The burden of persistent symptoms after COVID-19 (long COVID): a meta-analysis of controlled studies in children and adults

BACKGROUND

Previous meta-analyses estimating the prevalence of the post-COVID-19 condition (PCC) were confounded by the lack of negative control groups. This may result in an overestimation of the prevalence of those experiencing PCC, as these symptoms are non-specific and common in the general population. In this study, we aimed to compare the burden of persistent symptoms among COVID-19 survivors relative to COVID-19-negative controls.

METHODS

A systematic literature search was conducted using the following databases (PubMed, Web of Science, and Scopus) until July 2023 for comparative studies that examined the prevalence of persistent symptoms in COVID-19 survivors. Given that many of the symptoms among COVID-19 survivors overlap with post-hospitalization syndrome and post-intensive care syndrome, we included studies that compare the prevalence of persistent symptoms in hospitalized COVID-19 patients relative to non-COVID-19 hospitalized patients and in non-hospitalized COVID-19 patients relative to healthy controls that reported outcomes after at least 3 months since infection. The results of the meta-analysis were reported as odds ratios with a 95% confidence interval based on the random effects model.

RESULTS

Twenty articles were included in this study. Our analysis of symptomatology in non-hospitalized COVID-19 patients compared to negative controls revealed that the majority of symptoms examined were not related to COVID-19 infection and appeared equally prevalent in both cohorts. However, non-COVID-19 hospitalized patients had higher odds of occurrence of certain symptoms like anosmia, ageusia, fatigue, dyspnea, and brain fog (P < 0.05). Particularly, anosmia and ageusia showed substantially elevated odds relative to the negative control group at 11.27 and 9.76, respectively, P < 0.05. In contrast, analysis of hospitalized COVID-19 patients compared to those hospitalized for other indications did not demonstrate significantly higher odds for the tested symptoms.

CONCLUSIONS

The persistent symptoms in COVID-19 survivors may result from hospitalization for causes unrelated to COVID-19 and are commonly reported among the general population. Although certain symptoms exhibited higher odds in non-hospitalized COVID-19 patients relative to controls, these symptoms are common post-viral illnesses. Therefore, the persistent symptoms after COVID-19 may not be unique to SARS-CoV-2. Future studies including well-matched control groups when investigating persistent symptoms in COVID-19 survivors are warranted to draw a firm conclusion.

The effect of using personal protective equipment and aerosol box in the emergency department on the intubation times

Background

Endotracheal intubation is a procedure commonly performed in the emergency department (ED). Endotracheal intubation poses a risk of exposure to infectious aerosol droplets.

Aim

The present study aims to test the effect of using an aerosol box (AB) and personal protective equipment (PPE) on the intubation time while performing endotracheal intubation manikin.

Subjects and Methods

The study participants (11 emergency specialists, 11 emergency physicians, and 11 general practitioners) performed endotracheal intubation on a training manikin in three different airway simulations. Simulation 1 had neither PPE nor AB, simulation 2 had PPE, and simulation 3 had both PPE and AB. The intubation times, the number of intubation attempts, and the discomfort caused by the AB were recorded.

Results

There was no significant difference in the number of intubation attempts between the physicians according to their position and airway simulations (p > 0.05). There was a significant difference at all time points except for the time to endotracheal tube cuff inflation in three different airway simulations using PPE and an AB (p < 0.05). The median intubation times were longer using PPE and an AB.

Conclusion

The use of PPE and an AB significantly increases the total intubation time.

The effectiveness of long Pulsed Nd:YAG Laser alone for treatment of keloids and hypertrophic scars versus its combination with bleomycin

BACKGROUND AND OBJECTIVES

Pathological scars are benign hyper-proliferative growths of dermal collagen that causes severe psychological and physical problems. This study was performed to assess and compare safety and clinical efficiency of combined pulsed Nd-YAG laser and intralesional bleomycin versus pulsed Nd-YAG laser alone to treat the hypertrophic scars and keloids.

PATIENTS AND METHODS

Randomly, 40 patients with hypertrophic scars or keloids were divided into two groups A and B. Group A were handled by pulsed Nd:YAG laser and intralesional bleomycin while group B were handled by pulsed Nd:YAG laser only. Response was assessed subjectively by clinical imaging and modified Vancouver Scar Scale (mVSS). While for objective evaluation, skin biopsies were taken from volunteer patients before and after treatment, and were examined by Hematoxylin and eosin staining (H&E) and Masson trichrome staining.

RESULTS

Our study demonstrated almost complete improvement in 4 (20%) patients, partial improvement in 16 (80%) patients and 0 patient with no improvement in group A. Furthermore, in group B, we demonstrated almost complete improvement in 2 (10%) patients, partial in 14 (70%) patients and no improvement in 4 (20%) patients. Modified Vancouver Scar Scale reduced from 10.15 to 3.5 in group A and from 11.05 to 4.95 in group B. Elastica Masson-Goldner staining and Hematoxylin and eosin staining showed that treatment in both groups structurally changed tissue collagen.

