear method to set up a series of connected lines on a logarithmic scale and the Monte Carlo permutation method to figure out the direction or statistical significance. A significance level of 5% was established for the execution of all statistical tests.

RESULTS

Overall, a trend of reduction in psychiatric hospitalization rates was observed. However, these trends exhibited fluctuations when analyzed in isolation with respect to the type of disorder, gender, and age group. In contrast to the general trend, the number of hospitalizations for affective disorders and disorders linked to stress and somatization went up. This was especially true between 2021 and 2023, when the number of hospitalizations for other disorders went down more significantly. The predominance of hospitalizations in the male gender was significant. However, the trends of decrease were less pronounced in the male group, especially regarding hospitalizations associated with alcohol and other substance use, which draws attention to the hospitalization rates of the female sex. As it relates to dementias, the national picture shows that hospitalizations are going down, and most of the patients are women and older adults or people who are very old. However, an analysis of the state scenario showed that hospitalizations went up for adults, more than for the elderly combined, with more men than women.

CONCLUSION

the results achieved in this research confirm the findings, both nationally and internationally. Studies have shown that investments made through the National Mental Health Policy and the effects of Covid-19 led to a drop in the number of people admitted to psychiatric hospitals. This was because of the restructuring of the care model, which meant that hospitalizations had to be prioritized to meet the needs of Covid-19, which hurt people with mental disorders.

State Policy Strategies to Promote the Recruitment and Retention of the Behavioral Health Workforce

Policy Points To address persistent gaps in behavioral health care access and availability, particularly for underresourced populations, state policymakers have implemented four core strategies to address the shortage of behavioral health providers serving the Medicaid population. In this paper, we describe each of these state policy strategies, discuss their potential workforce and service impacts, and highlight unanswered questions about their effectiveness and implementation. Altogether, our review of these policy strategies suggests that rigorous evaluation of these state policy strategies is needed along with broader transformations to the behavioral health system to sustainably grow and retain the workforce in the long term.

STatin TReatment for COVID-19 to Optimise NeuroloGical recovERy (STRONGER): study protocol for a randomised, open label clinical trial in patients with persistent neurological symptoms after COVID-19 infection

INTRODUCTION

Increasing awareness of the high frequency, wide spectrum and disabling nature of symptoms that can persist following COVID-19 infection has prompted the investigation of management strategies. Our study aims to determine the effectiveness of atorvastatin on cognitive function, physical activity, mood, health-related quality of life and features of neurovascular impairment and neuroinflammation in adults with ongoing neurological symptoms after COVID-19 infection.

METHODS AND ANALYSIS

The STatin TReatment for COVID-19 to Optimise NeuroloGical recovERy study is an ongoing international, investigator-initiated and conducted, multicentre, prospective, randomised, open label, blinded endpoint trial with fixed time points for outcome assessments. A total of 410 participants with long covid neurological symptoms were planned to be randomly assigned to either the intervention group to receive 40 mg atorvastatin for 12 months or to a control group of no treatment, on top of usual care.

ETHICS AND DISSEMINATION

This study protocol was designed, implemented and reported, in accordance with the International Conference on Harmonisation guidelines for Good Clinical Practice, the National Health and Medical Research Council of Australia, the National Statement on Ethical Conduct in Human Research and with the ethical principles laid down in the World Medical Association Declaration of Helsinki. Central ethics committee approval was obtained from Sydney Local Health District Royal Prince Alfred Hospital Ethics (No: X21-0113 and 2021/ETH00777 10) in Australia. Site-specific ethics committee approvals were obtained elsewhere before any local study activities. All participants provided written informed consent.

TRIAL REGISTRATION NUMBER

The study protocol is registered at Clinicaltrials.gov (NCT04904536).

Exploring the landscape of long COVID: prevalence and associated factors in patients assisted by a telehealth service

INTRODUCTION

Long COVID is a condition that occurs in patients with a previous history of COVID-19, and symptoms that cannot be explained by another diagnosis persist.

OBJECTIVE

To evaluate the prevalence of long COVID and associated factors in patients treated with a public telehealth service during acute COVID-19.

METHOD

This was a cross-sectional study involving users of a COVID-19 telehealth service offered during the critical phase of the pandemic, called TeleCOVID-MG. Individuals older than 18 years of age who tested positive for SARS-CoV-2 and were monitored during social isolation were eligible. Prevalence was calculated, and descriptive analysis and group comparisons (patients with and without long COVID symptoms) were performed in addition to logistic regression with odds ratios and 95% confidence intervals.

RESULTS

Among the 699 patients included in the study, 60.8% were women aged between 30 and 49 years (44.6%) and had a high school education (46.5%). The main comorbidities were hypertension (20.9%), diabetes (8.3%), and heart disease (3.9%). The incidence of long COVID was 26.8% (95% CI: 23.5; 30.1). Cognitive symptoms (49.7%), chronic diarrhea (49.2%), and cough (40.6%) were the most persistent symptoms. Female sex (OR: 2.51), secondary education (OR: 2.13), elementary education (OR: 2.81), monthly income between 600 and 1,000 USD (OR: 5.85), supplementary health assistance (OR: 1.98), anosmia during acute COVID-19 (OR: 4.52) and need for in-person care (OR: 2.44) were factors associated with a higher incidence of long COVID.

CONCLUSION

Long COVID affected almost one-third of the study population. Although the COVID-19 pandemic is under control, the virus continues to infect individuals, raising doubts about the long-term complications of the disease.

Improving Health and Well-Being of People With Post-COVID-19 Consequences in South Africa: Situation Analysis and Pilot Intervention Design

Background

Multisystemic complications post-COVID-19 infection are increasingly described in the literature, yet guidance on the management remains limited.

objectives

This study aimed to assess the needs, preferences, challenges, and existing interventions for individuals with post-COVID-19 symptoms. Based on this, we aimed to develop a context-adapted intervention to improve the overall health and well-being of individuals with post-COVID-19 complications.

Methods

We conducted a cross-sectional mixed-methods situation analysis assessing the needs, preferences, challenges, and existing interventions for patients with post-COVID-19 symptoms. We collected data through questionnaires, semistructured in-depth interviews, and focus group discussions (FGDs) from individuals diagnosed with COVID-19 within the previous 18-month period and health care providers who managed patients with COVID-19 in both inpatient and outpatient settings. Quantitative data were summarized using descriptive statistics, qualitative data were transcribed, and deductive analysis focused on suggestions for future interventions. Findings guided the development of a group intervention.

Results

We conducted 60 questionnaires, 13 interviews, and 3 FGDs. Questionnaires showed limited knowledge of post-COVID-19 complications at 26.7% (16/60). Of those who received any rehabilitation for COVID-19 (19/60, 31.7%), 94.7% (18/19) found it helpful for their recovery. Just over half (23/41, 56%) of those who did not receive rehabilitation reported that they would have liked to. The majority viewed rehabilitation as an important adjunct to post-COVID-19 care (56/60, 93.3%) and that support groups would be helpful (53/60, 88.3%). Qualitative results highlighted the need for mental health support, structured post-COVID-19 follow-up, and financial aid in post-COVID-19 care. Based on the insights from the situation analysis, the theory of change framework, and existing post-COVID-19 evidence, we designed and conducted a pilot support group and rehabilitation intervention for individuals with post-COVID-19 complications. Our main objective was to assess the change in physical and psychological well-being pre- and postintervention. The intervention included 8 weekly themed group sessions supplemented by home tasks. Effectiveness of the intervention was evaluated by questionnaires pre- and postintervention on post-COVID-19 symptoms, quality of life with the EuroQoL 5-Dimension 5-Level, short Warwick-Edinburgh Mental Wellbeing Scale, and physical function by spirometry and 1-minute sit-to-stand test. We also assessed the feasibility and acceptability of the intervention by questionnaires and semistructured in-depth interviews. The intervention outcome analysis is yet to be conducted.

Conclusions

Insights from patients and health care providers on the characteristics of post-COVID-19 complications helped guide the development of a context-adapted intervention program with potential to improve health and well-being post-COVID-19.

Possible link between steatotic liver diseases, severe COVID-19 and cognitive impairment in post-COVID-19 syndrome

PURPOSE

Steatotic liver diseases (SLD) have become more prevalent over the last decade and are associated not only with cardiometabolic diseases but also with psychological symptoms (depression, fatigue). These symptoms are also common in post-COVID syndrome (PCS). Therefore, the aim of the study was to analyze the burden of SLD in PCS patients.

METHODS

We systematically screened all PCS patients from our post-COVID outpatient clinic using transient elastography, structured questionnaires for neurocognitive evaluation and blood sample analysis. Controls without PCS and without known liver diseases were also recruited and assessed with the same approach.

RESULTS

560 PCS patients and 103 healthy controls were included. The overall prevalence of SLD was high in both cohorts (57 vs. 53%). PCS patients with SLD were more frequently male (41 vs. 24%), older (52 vs. 44 years) and had more cardiometabolic diseases (87.0 vs. 46.4%). Cognitive impairment was more related to SLD in PCS patients than in the no-SLD group (OR: 1.68, CI: 1.14-2.46, p = 0.008). The presence of SLD was related to severe COVID-19 with hospitalization (OR: 2.91, CI: 1.85-4.56, p < 0.001). Within 1 year of the follow-up, 152 of 289 patients described a resolution in PCS irrespective of the presence or absence of SLD (log-rank p = 0.96).

