Sex and age affect acute and persisting COVID-19 illness

Sex-related differences in the association between migraine, COVID-19, and long COVID: a population-based cohort

Background

Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, placed unprecedented pressure on public health systems due to its mortality and global panic-and later due to long COVID challenges. One of these long COVID symptoms, headache, often resembles migraine-like features. Migraine shares similarities with COVID-19 and long COVID, yet the influence of sex is understudied. Our primary objective was to study the interrelationship between COVID-19 and migraine prevalence, while considering sex differences. The secondary objective was to examine how long COVID symptoms (headache, anosmia, memory, and concentration problems) affect males and females with and without COVID-19 and migraine.

Methods

All analyses were conducted using Lifelines, a prospective cohort study in the northern Netherlands. Baseline characteristics (2006-2014), self-reported migraine diagnoses (until 2021), and questionnaires on COVID-19 and long COVID symptoms (2020-2022) were collected. Logistic regression analyses were conducted to study the association between lifetime migraine and current SARS-CoV-2 infections while adjusting for age, sex, diet, educational attainment, activity, and smoking. Descriptive and sex-stratified analyses were conducted on long COVID symptoms.

Results

A total of 150,507 individuals were included, of which 29,680 (19.7%) reported migraine and 120,827 (80.3%) not. A total of 1,867 individuals with migraine [6.3% of individuals with migraine, 44.0 years (IQR 36.1-50.3)] and 6,797 individuals without migraine [5.6% of individuals without migraine, 44.4 years (IQR 35.3-52.2)] reported to be SARS-CoV-2 infected. The majority of individuals with migraine consisted of females (77.0% of those with migraine vs. 54.0% of those without migraine). The adjusted odds of having SARS-CoV-2 infections was 6.3% higher among those with (a history of) migraine compared with individuals without migraine in the logistic regression model (OR = 1.06, 95% CI 1.01-1.12). A slightly higher OR was observed in females (OR = 1.08, 95% CI 1.02-1.15), and the association was not apparent in males (OR = 1.00, 95% CI 0.88-1.12). Secondary analyses revealed that individuals with both migraine and COVID-19, and females in particular, were the most frequently bothered by long COVID symptoms headache, anosmia, concentration, and memory problems. Individuals with none of these diseases were the least bothered.

Conclusions

Individuals with migraine, especially females, are slightly more likely to report and/or contract COVID-19. Those with both conditions report long COVID symptoms more frequently, suggesting a shared vulnerability or pathophysiology. This may indicate the need for clinical surveillance of migraine patients recovering from COVID-19.

Long COVID patients' brain activation is suppressed during walking and severer symptoms lead to stronger suppression

This research aims to study the factors contributing to Long COVID and its effects on motor and cognitive brain regions using population surveys and brain imaging. The goal is to provide new insights into the neurological effects of the illness and establish a basis for addressing neuropsychiatric symptoms associated with Long COVID. Study 1 used a cross-sectional design to collect data on demographic characteristics and factors related to Long COVID symptoms in 551 participants. In Study 2, subjects with Long COVID and SARS-CoV-2 uninfected individuals underwent fNIRS monitoring while performing various tasks. Study 1 found that gender, age, BMI, Days since the first SARS-CoV-2 infection, and Symptoms at first onset influenced Long COVID performance. Study 2 demonstrated that individuals in the SARS-CoV-2 uninfected group exhibited greater activation of cognitive function-related brain regions than those in the Long COVID group while performing a level walking task. Furthermore, individuals in the Long COVID group without functional impairment displayed higher activation of brain regions associated with motor function during a weight-bearing walking task than those with functional impairment. Among individuals with Long COVID, those with mild symptoms at onset exhibited increased activation of brain regions linked to motor and cognitive function relative to those with moderate symptoms at onset. Individuals with Long COVID exhibited decreased activation in brain regions associated with cognitive and motor function compared to SARS-CoV-2 uninfected individuals. Moreover, those with more severe initial symptoms or functional impairment displayed heightened inhibition in these brain regions.