CONCLUSION

Long-pulsed Nd-YAG laser combined with intralesional bleomycin could be a promising way for treatment of keloids or hypertrophic scars.

Disruption of brain conductivity and permittivity and neurotransmitters induced by citrate-coated silver nanoparticles in male rats

As one of the most exonerative, competitive, and abundant nanoparticles in curative uses, silver nanoparticles (AgNPs) play a growing important role in developing global neurodegeneration. Herein, we inspected the neurotoxic and histopathological effects of the oral dose of 26.9 nm citrate-coated AgNPs (100 and 1000 mg/kgbw, 28 days) on the brain conductivity and permittivity combined with neurotransmitter assays. While male mice in the control group were given deionized water. In terms of biophysical levels, the brain electric conductivity and relative permittivity were significantly decreased in the 26.9 nm citrate-coated AgNP treated groups versus the controls. Besides, 26.9 nm citrate-coated AgNP treatment resulted in a significant deficiency in the concentrations of brain acetylcholine esterase, dopamine, and serotonin. Total brain contents of silver ion significantly increased in a dose-dependent manner. Further, light and electron microscopy revealed a progressive disruption in the lamellar pattern of the myelinated axons of the nerve fibers, in addition to the accumulation of nanosilver in lysosomes and swollen mitochondria in axoplasm. In conclusion, 26.9 nm citrate-coated AgNPs are capable of gaining access to the brain of mice and causing electric conductivity and relative permittivity damage along with a high degree of cellular toxicity in the brain tissue. Therefore, the present study highlights, for the first time, the adverse effects of the citrate-coated AgNPs to the brain of mice and raises the concern of their probable neurotoxic impacts which is helpful for conclusive interpretation of future behavioral and potential neurodegeneration-based aspects. It would be of interest to investigate citrate-coated AgNPs mediated axonal relevant-signal transduction levels in future studies.

Mapping the effect of drugs on ACE2 as a novel target site for COVID-19 therapy

Angiotensin converting enzyme 2 (ACE2) has potentially conflicting roles in health and disease. COVID-19 coronavirus binds to human cells via ACE2 receptor, which is expressed on almost all body organs. Boosting the ACE2 receptor levels on heart and lung cells may provide more cellular enter to virus thereby worsening the infection. Therefore, among the drug targets, ACE2 is suggested as a vital target of COVID-19 therapy. This hypothesis is based on the protective role of the drugs acting on ACE2. Therefore, this review discusses the impact and challenges of using ACE2 as a target in the current therapy of COVID-19.

Prevalence, antibiogram and virulence characterization of Vibrio isolates from fish and shellfish in Egypt: a possible zoonotic hazard to humans

AIMS

Infection of seafood with pathogenic species of the genus Vibrio causes human food-borne illnesses. This study was executed to examine the antimicrobial resistance phenotypes, biofilm-forming capability and virulence-associated genes of Vibrio from fish and shellfishes.

METHODS AND RESULTS

Three hundred fresh water and marine fish and shellfish samples were collected from wet markets and supermarkets in Mansoura, Egypt. Bacteriological examination and PCR amplification identified 92 Vibrio spp., including 42 Vibrio parahaemolyticus and 50 Vibrio alginolyticus isolates from the examined fish and shellfish (infection rate: 30·67%). However, V. vulnificus was not found in this study. Vibrio spp. exhibited variable frequencies of antimicrobial resistance with higher percentages to ampicillin and penicillin. Multidrug resistance (MDR) was detected in 69·04 and 38% of V. parahaemolyticus and V. alginolyticus respectively. PCR testing of virulence genes, tdh, trh and tlh revealed the presence of tlh and trh in 100 and 11·9% of V. parahaemolyticus isolates respectively and none of V. alginolyticus carried any of these genes. Biofilm-forming capability was displayed by 76% of V. parahaemolyticus and 73·8% of V. alginolyticus isolates. Both V. parahaemolyticus and V. alginolyticus showed nonsignificant weak positive correlations (r < 0·4) between antimicrobial pairs belonging to different classes; however, a significant positive correlation (P <0·05) between trh and resistance to erythromycin (r = 0·45) and imipenem (r = 0·38) was only identified in V. parahaemolyticus.

CONCLUSIONS

This study reports the existence of MDR strains of V. parahaemolyticus and V. alginolyticus from the common types of fishes and shellfishes in Egypt. Furthermore, the presence of virulence genes in these isolates and the ability to produce a biofilm in vitro pose potential health hazards to consumers.