CONCLUSIONS

SLD is associated with severe COVID-19 and cognitive dysfunction in PCS. Longitudinal studies are needed to assess the role of hepatic steatosis, development of post-acute infection regulation (e.g., SARS-CoV-2) and to differentiate between SLD-associated symptoms and PCS.

Long COVID in pediatric age: an observational, prospective, longitudinal, multicenter study in Italy

Introduction

This observational prospective longitudinal multicenter study examines the occurrence and characteristics of long COVID (LC) in the Italian pediatric population.

Methods

Conducted across 12 Pediatric Units in Italy from January to March 2022, the study involved 1129 children diagnosed with SARS-CoV-2 infection. Data were collected via self-administered questionnaires at 1-3 months, 3-6 months, and 6-12 months post-infection, with LC defined as symptoms persisting for at least 2 months and occurring 3 months post-diagnosis.

Results

Results revealed that 68.6% of children reported at least one post-COVID symptom, with 16.2% experiencing LC. The most frequent symptoms included respiratory issues (43.4%), neurological and cognitive dysfunction (27.7%), gastrointestinal symptoms (22.1%), fatigue (21.6%), and sleep disturbances (18.8%). Age and gender differences were significant, with older children and females more prone to cardiovascular and neurological & cognitive dysfunction.

Discussion

The study highlights that LC in children presents similarly to adults, though less frequently. The occurrence of LC was lower compared to adult populations, likely due to the generally milder course of COVID-19 in children. The findings underscore the need for targeted follow-up and support for affected children, especially considering the long-term persistence of symptoms. Further research is necessary to explore the impact of COVID-19 vaccines on pediatric LC and the effects of different SARS-CoV-2 variants. These insights are crucial for developing strategies to manage and mitigate long-term impacts in children recovering from COVID-19.

Health and social service provider perspectives on challenges, approaches, and recommendations for treating long COVID: a qualitative study of Canadian provider experiences

BACKGROUND

Many people who contract the SAR-CoV-2 virus present with multiple persistent and debilitating physical, cognitive and mental health symptoms that endure beyond the acute infection period. This new syndrome - generally referred to as long COVID - negatively affects patients' emotional wellbeing and quality of life, and presents a major challenge for treatment providers. Considering the lack of evidence-based treatment and supports, this qualitative descriptive study explores the experiences of Canadian health and social service providers working with individuals with long COVID, as well as their suggestions for intervention development.

METHODS

Twenty health and social service providers between the ages of 29 and 57 across Canada completed virtual individual interviews to discuss their care experiences and service recommendations for long COVID. Participants were from a range of service sectors, including primary care, rehabilitation, mental health, and community support. Interviews were recorded, transcribed, and analyzed using codebook thematic analysis.

RESULTS

Four themes illustrated providers' the experiences of (1) selecting personalized treatments based on patient presentation and similar conditions amidst uncertainty; and their recommendations for long COVID services, including (2) building an integrated and evidence-based model of care; (3) providing holistic support for patients and families through psychoeducation and daily living resources; and (4) caring for mental health in long COVID.

CONCLUSIONS

Canadian health and social service providers are adopting personalized treatment approaches to address the symptom persistence of long COVID in the face of a considerable knowledge gap. A comprehensive, integrated care pathway is needed to support patients' physical and psychosocial wellbeing while increasing provider preparedness to treat this complex condition.

Suppression of miR-155 Attenuates Lung Cytokine Storm Induced by SARS-CoV-2 Infection

Coronavirus disease 2019 (COVID-19) is a deadly human viral disease with a high rate of infection, morbidity, and mortality. Although vaccines and antiviral treatments are available, hospitalizations remain steady, and concerns about long-term consequences persist. Therefore, there is a great urgency to develop novel therapies. Here, we analyzed the role of miR-155, one of the most powerful drivers of host antiviral responses including immune and inflammatory responses, in the pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Endogenous microRNAs (miRNAs, miRs) are key molecules in preventing viral entry and replication while building an antiviral cellular defense. Our study reveals that miR-155 expression is elevated in patients with COVID-19. Using a mouse model transgenic for human angiotensin-converting enzyme receptor 2, we evaluated the potential of anti-miR-155 therapy. Treating SARS-CoV-2-infected mice with anti-miR-155 significantly reduced miR-155 expression, improved survival, and slightly increased body weight. Notably, these mice showed altered expression of cytokines in the lungs. These findings suggest anti-miR-155 could be a promising therapy to mitigate the cytokine storm and long-lasting symptoms induced by SARS-CoV-2 infection, improving public health outcomes and enhancing global pandemic preparedness.

Superset Versus Traditional Resistance Training Prescriptions: A Systematic Review and Meta-analysis Exploring Acute and Chronic Effects on Mechanical, Metabolic, and Perceptual Variables

BACKGROUND

Supersets are a time-efficient resistance training (RT) method that involve the sequencing of two exercises with little or no rest between them. However, despite their common implementation during RT, a comprehensive and quantitative review is still lacking.

OBJECTIVES

The primary aim of this systematic review and meta-analysis was to compare the acute and chronic effects of superset and traditional set prescriptions on mechanical, metabolic, and perceptual variables. We also aimed to conduct subgroup analyses to determine the effect of different types of supersets (agonist-antagonist, similar biomechanical, and alternate peripheral supersets).

METHODS

A systematic literature search was conducted in PubMed, Web of Science, Embase, and EBSCO databases from inception to 10 February 2024. Studies written in English and meeting our inclusion criteria were included. Pooled meta-analysis and subgroup meta-analysis were performed using a random-effects model.

RESULTS

Nineteen studies involving 313 participants were included. Although there was considerable variance in certain outcomes, our estimated effects suggested that, compared with traditional set prescription, supersets allow for (1) a similar total number of repetitions [standardized mean differences (SMD) =  - 0.03; p = 0.92] and volume load (SMD = 0.05; p = 0.86) with a shorter session duration and increased training efficiency (SMD = 1.74; p = 0.01); (2) higher blood lactate concentration during (SMD = 0.94; p = 0.03) and after (SMD = 1.13; p < 0.01) RT; (3) higher energy cost during RT (SMD = 1.93; p = 0.04); (4) similar creatine kinase concentration after RT (SMD = 0.22; p = 0.36), surface electromyography (SMD = 0.01; p = 0.98), acute muscle swelling (SMD = - 0.28; p = 0.36) and blood pressure (systolic blood pressure [SMD = 0.08; p = 0.71], diastolic blood pressure [SMD = - 0.05; p = 0.85], and mean arterial pressure [SMD = - 0.03; p = 0.88]); (5) higher rating of perceived exertion (SMD = 0.77; p = 0.02) and similar perceived recovery (SMD = 0.32; p = 0.33); and (6) similar chronic adaptations in maximal strength (SMD = 0.10; p = 0.36), strength endurance (SMD = 0.07; p = 0.81), and muscle hypertrophy (SMD =  - 0.05; p = 0.87). The subgroup analysis revealed that utilizing agonist-antagonist supersets leads to a significant increase in the number of repetitions that are able to be completed compared with traditional sets (SMD = 0.68; p = 0.01). Similar biomechanical supersets led to less volume load (SMD =  - 1.08; p < 0.01) compared with traditional sets.

CONCLUSIONS

Supersets provide a time-efficient alternative to traditional RT, reducing session duration without compromising training volume, muscle activation, perceived recovery, or chronic adaptations in maximal strength, strength endurance, and muscle hypertrophy. Thus, supersets can be effectively implemented by athletes with busy schedules and RT enthusiasts whose main barrier to exercise is time. However, it should be noted that supersets generally induce higher internal loads, more severe muscle damage, and increased perceived exertion, potentially necessitating extended recovery times between sessions. Additionally, superset RT may have a similar potential to traditional RT in eliciting post-exercise hypotension. Regarding different types of supersets, agonist-antagonist supersets are more suitable for maintaining training volume, while similar biomechanical supersets concentrate stimulation on the same muscle group, compromising volume load.

PROTOCOL REGISTRATION

The original protocol for this review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) in December 2023 (CRD42023491533).

Long COVID in patients with systemic lupus erythematosus: A case-control study

BackgroundLong COVID was defined by the WHO as continuation or development of new symptoms 3 months after the initial SARS-CoV2 infection, with these symptoms lasting for ≥2 months without alternative explanations.ObjectivesTo compare the incidence of long COVID in patients with SLE with matched controls after a SARS-CoV2 infection.MethodsConsecutive patients (≥18 years) who fulfilled the ACR or SLICC criteria for SLE between July to November 2023 were recruited. Those with SARS-CoV2 infection (positive rapid antigen test [RAT] or PCR) were identified by a self-reported questionnaire, which also captured the duration and severity of a number of pre-defined symptoms of long COVID. An equal number of healthy subjects, matched for gender and age, who had SARS-CoV2 infection in the same period were recruited for the same survey. The incidence and presentation of long COVID was compared between patients and controls, and risk factors for long COVID in SLE patients were studied.ResultsA total of 211 SLE patients (97.6% women, age 44.2 ± 11.9 years) and 211 healthy controls (97.6% women, age 44.2 ± 11.9 years) were studied. In all patients, the most common long COVID symptoms were fatigue (30.1%), worsening of memory (29.1%), difficulty to concentrate (26.3%), cough (23.2%) and insomnia (18.9%). Compared with controls, the incidence of long COVID was significantly higher in SLE patients (54.5% vs 34.6%; OR 2.27 [1.53-3.35]). Symptoms of worsening of memory (OR 2.77 [1.78-4.31]), chest pain (OR 4.18 [1.16-15.0]), palpitation (OR 3.43 [1.58-7.47]) and arthralgia (OR 2.67 [1.29-5.53]) were significantly more common in SLE patients than controls. However, no clinical and serological factors were significantly associated with the occurrence of long COVID in SLE patients except the ever use of hydroxychloroquine (OR 2.03 [1.04-3.96]).ConclusionsLong COVID is more common in SLE patients than matched controls after a SARS-CoV2 infection. The development of long COVID symptoms in SLE is largely unpredictable.