Development of a Model for Predicting Mortality Among Patients Hospitalized with COVID-19 During Their Stay in a Clinical Centre

Background: Various tools have been proposed for predicting mortality among patients hospitalized with COVID-19 to improve clinical decision-making, the predictive capacities of which vary in different populations. The objective of this study was to develop a model for predicting mortality among patients hospitalized with COVID-19 during their time in a clinical centre. Methods: This was a retrospective study that included 201 patients hospitalized with COVID-19. Mortality was evaluated with the Kaplan-Meier curve and Cox proportional hazards models. Six models were generated for predicting mortality from laboratory markers and patients' epidemiological data during their stay in a clinical centre. Results: The model that presented the best predictive power used D-dimer adjusted for C-reactive protein (CRP) and oxygen saturation. The sensitivity (Sn) and specificity (Sp) at 15 days were 75% and 71.9%, respectively. At 30 days, Sn was 75% and Sp was 75.4%. Conclusions: These results allowed us to establish a model for predicting mortality among patients hospitalized with COVID-19 based on D-dimer laboratory biomarkers adjusted for CRP and oxygen saturation. This mortality predictor will allow patients to be identified who require more continuous monitoring and health care.

COVID-19 Vaccine Uptake among People with Spinal Cord Injury and Dysfunction in Ontario, Canada: A Population-Based Retrospective Cohort Study

Persons with disabilities experience numerous barriers to healthcare access including vaccine accessibility. The purpose of this study was to determine COVID-19 vaccine uptake in the spinal cord injury and disease (SCI/D) population of Ontario and identify potential factors influencing C OVID-19 vaccine uptake. This was a retrospective closed-cohort study using administrative health data on individuals with SCI/D of traumatic and non-traumatic causes to examine the monthly number of COVID-19 vaccine doses received between December 2020 and December 2023. Logistic regression analysis was used to examine the potential association between socio-demographic, clinical, and neighbourhood characteristics with initial COVID-19 vaccine receipt and booster dose uptake. By the end of the observation period in December 2023, 82.9% received the full two-dose coverage and 65.6% received at least one additional booster dose in a cohort of 3574 individuals with SCI/D. SCI/D individuals showed a comparable COVID-19 vaccine uptake percentage to the general population. Sociodemographic, clinical, and neighbourhood characteristics were associated with COVID-19 vaccine uptake in the SCI/D population, including age, type of injury, number of comorbidities, mental health history, and neighbourhood characteristics such as income. Further investigation is necessary to determine the causation effects of these relationships with vaccine uptake to address health equity concerns.

An immersive virtual reality-based object-location memory task reveals spatial long-term memory alterations in Long-COVID

Object-location memory (OLM) is a type of declarative memory for spatial information and consists of the individual's ability to establish accurate associations between objects and their spatial locations. Long-COVID describes the long-term effects of the COVID-19 disease. Long-COVID patients show medial temporal lobe dysfunction and neuropsychological alterations affecting memory. This study aimed to assess OLM in a group of Long-COVID patients, n=66, and a Control group of healthy individuals with similar age and sex composition, n=21, using an immersive virtual reality (iVR)-based OLM task. We also explored associations between the performance in the iVR-based OLM task and general cognitive function (MoCA), and both verbal (VSTM) and visuospatial (SSTM) span. The Long-COVID group showed fewer correct responses, made more task attempts, and invested more time in the iVR-based OLM task than the Control group. Delayed memory was more severely altered than immediate memory in Long-COVID participants. Better MoCA scores of the Long-COVID group were strongly associated with shorter times to complete the immediate recall of the iVR-based OLM task. Besides, the months elapsed since the COVID-19 infection were slightly associated with fewer correct responses in the immediate and 24-hour recalls. These results corroborate previous findings of memory alterations in the Long-COVID syndrome using an iVR-based OLM task, adding new evidence on spatial memory and long-term memory in this population. Implementing spatial iVR tasks to clinical research may improve our understanding of neuropsychological disorders.