Ensitrelvir treatment-emergent amino acid substitutions in SARS-CoV-2 3CLpro detected in the SCORPIO-SR phase 3 trial

The impact of treatment-emergent amino acid substitutions (TEAASs) in severe acute respiratory syndome coronavirus 2 (SARS-CoV-2) 3C-like protease (3CLpro) on clinical and virologic outcomes was evaluated in patients with mild-to-moderate coronavirus disease 2019 (COVID-19) who received ensitrelvir 125 mg in the SCORPIO-SR trial. Individuals were randomised to ensitrelvir or matched placebo once daily for 5 days (first dose <72 h after disease onset). 3CLpro-TEAASs were identified by sequencing nsp5 encoding 3CLpro from pre- and post-treatment nasopharyngeal swabs. Time to resolution of a composite of five characteristic COVID-19 symptoms (TTR) was compared between patients with and without the most common 3CLpro-TEAASs in the ensitrelvir arm. The ensitrelvir and placebo intention-to-treat populations comprised 345 and 341 patients, respectively. 3CLpro-TEAASs were detected in 19/204 (9.3%) ensitrelvir-treated and 3/137 (2.2%) placebo-treated patients with paired sequence data. The most common 3CLpro-TEAASs in the ensitrelvir arm were M49L (n = 12), M49I (n = 3) and S144A (n = 2). In the placebo arm, all 3CLpro-TEAASs occurred in ≤1 patient. Median (95% confidence interval) TTR was comparable between patients with and without those TEAASs (158.8 h [112.1-281.9] vs 189.7 h [151.4-234.4]). Mean viral RNA levels declined more slowly in patients with M49L/I or S144A versus those without. Reductions in viral titre were unaffected by these TEAASs. The characteristics of recombinant SARS-CoV-2 with 3CLpro mutations were explored in vitro. Recombinant viruses with some 3CLpro mutations had reduced susceptibility to ensitrelvir in vitro, with limited effects on viral and competitive fitness. Continued surveillance is warranted to monitor the spread of viruses with 3CLpro mutations.

Identification of CD209 as an Intervention Target for Type 2 Diabetes After COVID-19 Infection: Insights From Proteome-Wide Mendelian Randomization

ARTICLE HIGHLIGHTS

Increasing evidence links coronavirus disease 2019 (COVID-19) infection with heightened type 2 diabetes (T2D) risk; however, the mechanisms underlying this relationship remain poorly understood. We aimed to identify mediating proteins linking COVID-19 infection with T2D, elucidating how COVID-19 might heighten T2D risk. Protein CD209 and central obesity potentially play a crucial role between COVID-19 susceptibility and T2D. Our results highlight CD209 as a potential intervention target for T2D prevention following COVID-19 infection.

Long-term health consequences of COVID-19 in young adults: a focus on respiratory and cardiovascular endurance

INTRODUCTION

The COVID-19 pandemic has significantly impacted health, extending beyond the acute phase of illness. Among young adults, "long COVID" has raised concerns regarding respiratory and cardiovascular endurance. This study evaluates pulmonary function test (PFT), distance travelled in the 6-min walk test (6MWT), and changes in SpO2 and respiratory rate before and after 6MWT in COVID-19 convalescent patients compared to healthy controls.

METHODS

This case-control study included 45 controls and 45 COVID-19 convalescent patients confirmed by RT-PCR. Data on PFT, distance travelled in 6MWT, SpO2, and respiratory rate were collected. The associations were analyzed using the Student t-test and ANOVA, with p < 0.05 considered significant.

RESULTS

Significant reductions were observed in FVC (p = 0.02), FEV1 (p = 0.007), FEF25% (p = 0.0001), FEF50% (p = 0.003), FEF25-75% (p = 0.02), and PEFR (p = 0.0001), with an increased lung age (p = 0.01) in COVID-19 convalescent patients compared to controls. No significant difference was observed in FEV1/FVC ratio, FEV3, FEV3/FVC ratio, or FEF75%. While percentage saturation of oxygen, respiratory rate, and distance travelled in 6MWT showed no significant differences between groups, respiratory rate (p = 0.0001) and pulse rate (p = 0.001) differed significantly before and after 6MWT.

CONCLUSIONS

COVID-19 convalescent patients exhibited significant declines in FVC, FEV1, FEF25%, FEF50%, and FEF25-75%, indicating potential restrictive or obstructive lung defects. Increased lung age also suggests long-term impacts of SARS-CoV-2 on respiratory performance.

Kyungok-go for fatigue in patients with long COVID: Double-blind, randomized, multicenter, pilot clinical study protocol

The most common symptom reported by patients after recovery from coronavirus disease 2019 (COVID-19) is fatigue. However, robust clinical evidence supporting the effectiveness of treatments and interventions for fatigue in COVID-19 survivors is lacking. This pilot clinical trial aims to assess the safety and efficacy of Kyungok-go, a herbal preparation targeting fatigue, in patients after recovering from COVID-19. The study will include 100 participants with persistent fatigue for more than 12 weeks after COVID-19 recovery. They will be randomly allocated into two groups: the Kyungok-go group (n =  50) and the placebo group (n =  50). Kyungok-go or placebo will be administered twice daily for 12 weeks, and the participants will be assessed at 4-week intervals. The primary outcome will be the change in the Fatigue Severity Scale score. Secondary outcomes will include cognitive function, physical function, quality of life, depression, sleep quality, medication adherence, and feasibility. This study is the first attempt to investigate the safety and efficacy of Kyungok-go for relieving fatigue related to long COVID. The results are expected to contribute to the establishment of a knowledge base and reveal the potential of herbal medicine prescriptions for managing and recovering from the most common sequelae of COVID-19. Trial registration number: KCT0008789.

Post-COVID-19 Syndrome as Described by Patients: A Qualitative Study

Background/Objectives: Growing interest in post-viral conditions following COVID-19 infection has led researchers and clinicians to develop several definitions of post-COVID-19 syndrome. This study aimed to understand the meaning given to post-COVID-19 syndrome by individuals who survived the first wave of the pandemic two years after its onset. Methods: A descriptive qualitative study was performed according to the Standards for Reporting Qualitative Research guidelines. An inductive and content analysis were adopted on narratives collected via the interview of patients who had been infected with SARS-CoV-2 during the first pandemic wave in the Friuli Venezia Giulia Region (Italy). Results: This study included 230 patients, of whom 158 experienced post-COVID-19 syndrome, and 46 (29.1%) reported suffering from this condition 24 months after the infection. On average, patients experienced three symptoms, with most of them experiencing at least one. Seventy-five patients reported being familiar with the definition of the post-COVID-19 syndrome, mainly through media and the internet (28.9% and 28.2%, respectively). The post-COVID-19 syndrome was described as characterized by two themes: (a) the experience of interrelated physical and psychological symptoms and (b) the experience of fighting like warriors for a long time. Conclusions: The post-COVID-19 syndrome is highly prevalent but poorly understood. Patients rely on low-quality information rather than that offered by clinicians. The post-COVID-19 syndrome appears to be a complex syndrome encompassing physical and mental symptoms, as well as those disabling the person with an unclear trajectory. There is a need to focus on the long-term consequences of COVID-19, incorporating insights from individuals' lived experiences.

How long is Long-COVID? Symptomatic improvement between 12 and 18 months in a prospective cohort study

INTRODUCTION

COVID-19 infection can precede, in a proportion of patients, a prolonged syndrome including fatigue, exercise intolerance, mood and cognitive problems. This study aimed to describe the profile of fatigue-related, exercise-related, mood-related and cognitive-related outcomes in a COVID-19-exposed group compared with controls.

METHODS

113 serving UK Armed Forces participants were followed up at 5, 12 (n=88) and 18 months (n=70) following COVID-19. At 18 months, 56 were in the COVID-19-exposed group with 14 matched controls. Exposed participants included hospitalised (n=25) and community (n=31) managed participants. 43 described at least one of the six most frequent symptoms at 5 months: fatigue, shortness of breath, chest pain, joint pain, exercise intolerance and anosmia. Participants completed a symptom checklist, patient-reported outcome measures (PROMs), the National Institute for Health cognitive battery and a 6-minute walk test (6MWT). PROMs included the Fatigue Assessment Scale (FAS), Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and Patient Checklist-5 (PCL-5) for post-traumatic stress.

RESULTS

At 5 and 12 months, exposed participants presented with higher PHQ-9, PCL-5 and FAS scores than controls (ES (effect size) ≥0.25, p≤0.04). By 12 months, GAD-7 was not significantly different to controls (ES <0.13, p=0.292). Remaining PROMs lost significant difference by 18 months (ES ≤0.11, p≥0.28). No significant differences in the cognitive scales were observed at any time point (F=1.96, p=0.167). At 5 and 12 months, exposed participants recorded significantly lower distances on the 6MWT (ηp 2≥0.126, p<0.01). 6MWT distance lost significant difference by 18 months (ηp 2<0.039, p>0.15).

CONCLUSIONS

This prospective cohort-controlled study observed adverse outcomes in depression, post-traumatic stress, fatigue and submaximal exercise performance up to 12 months but improved by 18-month follow-up, in participants exposed to COVID-19 compared with a matched control group.

Gut Microbiome dysbiosis and immune activation correlate with somatic and neuropsychiatric symptoms in COVID-19 patients

BACKGROUND

Infection with SARS-CoV-2, the virus responsible for COVID-19, can lead to a range of physical symptoms and mental health challenges, including stress, anxiety, and depression. These effects are particularly pronounced in hospitalized patients, likely due to the virus's direct and indirect impact on the nervous system. Gut dysbiosis, an imbalance in the gut microbiome, has been implicated in immune dysfunction and chronic inflammation in COVID-19 patients. However, the interactions between gut microbiome composition and the physical and mental symptoms of COVID-19 remain incompletely understood.

METHODS

We investigated the association between physical and mental symptoms, cytokine profiles, and gut microbiota composition in 124 hospitalized COVID-19 patients. We collected data on demographics, COVID-19 severity, and mental health indicators (stress, anxiety, and depression). Gut microbiome profiling was performed using full-length 16 S rRNA gene sequencing to evaluate microbial diversity and composition.

RESULTS

COVID-19 severity was categorized as low (27.4%), moderate (29.8%), or critical (42.8%). Common symptoms included fever (66.1%) and cough (55.6%), while somatic symptoms (27.3%), anxiety (27.3%), depressive symptoms (39%), and stress (80.5%) were frequently self-reported. Elevated interleukin-6 levels in severe cases highlighted systemic inflammation, reduced gut bacterial diversity, particularly among women and obese patients, correlated with higher disease severity. Notably, the genus Mitsuokella was associated with increased physical symptoms and mental distress, while Granulicatella was linked to critical illness.

CONCLUSIONS

Our findings reveal significant associations between mental health status, systemic inflammation, and gut dysbiosis in hospitalized COVID-19 patients. These results indicate the potential for microbiome-targeted therapies to mitigate psychological and physical complications and improve recovery outcomes in this population.

Risk, determinants, and persistence of long-COVID in a population-based cohort study in Catalonia

BACKGROUND

Long-COVID has mostly been investigated in clinical settings. We aimed to assess the risk, subtypes, persistence, and determinants of long-COVID in a prospective population-based study of adults with a history of SARS-CoV-2 infection in Catalonia.

METHODS

We examined 2764 infected individuals from a population-based cohort (COVICAT) established before the pandemic and followed up three times across the pandemic (2020, 2021, 2023). We assessed immunoglobulin (Ig)G levels against SARS-CoV-2, clinical, vaccination, sociodemographic, and lifestyle factors. Long-COVID risk and subtypes were defined based on participant-reported symptoms and electronic health records. We identified a total of 647 long-COVID cases and compared them with 2117 infected individuals without the condition.

RESULTS

Between 2021 and 2023, 23% of infected subjects developed long-COVID symptoms. In 56% of long-COVID cases in 2021, symptoms persisted for 2 years. Long-COVID presented clinically in three subtypes, mild neuromuscular, mild respiratory, and severe multi-organ. The latter was associated with persistent long-COVID. Risk was higher among females, participants under 50 years, of low socioeconomic status, severe COVID-19 infection, elevated pre-vaccination IgG levels, obesity, and prior chronic disease, particularly asthma/chronic obstructive pulmonary disease and mental health conditions. A lower risk was associated to pre-infection vaccination, infection after omicron became the dominant variant, higher physical activity levels, and sleeping 6-8 h. Vaccination during the 3 months post-infection was also protective against long-COVID.

CONCLUSIONS

Long-COVID persisted for up to 2 years in half of the cases, and risk was influenced by multiple factors.

[Long-term persistence of post-COVID-19 symptoms: A two-year follow-up of a Primary Care cohort]

BACKGROUND

This study aims to determine the prevalence of long COVID two years after initial infection, identify prognostic factors, and assess its impact on quality of life.

METHODOLOGY

An ambispective cohort study was conducted with patients aged = 18 years from two health centers in Málaga, Spain, who tested positive for SARS-CoV-2 between October 2020 and May 2021. Systematic random sampling was performed in October 2022, with 5% precision, 5% alpha error, and 25% expected losses. The cohort was followed until May 2023. Dependent variables included long COVID (= 1 symptom lasting =8 weeks), symptom count, quality of life (EuroQol 5-D), and global health perception (EQ-EVA). Independent variables included age, sex, severity of initial infection severity, vaccination status, comorbidities, and reinfection.

RESULTS

Of 914 eligible individuals, 173 patients were sampled (mean age 47 years, 58.4% female). Long COVID was observed in 32.36% of participants, with 23% affected two years after infection. Fatigue and anosmia/dysgeusia were the most frequent symptoms. Prognostic factors for long COVID included higher initial infection severity, younger age, and reinfection. For symptom count, factors were depression, initial infection severity, and reinfection. Health perception was eight points lower in long COVID patients (77.72: SD=17.10 vs 86.15; SD=16.25; p<0.001). Female sex, older age, fewer comorbidities, and more vaccine doses were associated with better quality of life.

CONCLUSIONS

Thirty-two percent of patients experienced long COVID, mainly fatigue and anosmia/dysgeusia. It associates with higher initial severity, younger age, and reinfection, negatively impacting quality of life.

Post-infection symptoms up to 24 months after COVID-19: a matched cohort study in Berlin, Germany

Introduction

Long-term health consequences after mild COVID-19 are not well described. Our aim was to estimate their prevalence and describe the time course of signs and symptoms for a period of up to 24 months after SARS-CoV-2 infection.

Methods

We conducted a cohort study matched for age, sex, and test week among individuals who had attended the public COVID-19 test center at Charité-Universitätsmedizin Berlin, Germany. In early 2022, 576 former COVID-19 patients (>95% non-hospitalized) and 302 uninfected individuals responded to a questionnaire on retrospective monthly symptoms since the test date up to 24 months ago.

Results

Symptoms compatible with long COVID were present in 42.9% (247/576) of former COVID-19 patients, compared with 21.2% (64/302) in the uninfected group. In former patients, unadjusted odds ratios (OR) were highest for disturbed taste/smell (OR 9.1 [95% CI: 4.0-21.1]), memory difficulties (OR 5.1 [95% CI: 2.9-8.9]), and shortness of breath at rest (OR 4.5 [95% CI: 1.9-10.6]). In most former COVID-19 patients, symptoms occurred in one coherent period and resolved after a median of 6.5 months, while taste/smell disturbance and neurological/cognitive symptoms showed longer times until recovery. Factors associated with long COVID-compatible symptoms included hospitalization, symptomatic COVID-19 infection, low household income and female sex.

Conclusion

Post-infection symptoms in mild COVID-19 patients mostly persist for about half a year, but sometimes longer. Among uninfected individuals who never experienced COVID-19, 21.2% also reported long COVID-compatible symptoms. The current long COVID definition might require revision to prevent misclassification and over-reporting, and to improve diagnosis and prevalence estimates.

Neuropsychiatric Manifestations of Long COVID-19: A Narrative Review of Clinical Aspects and Therapeutic Approaches

The COVID-19 (C-19) pandemic has highlighted the significance of understanding the long-term effects of this disease on the quality of life of those infected. Long COVID-19 (L-C19) presents as persistent symptoms that continue beyond the main illness period, usually lasting weeks to years. One of the lesser-known but significant aspects of L-C19 is its impact on neuropsychiatric manifestations, which can have a profound effect on an individual's quality of life. Research shows that L-C19 creates neuropsychiatric issues such as mental fog, emotional problems, and brain disease symptoms, along with sleep changes, extreme fatigue, severe head pain, tremors with seizures, and pain in nerves. People with cognitive problems plus fatigue and mood disorders experience great difficulty handling everyday activities, personal hygiene, and social interactions. Neuropsychiatric symptoms make people withdraw from social activity and hurt relationships, thus causing feelings of loneliness. The unpredictable state of L-C19 generates heavy psychological pressure through emotional suffering, including depression and anxiety. Neuropsychiatric changes such as cognitive impairment, fatigue, and mood swings make it hard for people to work or study effectively, which decreases their output at school or work and lowers their job contentment. The purpose of this narrative review is to summarize the clinical data present in the literature regarding the neuropsychiatric manifestations of L-C19, to identify current methods of diagnosis and treatment that lead to correct management of the condition, and to highlight the impact of these manifestations on patients' quality of life.

COVID-19 related complications

The COVID-19 pandemic has significantly impacted global healthcare systems, revealed vulnerabilities and prompted a re-evaluation of medical practices. Acute complications from the virus, including cardiovascular and neurological issues, have underscored the necessity for timely medical interventions. Advances in diagnostic methods and personalized therapies have been pivotal in mitigating severe outcomes. Additionally, Long COVID has emerged as a complex challenge, affecting various body systems and leading to respiratory, cardiovascular, neurological, psychological, and musculoskeletal problems. This broad spectrum of complications highlights the importance of multidisciplinary management approaches that prioritize therapy, rehabilitation, and patient-centered care. Vulnerable populations such as paediatric patients, pregnant women, and immunocompromised individuals face unique risks and complications, necessitating continuous monitoring and tailored management strategies to reduce morbidity and mortality associated with COVID-19.