Dynamic changes of hematological and hemostatic parameters in COVID-19 hospitalized patients: Potential role as severity biomarkers for the Chilean population

Background

COVID-19 is still a global health issue, there is limited evidence in South America regarding laboratory biomarkers associated with severe disease. The objective of our study was to identify hematological and hemostatic changes associated with severe COVID-19.

Methods

A total of 170 hospitalized patients with COVID19 were included in the study, defining their severity according to established criteria. Demographic, clinical, and laboratory (days 1, 3, 7, 15) data were obtained. We performed a statistical analysis, assuming significance with a value of p < 0.05. We analyzed the correlation between severity and biomarkers and established cut-off values for severe patients through ROC curves, estimating Odds Ratio associated with severe disease.

Results

Day 1 was observed significant differences between moderate vs severe patients for leukocytes (WBC), Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and D-dimer, establishing cut-off points for each of them. The markers we found associated to risk of severe disease were WBC (OR=3.2396; p = 0.0003), NLR (OR=5.7084; p < 0.0001), PLR (OR=4.4094; p < 0.0001), Neutrophil (OR=4.1193; p < 0.0001), D-dimer (OR=2.7827; p = 0.0124).

Conclusions

The results allow to establish basic laboratory biomarkers associated to severe disease, which could be used as prognostic markers.

Iron dysregulation and inflammatory stress erythropoiesis associates with long-term outcome of COVID-19

Persistent symptoms following SARS-CoV-2 infection are increasingly reported, although the drivers of post-acute sequelae (PASC) of COVID-19 are unclear. Here we assessed 214 individuals infected with SARS-CoV-2, with varying disease severity, for one year from COVID-19 symptom onset to determine the early correlates of PASC. A multivariate signature detected beyond two weeks of disease, encompassing unresolving inflammation, anemia, low serum iron, altered iron-homeostasis gene expression and emerging stress erythropoiesis; differentiated those who reported PASC months later, irrespective of COVID-19 severity. A whole-blood heme-metabolism signature, enriched in hospitalized patients at month 1-3 post onset, coincided with pronounced iron-deficient reticulocytosis. Lymphopenia and low numbers of dendritic cells persisted in those with PASC, and single-cell analysis reported iron maldistribution, suggesting monocyte iron loading and increased iron demand in proliferating lymphocytes. Thus, defects in iron homeostasis, dysregulated erythropoiesis and immune dysfunction due to COVID-19 possibly contribute to inefficient oxygen transport, inflammatory disequilibrium and persisting symptomatology, and may be therapeutically tractable.

Psychometric properties and observational data for COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) for post-COVID-19 syndrome

BACKGROUND

The recently developed modified COVID-19 (coronavirus of 2019) Yorkshire Rehabilitation Scale (C19-YRSm) captures comprehensive biopsychosocial components of WHO's International Classification of Functioning, Disability, and Health related to the Long Covid or post-COVID syndrome. The scale response categories on C19-YRSm were done post hoc on data collected from the original version of C19-YRS.

AIM

To evaluate the C19-YRSm scale using reliability and validity measures.

DESIGN

Prospective, observational study.

METHODS

The study includes 369 patients (clinical group) and 426 subjects of the general population (control group) and captures their post-COVID-19 symptoms. In addition, the reliability of C19-YRSm was estimated by Cronbach's alpha coefficients of internal consistency and inter-item correlations for subscales ('Symptom severity, Functional disability, and Other symptoms'). Convergent validity was established using correlations between C19-YRSm and Fatigue Severity Scale (FSS). The incremental validity of C19-YRSm was measured by introducing a hierarchical regression model using the C19-YRSm 'Overall health' subscale and FSS as criterion variables.

RESULTS

C19-YRSm subscales have excellent internal consistencies (Cronbach's α value 0.81-0.96) and acceptable inter-item correlations (r value 0.23-0.79). Hereafter, the convergent validity of the C19-YRSm is good due to significant correlations between C19-YRSm subscales and FSS and C19-YRSm subscales. Finally, the hierarchical regression analysis supported consistent evidence for the incremental validity of the C19-YRSm subscales.