SPECT Perfusion Defects and Impaired Strain in Mild COVID-19: A Multimodal Imaging Study with a Female-Predominant Cohort

Background/Objectives: This study investigates the association between mild first-wave COVID-19 infection and subclinical abnormalities in echocardiographic strain parameters and myocardial perfusion using single-photon emission computed tomography (SPECT). Methods: We conducted a retrospective analysis of patients from June 2020 to March 2021 with a history of mild first-wave COVID-19 infection, presenting with nonspecific cardiac symptoms and referred for SPECT myocardial perfusion stress testing. Patients had no obstructive coronary artery disease (CAD) on follow-up invasive angiography or cardiac computed tomography angiography (CCTA) and had transthoracic echocardiographic images of sufficient quality for strain analysis using AutoSTRAIN (TOMTEC®). Results: Fifteen patients met the inclusion criteria. SPECT and echocardiography were reviewed for perfusion and strain defects, respectively, in the inferior, anterior, lateral, and septal myocardial segments. All patients had at least one perfusion abnormality on SPECT: 2/15 (13%) had a fixed defect in one segment, 3/15 (20%) in two, 3/15 (20%) in three, and 7/15 (47%) in four. While 13/15 (87%) patients had normal qualitative findings on traditional echocardiography, 12/15 (80%) had abnormal global longitudinal strain (GLS) (>-18%) and transregional wall strain abnormality in at least one segment. Abnormalities on SPECT and strain echocardiography demonstrated a moderate but significant 60% concordance, with an intraclass correlation coefficient (ICC) of 0.486 (p = 0.028). Conclusions: Patients with 'mild' COVID-19 infection demonstrated a high frequency of abnormalities on SPECT myocardial perfusion imaging (even in the absence of obstructive CAD) which appeared to be concordant with abnormal strain parameters on echocardiography, suggesting possible subclinical effects on myocardial tissue.

A systematic review of post COVID-19 condition in children and adolescents: Gap in evidence from low-and -middle-income countries and the impact of SARS-COV-2 variants

The long-term health consequences following COVID-19 have largely been reported in adult populations living in high-income countries. We therefore did a systematic review of post COVID-19 condition symptoms reported in children and adolescents (<18 years), aiming to identify and include publications from low- or middle-income countries (LMICs). From EMBASE, Medline, and Pubmed until the 30th of October 2023, we searched all studies reporting original and complete data of long-term outcomes of at least 20 children or adolescents under 18 years of age with a history of confirmed acute COVID-19 infection. We excluded non-English publications, pre-prints, unreviewed articles, grey literature, studies with inaccessible full text, and those limited to a specific population. Risk of Bias was assessed using STROBE guidelines for observational studies. We used descriptive narrative analysis to summarize the findings. Forty studies reporting 825,849 children and adolescents; the median age of those with persistent symptoms was consistently in the adolescent age range but not all studies included young children (<5 years). Only one study, with 58 participants aged 6-17 years, population was from a LMIC. Studies relied on symptom reporting rather than objective measures of organ dysfunction. The definition of post COVID-19 condition varied; most studies used persistent symptom duration of two or three months or more. However, since the symptom onset was not specified, it was difficult to identify which study is truly consistent with WHO's definition of post COVID-19 condition. Prevalence of post COVID-19 condition ranged from 1.8% to 70% but with marked heterogeneity between study populations and reporting criteria including the severity of acute COVID presentation. Most studies were undertaken when the Alpha variant was the predominant strain. The prevalence of post COVID-19 condition ranged from 6.7% to 70% in the Alpha variant-, 23% to 61.9% in the Delta-, 17% to 34.6% in the Omicron-, and 3.7% to 34% in the Other-variant predominated studies. The most reported symptoms were fatigue (70%), headache (37.5%) and respiratory symptoms (35%); fatigue was most reported in all variant subgroups. Only half of the studies included a control group. The variations in study population, reporting methods, reliance on symptom reporting alone and lack of control groups make it challenging to determine the impact of COVID-19 on post COVID health in children and adolescents. The lack of data from LMIC populations especially infants and young children is a major gap.

Chinese herbal medicine for dyspnea and persistent symptoms of long COVID: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Over 65 million people have long COVID. Evidence for using Chinese herbal medicine (CHM) to treat long COVID is growing. A systematic review of evidence for guiding clinical decision is warranted.

OBJECTIVE

To examine the effects and safety of CHM in alleviating the severity of dyspnea, fatigue, exercise intolerance, depression, anxiety and insomnia in long COVID adults based on registered randomized clinical trials (RCT).

SEARCH STRATEGY

World Health Organization International Clinical Trials Registry Platform and Chinese Clinical Trial Registry were searched for registered trial protocols from database inception to February 10, 2023. English (PubMed, Embase, AMED and CINAHL) and Chinese databases (CNKI, Wanfang Data and CQVIP) were then searched to identify relevant publications from December 2019 through April 6, 2023.

INCLUSION CRITERIA

Registered RCTs that compared the effects of Chinese herbal medicines or Chinese herbal formulas against a control treatment (i.e., the placebo or usual care) in adults with persistent symptoms of long COVID. The primary outcome of dyspnea, and secondary outcomes of fatigue, exercise intolerance, depression, anxiety and insomnia were measured using validated tools at the end of the treatment.

DATA EXTRACTION AND ANALYSIS

Data were extracted, and eligible RCTs were evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials and Grading of Recommendations, Assessment, Development and Evaluations independently by two researchers. Effect sizes were estimated by random-effects modelling and mean difference (MD). Heterogeneity between trials was quantified by I2.

RESULTS

Among the 38 registered clinical trials we identified, seven RCTs (1,519 patients) were included in the systematic review. One RCT had a low overall risk of bias. Compared to the control, CHM reduces dyspnea on the Borg Dyspnea Scale score (MD = -0.2, 95% confidence interval [CI] = -0.65 to 0.25) with moderate certainty, and reduces fatigue on the Borg Scale (MD = -0.48, 95% CI = -0.74 to -0.22) with low certainty. CHM clinically reduces depression on Hamilton Depression Rating Scale score (MD = -6.00, 95% CI = -7.56 to -4.44) and anxiety on Hamilton Anxiety Rating Scale score (MD = -6.10, 95% CI = -7.67 to -4.53), and reduces insomnia on the Insomnia Severity Index (MD = -4.86, 95% CI = -12.50 to 2.79) with moderate certainty. Meta-analysis of two RCTs (517 patients) showed that CHM clinically improves exercise intolerance by increasing 6-minute walking distance (MD = -15.92, 95% CI = -10.20 to 42.05) with substantial heterogeneity (I2 = 68%) and low certainty.

CONCLUSION

CHM is associated with a post-treatment clinical reduction in depression and anxiety in long COVID adults, compared to the control, but it does not have a strong treatment effect on dyspnea and insomnia. Effects of CHM on exercise intolerance and fatigue are uncertain, and the safety of using CHM remains questionable. Please cite this article as: Tsang MS, Zhou IW, Zhang AL, Xue CC. Chinese herbal medicine for dyspnea and persistent symptoms of long COVID: A systematic review and meta-analysis of randomized controlled trials. J Integr Med. 2025; 23(2): 126-137.

Osteonecrosis as a manifestation of Long-COVID Syndrome: a systematic review

Purpose SARS-CoV-2 is an RNA virus responsible for COVID-19 pandemic. Some authors described the set of persistent symptoms COVID-related as "Long-COVID Syndrome." Several cases of post-COVID-19 osteonecrosis (ON) are described. Our primary aim was to study the hypothetical correlation between SARS-CoV-2 infection and ON; our secondary aim was to understand if ON can be considered part of Long-COVID. Materials and methods We performed a systematic review following the Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines. Because COVID-19 is a recently described disease, we included all levels of evidence studies. We excluded studies lacking specification regarding the use of corticosteroids (CCS) and studies not related to COVID-19. The variables extracted were age, sex, risk factors, affected joints, signs and symptoms, magnetic resonance imaging (MRI) and X-ray features, histology, treatment of COVID-19, dose and duration of treatment with CCS, treatment of ON, follow-up, and treatment outcome. Results A total of 13 studies were included, involving 95 patients and 159 joints. Time between the diagnosis of COVID-19 and the onset of symptoms related to ON was 16 weeks on average. Time between the onset of symptoms and the MRI was 6 weeks. An average of 926.4 mg of prednisolone equivalent per patient were administered. On average, CCS were administered for 20.6 days. Conclusions Patients with a history of COVID-19 infection developed osteonecrosis prematurely and with a lower dose of CCS than usually reported in the literature. Symptoms of osteonecrosis occur within the interval of the period described as Long-COVID. Surgeons should not underestimate the persistence of arthralgia when a history of SARS-CoV-2 infection and use of CCS is reported.

Symptoms Patterns and Health-Related Quality of Life in a Real-Life Cohort of Long-COVID Patients: Complexity to Optimize Rehabilitation Treatment

OBJECTIVE

We wanted to identify prevalent symptoms and patterns of long-COVID syndrome, assess the impact on health-related quality of life, and explore factors linked to lower quality of life, including vaccination status and symptom count, in a real-life cohort.

DESIGN

This is an observational retrospective study.

RESULTS

We assessed 133 patients and 85 completed the evaluations. The most common symptoms reported were motor deficit (95.29%) and fatigue (94.12%), while respiratory symptoms, cognitive deficits, and weakness (76.47%) were less frequent. Many patients experienced multiple symptoms, with the majority reporting 5-8 symptoms simultaneously, most associated with fatigue. However, the number of symptoms did not correlate with health-related quality of life as measured by the 12-Item Short Form Survey questionnaire. Finally, vaccination status did not significantly affect 12-Item Short Form Survey scores or the number of reported symptoms.

CONCLUSIONS

Our analysis highlighted the presence of diverse multisystemic symptoms in long-COVID patients. Many individuals experienced multiple associated symptoms, negatively affecting their overall quality of life. Neither vaccination status nor the number of symptoms appeared to influence reported quality of life. This emphasizes the need for a comprehensive, early, and multidisciplinary approach to address the syndrome's diverse symptoms.

Insights into the epidemiology and clinical aspects of post-COVID-19 conditions in adult

ObjectivesWhile most individuals infected with COVID-19 recover completely within a few weeks, some continue to experience lingering symptoms. This study was conducted to identify and describe the clinical and subclinical manifestations of adult patients from the long-term effects of COVID-19.MethodsThe study analyzed 205 medical records of inpatients (age ≥ 16 years, ≥ 4 weeks post-COVID-19 recovery, and a negative SARS-CoV-2 status at enrollment) at Thong Nhat Hospital, Vietnam, from 6 September 2021 to 26 August 2022, using R language software.ResultsThe majority of patients hospitalized with long COVID-19 symptoms (92.68%) had normal consciousness. The most common symptoms on admission were fatigue (59.02%), dyspnea (52.68%), and cough (42.93%). In total, 80% of patients observed respiratory symptoms, primarily dyspnea, while 42.44% reported neurological symptoms, with sleep disturbance being the most common. Noticeably, 42.93% of patients experienced respiratory failure in the post-COVID-19 period, resembling acute respiratory distress syndrome.DiscussionThese findings provide crucial insights into the epidemiology, clinical, and subclinical aspects of post-COVID-19 conditions, shedding light on the prevalence of common symptoms and the demographic distribution of affected patients. Understanding these manifestations is vital for patient well-being, improved clinical practice, and targeted healthcare planning, potentially leading to better patient care, management, and future interventions.

Pre-pandemic leukocyte count is associated with severity of post-acute sequelae of SARS-CoV-2 infection among older women in the Women's Health Initiative

OBJECTIVE

Although dysregulated inflammation has been postulated as a biological mechanism associated with post-acute sequelae of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection (PASC) and shown to be a correlate and an outcome of PASC, it is unclear whether inflammatory markers can prospectively predict PASC risk. We examined the association of leukocyte count and high-sensitivity C-reactive protein (hsCRP) concentrations, measured ~25 years prior to the coronavirus disease 2019 (COVID-19) pandemic, with PASC, PASC severity, and PASC-associated cognitive outcomes at follow-up among postmenopausal women.

METHODS

Using biomarker data from blood specimens collected during pre-pandemic enrollment (1993-1998) and data on 1,237 Women's Health Initiative participants who completed a COVID-19 survey between June 2021 and February 2022, we constructed multivariable regression models that controlled for pertinent characteristics. PASC status was defined according to established World Health Organization criteria.

RESULTS

Controlling for baseline characteristics, log e -transformed leukocyte count (β = 0.27; 95% confidence interval, 0.07-0.47, P = 0.009) and leukocyte count ≥5.5 × 1,000 cells/µL (β = 0.13; 95% confidence interval, 0.02-0.23; P = 0.02) were positively associated with PASC severity, defined as the sum of PASC symptoms, but not associated with overall PASC occurrence or PASC-related cognitive outcomes. Concentration of hsCRP, available on only ~27% of participants, was not associated with any of the PASC outcomes, controlling for the same covariates.

CONCLUSIONS

Leukocyte count, a widely available clinical marker of systemic inflammation, is an independent predictor of PASC severity in postmenopausal women. Heightened inflammation preceding SARS-CoV-2 infection may contribute to PASC development. Limited statistical power to assess hsCRP role warrants further study.

Identifying influencing factors and constructing a prediction model for long COVID-19 in hemodialysis patients

PURPOSE

This study aimed to identify the potential influencing factors and construct a prediction model for long COVID in hemodialysis patients.

METHODS

We retrospectively reviewed 115 patients undergoing hemodialysis in a tertiary hospital between December 2022 and January 2023. Both univariate and multivariate logistic regression models were applied to identify potential influencing factors, and the prediction model was constructed using an ROC curve.

RESULTS

Of the 115 included patients, 60 experienced long COVID, with a prevalence of 52.2%. The univariate analysis found that a three-dose COVID-19 vaccination was associated with a reduced risk of long COVID (OR: 0.10; 95%CI: 0.01-0.86; P = 0.036). However, severe COVID (OR: 9.49; 95%CI: 1.14-78.90; P = 0.037), undergoing CT examination (OR: 3.01; 95%CI: 1.34-6.78; P = 0.008), and abnormal neutrophil (OR: 5.95; 95%CI: 1.26-28.19; P = 0.025), and platelet (OR: 2.39; 95%CI: 1.11-5.13; P = 0.025) counts were associated with a higher risk of long COVID. After adjusting for potential confounding factors, undergoing CT examination (OR: 2.60; 95%CI: 1.02-6.64; P = 0.046) and having abnormal neutrophil (OR: 8.16; 95%CI: 1.57-42.38; P = 0.013) and monocyte (OR: 17.77; 95%CI: 1.30-242.29; P = 0.031) counts were associated with a higher risk of long COVID. The prediction model constructed based on these factors showed a relatively better predictive value (AUC: 0.738; 95%CI: 0.648-0.828; P < 0.001).

CONCLUSIONS

The risk of long COVID-19 in hemodialysis patients was significantly related to undergoing CT examination and having abnormal neutrophil and monocyte counts, and the prediction model constructed using these factors showed a moderate predictive value.

Unmasking the Long-Term Effects of COVID-19 With a Focus on Chronic Fatigue Syndrome: A Community-Based Study From India

Background The COVID-19 pandemic has highlighted the enduring health burden of long COVID, scientifically termed the postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or PASC. Long COVID manifests as diverse symptoms affecting multiple organ systems, significantly impacting individuals globally, and especially underrepresented rural populations. Objective This study aimed to evaluate the prevalence of chronic fatigue syndrome (CFS) among laboratory-confirmed COVID-19 patients in rural India, focusing on identifying its predictors and the implications for healthcare systems in resource-limited settings. Methodology Retrospective data analysis was conducted on the follow-up visits of post-COVID-19 patients in the field practice area of AIIMS Mangalagiri, Nuthakki, Andhra Pradesh, India. The study involved 500 COVID-19 survivors diagnosed via reverse transcription polymerase chain reaction (RT-PCR) between 2023 and 2024. Data was collected via a semi-structured questionnaire to retrieve socio-demographic and clinical parameters, while CFS severity was assessed using a validated scoring system. Multivariable logistic regression and path analysis were used to examine the associations between the predictors of CFS. Results The prevalence of CFS was seen in 107 patients (21.4%; 95% CI: 18.01-25.22). Risk factors included older age (adjusted odds ratio or aOR: 15.90 for ≥60 years), female gender (aOR: 1.90), and comorbidities (aOR: 3.92). Common symptoms observed were fatigue in 180 (36%), joint pain in 185 (37%), and muscle pain in 182 (36.4%) patients. There was no significant association between vaccination and CFS. Conclusion The study underscores the substantial burden of post-COVID fatigue in rural populations, with female patients, older adults, and those with comorbidities being at greater risk. Tailored healthcare interventions and proactive post-COVID monitoring are critical to address this challenge. Future research should explore the underlying mechanisms and assess the role of vaccination in mitigating the post-COVID sequelae.

Prevalence and Determinants of Long-Term Post-COVID Conditions in the United States: 2022 Behavioral Risk Factor Surveillance System

BACKGROUND

A significant proportion of COVID survivors experience lingering and debilitating symptoms following acute COVID-19 infection. According to the national research plan on long COVID, it is a national priority to identify the prevalence of post-COVID conditions and their associated factors.

METHOD

We performed a cross-sectional analysis of the Prevention Behavioral Risk Factor Surveillance System (BRFSS) 2022, the largest continuously gathered health survey dataset worldwide by the Centers for Disease Control. After identifying individuals with a positive history of COVID-19, we grouped COVID-19 survivors based on whether they experienced long-term post-COVID conditions. Using survey-specific R packages, we compared the two groups' socio-demographics, comorbidities, and lifestyle-related factors. A logistic regression model was used to identify factors associated with post-COVID conditions.

RESULTS

The overall estimated prevalence of long-term post-COVID conditions among COVID survivors was 21.7%. Fatigue (5.7%), dyspnea (4.2%), and anosmia/ageusia (3.8%) were the most frequent symptoms. Based on multivariate logistic regression analysis, female sex, body mass index (BMI)≥25, lack of insurance, history of pulmonary disease, depression, and arthritis, being a former smoker, and sleep duration <7 h/d were associated with higher odds of post-COVID conditions. On the other hand, age >64 y/o, Black race, and annual household income ≥$100k were associated with lower odds of post-COVID conditions.