CONCLUSION

C19-YRSm is a reliable and valid self-assessment scale for the assessment of post-COVID-19 syndrome.

Altered metabolites in the periaqueductal gray of COVID-19 patients experiencing headaches: a longitudinal MRS study

Background

Headache is one of the most common symptoms of acute COVID-19 infection. However, its mechanisms remain poorly understood, and there is a lack of studies investigating changes in the periaqueductal gray (PAG) in COVID-19 patients exhibiting headaches.

Purpose

The study aimed to explore the alterations in metabolites of the PAG pre- and post-COVID-19 infection in individuals who suffered from headaches during the acute phase of the disease using proton magnetic resonance spectroscopy (1H-MRS).

Methods

Fifteen participants who experienced headaches during the acute phase of COVID-19 were recruited. All subjects underwent two proton magnetic resonance spectroscopy (1H-MRS) examinations focusing on the PAG before and after they were infected. Metabolite changes were assessed between the pre- and post-infection groups.

Results

The combined glutamine and glutamate/total creatine ratio (Glx/tCr) was increased in the PAG following COVID-19 infection. The total choline/total creatine ratio (tCho/tCr) in the pre-infection group was negatively correlated with the duration of headache during the COVID-19 acute phase.

Conclusion

The present study indicates that PAG plays a pivotal role in COVID-19 headaches, thereby supporting the involvement of trigeminovascular system activation in the pathophysiology of COVID-19 headaches.

Altered brain function and structure pre- and post- COVID-19 infection: a longitudinal study

BACKGROUND

Evidence indicates that the SARS-CoV-2 virus can infect the brain, resulting in central nervous system symptoms. However, there is a lack of a longitudinal imaging study investigating the impact of Coronavirus disease 2019 (COVID-19) infection on brain function. Consequently, this study aimed to fill this knowledge gap using functional magnetic resonance imaging (fMRI).

METHODS

Twenty-one participants underwent two resting-state fMRI scans before and after infection. The amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) were assessed to identify the brain function changes. Additionally, voxel-based morphometry (VBM) was utilized to assess changes in brain structure. Subsequently, brain regions that showed significant differences were identified as regions of interest (ROI) in functional connectivity analysis (FC).

RESULTS

After infection, ALFF was increased in the bilateral paracentral lobe and postcentral gyrus while decreased in the bilateral precuneus. Moreover, ReHo was decreased in the cerebellar vermis, accompanied by a decrease in FC with the bilateral postcentral gyrus. Furthermore, gray matter volume (GMV) reduction was observed in the left thalamus. The results of the correlation analysis revealed a negative correlation between ALFF values in the bilateral precuneus and scores on the self-rating anxiety scale (SAS) in pre- and post-infection datasets.

CONCLUSION

Neuroimaging alterations may occur before the manifestation of clinical symptoms, indicating that the functioning of the motor and sensory systems, as well as their connection, might be affected following infection. This alteration can potentially increase the potential of maladaptive responses to environmental stimuli. Furthermore, patients may be susceptible to future emotional disorders.

Immune Response after SARS-CoV-2 Infection with Residual Post-COVID Symptoms

Many patients develop post-acute COVID syndrome (long COVID (LC)). We compared the immune response of LC and individuals with post-COVID full recovery (HC) during the Omicron pandemic. Two hundred ninety-two patients with confirmed COVID infections from January to May 2022 were enrolled. We observed anti-SARS-CoV-2 receptor-binding domain immunoglobulin G, surrogate virus neutralization test, T cell subsets, and neutralizing antibodies against Wuhan, BA.1, and BA.5 viruses (NeuT). NeuT was markedly reduced against BA.1 and BA.5 in HC and LC groups, while antibodies were more sustained with three doses and an updated booster shot than ≤2-dose vaccinations. The viral neutralization ability declined at >84-days after COVID-19 onset (PC) in both groups. PD1-expressed central and effector memory CD4+ T cells, and central memory CD8+ T cells were reduced in the first months PC in LC. Therefore, booster vaccines may be required sooner after the most recent infection to rescue T cell function for people with symptomatic LC.