CONCLUSION

Our findings indicate a notable prevalence of post-COVID conditions, particularly among middle-aged women and individuals with comorbidities or adverse lifestyles. This high-risk demographic may require long-term follow-up and support. Further investigations are essential to facilitate the development of specified healthcare and therapeutic strategies for those suffering from post-COVID conditions.

Ongoing Symptoms After Acute SARS-CoV-2 or Influenza Infection in a Case-Ascertained Household Transmission Study: 7 US Sites, 2021-2023

BACKGROUND

The prevalence and risk factors for ongoing symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [SCV2]) or influenza infection are not well characterized. We conducted a prospective cohort study of households wherein ≥1 individual was infected with SCV2 or influenza to evaluate prevalence of and factors associated with ongoing symptoms at 90 days.

METHODS

Index cases and their household contacts provided baseline health and sociodemographic information and collected daily respiratory specimens for 10 days following enrollment. Participants completed a follow-up survey 90 days after enrollment to characterize ongoing symptoms.

RESULTS

We analyzed 1967 participants enrolled between December 2021 and May 2023. The risk of ongoing symptoms did not differ by infection status in SCV2 (SCV2-positive: 15.6%; SCV2-negative: 13.9%; odds ratio [OR]: 1.14; 95% CI: .7-1.69) or influenza (influenza-positive: 8.8%; influenza-negative: 10.0%; OR: .87; 95% CI: .45-1.72) households. However, among study participants with a documented infection, SCV2-positive participants had nearly twice the odds of ongoing symptoms as influenza-positive participants (OR: 1.92; 95% CI: 1.27-2.97).

CONCLUSIONS

These results suggest that SCV2 households have a significantly higher prevalence of ongoing symptoms compared with influenza households (OR: 1.78; 95% CI: 1.28-2.47). Among participants with SCV2 infection, underlying conditions (adjusted OR [aOR]: 2.65; 95% CI: 1.80-3.90) and coronavirus disease 2019 (COVID-19)-like symptoms (aOR: 2.92; 95% CI: 1.15-7.43) during acute infection increased odds of ongoing symptoms at 90 days, whereas hybrid immunity reduced the odds of ongoing symptoms (aOR: 0.44; 95% CI: .22-.90).

Course of General Fatigue in Patients with Post-COVID-19 Conditions Who Were Prescribed Hochuekkito: A Single-Center Exploratory Pilot Study

Background: After the start of the COVID-19 pandemic, general fatigue in patients with long COVID and post-COVID-19 conditions (PCC) became a medical issue. Although there is a lack of evidence-based treatments, Kampo medicine (traditional Japanese medicine) has gained attention in Japan. At an outpatient clinic in Japan specializing in long COVID, 24% of all prescriptions were Kampo medicines, and 72% of Kampo medicine prescriptions were hochuekkito. However, there has been no prospective, quantitative study on the course of fatigue in patients with long COVID and PCC who were prescribed hochuekkito. The aim of this study was to clarify the course of fatigue in those patients. Methods: This study included patients aged 18 years or older with general fatigue who visited the long COVID specialized outpatient clinic at Okayama University Hospital and consented to participate after being prescribed hochuekkito. We reviewed the backgrounds of the patients, and we evaluated the patients' fatigue assessment scale in person or online. Results: Twenty patients were enrolled in this study from September to December in 2023. The average age of the patients was 42.9 years (SD: 15.8 years) and 12 patients (60%) were female. After hochuekkito administration, the fatigue assessment scale score decreased from 35.9 (SD: 5.9) at the initial visit to 31.2 (SD: 9.4) after 8 weeks, indicating a trend for improvement in fatigue (difference: 4.7; 95% CI: 0.5-8.9). Conclusions: A trend for improvement in fatigue was observed in patients with long COVID and PCC who were prescribed hochuekkito, indicating a potential benefit of hochuekkito for general fatigue in such patients. General fatigue in patients with long COVID or PCC can be classified as post-infectious fatigue syndrome and is considered a condition of qi deficiency in Kampo medicine, for which hochuekkito is appropriately indicated.

Defining brain fog across medical conditions

'Brain fog' is commonly reported in more than a dozen chronic diseases, but what is it? We review research across conditions which has characterised brain fog and evaluate its definitions and objective correlates. Brain fog has been used to refer to a variable set of overlapping symptoms implicating cognition, fatigue, and affect. It has been defined as a distinct symptom, a syndrome, or a nonspecific term. We consider the evidence that brain fog is a transdiagnostic entity with a common phenomenology and profile of objective cognitive deficits. We discuss where these commonalities arise and argue that linguistic ambiguity, shared cognitive impairments, and noncognitive factors are more likely than shared neurobiology. We suggest how future research might apply existing tools to disambiguate the phenomena that brain fog conflates.

Association of Mediterranean Diet with Cardiovascular Risk Factors and with Metabolic Syndrome in Subjects with Long COVID: BioICOPER Study

BACKGROUND

Long COVID has been associated with increased cardiovascular risk and chronic low-grade inflammation, raising concerns about its long-term metabolic consequences. Given that the Mediterranean diet (MD) has shown beneficial effects on cardiovascular risk factors and inflammation in various populations, it is important to explore its potential impact on individuals with Long COVID. Therefore, the aim is to determine the association of the MD with cardiovascular risk factors (CVRF) and metabolic syndrome (MetS) in Caucasian subjects diagnosed with Long COVID.

METHODS

Cross-sectional study, 305 subjects diagnosed with Long COVID were included following the WHO criteria. Adherence to MD was evaluated with the MEDAS (Mediterranean Diet Adherence Screener) with 14 items used in Prevention with Mediterranean Diet study (PREDIMED study). The criteria considered to diagnose MetS were blood pressure, glycemia, triglycerides, HDL cholesterol, and waist circumference. Other CVRFs considered were tobacco consumption, total cholesterol, LDL cholesterol, body mass index, and baseline uric acid levels. The association between MD with CVRF and the number and components of MetS was analyzed using multiple regression models and multinomial regression.

RESULTS

The mean age was 52.75 ± 11.94 years (men 55.74 ± 12.22 and women 51.33 ± 11.57; p = 0.002), (68% women). The mean of the MEDAS questionnaire was 7.76 ± 2.37. The presented MetS were 23.6% (39.8% men and 15.9% women p < 0.001). In the multiple regression analysis, after adjusting for age and average time from acute COVID-19 infection to the date of inclusion in this study, the mean MD score showed a negative association with uric acid (β = -0.295; 95% CI: -0.496 to -0.093), BMI (β = -0.049; 95% CI: -0.096 to -0.002), the number of MetS components (β = -0.210; 95% CI: -0.410 to -0.010), and waist circumference (WC) (β = -0.021; 95% CI: -0.037 to -0.003) and a positive association with HDL cholesterol (β = -0.018; 95% CI: 0.001 to -0.037).

CONCLUSIONS

The findings of this study suggest that higher Mediterranean diet scores are associated with lower levels of uric acid, fewer MetS components, smaller waist circumference, and higher HDL cholesterol levels in individuals with Long COVID.

Long COVID and Lung Involvement: A One-Year Longitudinal, Real-Life Study

Background and Objectives: Long COVID as a condition typically manifests itself three months after the initial onset of SARS-CoV-2 infection, with symptoms persisting for a minimum of two months. The aim of the present research was to identify potential predictors of post-COVID-19 syndrome (long COVID-19) and to evaluate factors associated with the presence of post-COVID-19 interstitial lung disease and functional decline. Materials and Methods: 210 patients hospitalized for confirmed SARS-CoV-2 infections mild, moderate, severe, and critical form have been evaluated at 3, 6 and twelve months. Results: Among them only one has been with a suspicion of interstitial lung disease after one year, the rest had no change in the lung. No risk factor from the baseline/3-month or 6-month evaluations significantly influenced patients' status at 12 months. The longer the duration of hospitalization, the lower the FVC and DLCO were at 3 months, but the longer the duration of hospitalization, the higher the number of symptoms at 3 months and 6 months. In a multivariate linear regression analysis, the number of hospitalization days remained statistically significant only for the number of symptoms at 3 months and 6 months. Conclusions: Long COVID seems to be related to the severity of the initial disease, and among the most persistent. Post-COVID-19 interstitial lung disease does not seem to be a frequent entity, as in our study only 0.5% out of 210 patients had it.

Prevalence of cardiovascular symptoms in post-acute COVID-19 syndrome: a meta-analysis

BACKGROUND

Since its emergence in 2019, COVID-19 has continued to pose significant threats to both the physical and mental health of the global population, as well as to healthcare systems worldwide (Raman et al., Eur Heart J 43:1157-1172, 2022). Emerging evidence indicates that COVID-19 may lead to post-acute COVID-19 syndrome (PACS) with cardiovascular implications, potentially driven by factors such as ACE2 interaction with viruses, systemic inflammation, and endothelial dysfunction. However, there remains a limited amount of research on the cardiovascular manifestations of PACS, which may delay the development of optimal treatment strategies for affected patients. Therefore, it is crucial to investigate the prevalence of cardiovascular sequelae in COVID-19 patients and to determine whether COVID-19 infection acts as an independent risk factor for these outcomes.

METHODS

This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024524290). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to March 17, 2024. The primary outcomes included hypertension, palpitations, and chest pain, with pooled effect estimate reported as proportions and odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity and subgroup analysis were performed to assess the robustness of the results and to identify sources of heterogeneity.

RESULTS

A total of 37 studies, encompassing 2,965,467 patients, were included in the analysis. Pooled results from case-control studies revealed that, compared to the control group, the ORs of chest pain in the COVID-19 group was 4.0 (95% CI: 1.6, 10.0). The ORs for palpitation and hypertension were 3.4 (95% CI: 1.1, 10.2) and 1.7 (95% CI: 1.6, 1.8), respectively. The proportions of PACS patients experiencing chest pain, palpitation, and hypertension as sequelae were 22% (95% CI: 14%, 33%), 18% (95% CI: 13%, 24%), and 19% (95% CI: 12%, 31%), respectively.

CONCLUSIONS

Our findings indicate that 15% of COVID-19 patients experience cardiovascular sequelae. Furthermore, COVID-19 infection significantly increases the likelihood of developing these sequelae compared to uninfected individuals. Future research should prioritize investigating the underlying pathological mechanisms and developing targeted preventive and management strategies.

TRIAL REGISTRATION

CRD42024524290.

Vitamin D Deficiency Meets Hill's Criteria for Causation in SARS-CoV-2 Susceptibility, Complications, and Mortality: A Systematic Review

Clinical trials consistently demonstrate an inverse correlation between serum 25-hydroxyvitamin D [25(OH)D; calcifediol] levels and the risk of symptomatic SARS-CoV-2 disease, complications, and mortality. This systematic review (SR), guided by Bradford Hill's causality criteria, analyzed 294 peer-reviewed manuscripts published between December 2019 and November 2024, focusing on plausibility, consistency, and biological gradient. Evidence confirms that cholecalciferol (D3) and calcifediol significantly reduce symptomatic disease, complications, hospitalizations, and mortality, with optimal effects above 50 ng/mL. While vitamin D requires 3-4 days to act, calcifediol shows effects within 24 h. Among 329 trials, only 11 (3%) showed no benefit due to flawed designs. At USD 2/patient, D3 supplementation is far cheaper than hospitalization costs and more effective than standard interventions. This SR establishes a strong inverse relationship between 25(OH)D levels and SARS-CoV-2 vulnerability, meeting Hill's criteria. Vitamin D3 and calcifediol reduce infections, complications, hospitalizations, and deaths by ~50%, outperforming all patented, FDA-approved COVID-19 therapies. With over 300 trials confirming these findings, waiting for further studies is unnecessary before incorporating them into clinical protocols. Health agencies and scientific societies must recognize the significance of these results and incorporate D3 and calcifediol for prophylaxis and early treatment protocols of SARS-CoV-2 and similar viral infections. Promoting safe sun exposure and adequate vitamin D3 supplementation within communities to maintain 25(OH)D levels above 40 ng/mL (therapeutic range: 40-80 ng/mL) strengthens immune systems, reduces hospitalizations and deaths, and significantly lowers healthcare costs. When serum 25(OH)D levels exceed 70 ng/mL, taking vitamin K2 (100 µg/day or 800 µg/week) alongside vitamin D helps direct any excess calcium to bones. The recommended vitamin D dosage (approximately 70 IU/kg of body weight for a non-obese adult) to maintain 25(OH)D levels between 50-100 ng/mL is safe and cost-effective for disease prevention, ensuring optimal health outcomes.

Severity Matters: How COVID-19 Severity Impacts Long-Term Effects on Symptoms, Physical Activity and Functionality-An Observational Study

BACKGROUND/OBJECTIVES

The existing literature has described the common symptoms and long-term effects of coronavirus disease (COVID-19). However, there is a lack of detailed information on how different degrees of disease severity affect survivors differently. This study aims to fill that gap by evaluating the symptoms, physical activity, and functionality of COVID-19 survivors across a spectrum of severity levels, comparing them with those of healthy individuals.

METHODS

An observational study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria and checklist. Participants were divided into 5 groups based on COVID-19 severity according to the World Health Organization classification: healthy (COVID-19-negative), mild (symptomatic without pneumonia or dyspnoea), moderate (pneumonia and dyspnoea without hospitalisation), severe (severe pneumonia requiring hospitalisation), and critical (severe pneumonia with admission to the intensive care unit). Descriptive variables, symptoms (Fatigue Borg Scale, Fatigue Impact Scale, Fatigue Severity Scale, Dyspnoea Borg Scale, Visual Analogue Scale, Hospital Anxiety and Depression Scale, and European Quality of Life-5 Dimensions), physical activity (the International Physical Activity Questionnaire) and functionality (Patient-Specific Functional Scale, Short Physical Performance Battery, Arm Curl test, and 2 min step test) were measured.

RESULTS

A total of 304 participants were included: healthy (n = 42), mild (n = 143), moderate (n = 49), severe (n = 52), and critical (n = 18) COVID-19 patients. The impact of COVID-19 on surviving patients varies significantly with the severity of the disease. The results show that the hospitalisation time, age, and comorbidities of the patients are greater in those with a greater severity of the disease. Patients with more severe COVID-19 also experience greater frailty, dysphagia, fatigue, dyspnoea, and pain. Additionally, those with severe cases have poorer overall health, reduced physical activity, and diminished functionality. No evidence of post-COVID-19 anxiety or depression is found in the sample, even considering the timeframe between the negative test and the assessment.

CONCLUSIONS

Patients with higher COVID-19 severity (severe or critical) experience more symptoms than those with lower COVID-19 severity (mild or moderate). Additionally, those with severe cases have poorer overall health, reduced physical activity and diminished functionality. Register: Clinicaltrials.gov: NCT05731817.

Definitions and symptoms of the post-COVID syndrome: an updated systematic umbrella review

Post-COVID syndrome (PCS) describes a persistent complex of symptoms following a COVID-19 episode, lasting at least 4 to 12 weeks, depending on the specific criteria used for its definition. It is often associated with moderate to severe impairments of daily life and represents a major burden for many people worldwide. However, especially during the first two years of the COVID-19 pandemic, therapeutic and diagnostic uncertainties were prominent due to the novelty of the disease and non-specific definitions that overlooked functional deficits and lacked objective assessment. The present work comprehensively examines the status of PCS definitions as depicted in recent reviews and meta-analyses, alongside exploring associated symptoms and functional impairments. We searched the database Pubmed for reviews and meta-analysis evaluating PCS in the period between May 31, 2022, to December 31, 2023. Out of 95 studies, 33 were selected for inclusion in our analyses. Furthermore, we extended upon prior research by systematically recording the symptoms linked with PCS as identified in the studies. We found that fatigue, neurological complaints, and exercise intolerance were the most frequently reported symptoms. In conclusion, over the past eighteen months, there has been a notable increase in quantity and quality of research studies on PCS. However, there still remains a clear need for improvement, particularly with regard to the definition of the symptoms necessary for diagnosing this syndrome. Enhancing this aspect will render future research more comparable and precise, thereby advancing and understanding PCS.

Fully remote versus hybrid supervision of pulmonary telerehabilitation in COVID-19: a randomized clinical trial

BACKGROUND

The restrictions imposed by the COVID-19 pandemic have impeded the traditional rehabilitation process, prompting the widespread adoption of remote programs for the recovery of survivors.

AIM

The aim of this study was to evaluate and compare the effectiveness of a pulmonary telerehabilitation program (PTRP) in the exclusively remote modality versus the hybrid modality (remote and face-to-face) in patients with persistent respiratory dysfunction following hospitalization for COVID-19 pneumonia, and to compare the functional capacity of patients who participated in a PTRP with those who did not.

DESIGN

A randomised, interventional, prospective clinical trial was conducted. In parallel, an observational cohort study was conducted.

SETTING

Outpatient rehabilitation clinic and home-based rehabilitation program.

POPULATION

Thirty patients post-COVID-19 were randomised into two groups: G1 (fully remote supervision of PTRP) or G2 (hybrid supervision of PTRP). Thirty-seven post-COVID-19 patients were followed up without participating in PTRP (non-intervention group - NIG).

METHODS

Patients with persistent respiratory dysfunction and reduced functional capacity, as measured by the Six Minute Walk Test (6MWT), after hospitalization for COVID-19 pneumonia, were considered eligible for a PTRP. To assess the efficacy of the PTRP, the primary outcome (I) was distance walked on the 6MWT (6MWD) and the secondary outcome (II) was quality of life as assessed by the SF-36 questionnaire.

RESULTS

Both G1 and G2 demonstrated similar improvement in 6MWD, P<0.001 and quality of life (P<0.05). The IG showed higher 6MWD than the NIG (P<0.001). The increase in 6MWD for the IG was 140.5 m, while for the NIG it was 16.8 m (P=0.002).

CONCLUSIONS

The PTRP was found to be a feasible and highly effective intervention for restoring functional capacity and improving quality of life, regardless of the type of supervision. Furthermore, this functional gain was maintained over the long term. In patients with pulmonary dysfunction, participation in the PTRP improved functional capacity compared with those who were simply advised to resume physical activity during recovery.

CLINICAL REHABILITATION IMPACT

Telerehabilitation has been demonstrated to be a viable and efficacious alternative to traditional in-person programs in low-income contexts.