SIGNIFICANCE AND IMPACT OF THE STUDY

Frequent monitoring of seafood for the presence of Vibrio spp. and their antimicrobial susceptibility, virulence determinants and biofilm-forming capability is important for assessing the risk posed by these organisms to the public and for improving food safety.

Spontaneous Ruptured Splenic Artery Aneurysm: A Case Report

Splenic artery aneurysms are rare and occur predominantly in women. Most of them are asymptomatic until the aneurysms rupture. We report a previously healthy 46-year-old female who attended emergency department with abdominal pain for four hours. She had left upper quadrant tenderness and pulsatile mass. Laboratory tests showed her haematocrit 29.8%. Subsequent examinations with ultrasound and computed tomography (CT) showed a large aneurysm of the splenic artery and a heterogeneous hypodense shadows around the aneurysmal sac and perihepatic area. Just after CT scan she collapsed and was taken into emergency surgery. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the fifth day, she was discharged from the hospital with complete recovery. This case report highlights that rapid resuscitation, diagnostic imaging, surgical consultation, and subsequent laparotomy remain the priorities in patient management.

Reversible cerebral vasoconstriction syndrome

Reversible cerebral vasoconstriction syndrome (RCVS) is an underdiagnosed condition which usually presents as severe headache with or without neurological deficit. We report the case of a 55-year-old woman who presented with headache and multifocal intracerebral haemorrhage. We review the literature regarding the presentation, pathophysiology and management of RCVS and discuss how to differentiate it from cerebral vasculitis.

Amelioration of chronic relapsing experimental autoimmune encephalomyelitis (cr-eae) using thymoquinone - biomed 2009

Axonal damage, demylination and inflammation of the central nervous system are the major pathological features of the human multiple sclerosis (MS). MS is thought to be due to abnormal T cell mediated immune response. Oxidative stress plays an important role in the advancement of MS. The management of oxidative stress by outlining central role of reduced glutathione. In our experiment we used Experimental autoimmune encephalomyelitis (EAE) animal model that mimic human MS and tested the effect of Thymoquinone (TQ), an oil constituent of Nigella Sativa also known as black seed. Thirty female mice of strain C57BL/6J and aged between 6 to 12 weeks were placed into 3 groups of 10 and were given Myelin Oligodendrocyte Glycoprotein (MOG) subcutaneously (SC) to induce EAE. Group A was the control group. Group B received MOG (SC) and TQ intraperiotoneally (IP) from day 1 till day 50. Group C received MOG (SC) and TQ (IP) on the appearance of first sign and symptoms of chronic relapsing EAE (CR-EAE). All Mice were examined daily for behavioral deficits and all euthanized and sacrificed on day 50. Preliminary result showed that TQ due to its antioxidant effect is almost 90% preventive and 50% curative in CR-EAE. This result could assist further studies on the mechanism of action of TQ in CR-EAE and explore the possibility of treating the human chronic relapsing multiple sclerosis phase.

Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia

BACKGROUND

Brain abscesses and ischaemic strokes complicate pulmonary arteriovenous malformations (PAVMs). At risk individuals are poorly recognised. Stroke/abscess risk factors have not been defined.

METHODS

A cohort study of 323 consecutive individuals with PAVMs (n = 219) and/or the commonly associated condition hereditary haemorrhagic telangiectasia (HHT, n = 305) was performed. Most of the 201 individuals with PAVMs and HHT had no respiratory symptoms, and were unaware they had HHT. Anderson-Gill models assessed constant and time dependent potential predictive variables for stroke/abscess, and rate reduction by PAVM embolisation.

RESULTS

57 individuals with PAVMs and HHT experienced brain abscess or ischaemic stroke, usually prior to the diagnosis of underlying PAVMs/HHT. The primary determinants of stroke and abscess risks were unrelated to severity of PAVMs. Males had higher brain abscess rates (hazard ratio 3.61 (95% CI 1.58, 8.25), p = 0.0024); interventional histories and bacteriological isolates suggested dental sources. Once adjusted for gender, there was a marginal association between brain abscess and low oxygen saturation. For ischaemic stroke, there was no association with any marker of PAVM severity, or with conventional neurovascular risk factors. Surprisingly, low mean pulmonary artery pressure was strongly associated with ischaemic stroke (hazard ratio 0.89 (95% CI 0.83, 0.95) per mm Hg increase; p = 6.2x10(-5)). PAVM embolisation significantly reduced ischaemic stroke rate (p = 0.028); no strokes/abscesses occurred following obliteration of all angiographically visible PAVMs. The mean PAVM diagnosis-treatment interval was longer, however, when neurological risks were unrecognised.

CONCLUSIONS

Ischaemic strokes and brain abscesses occur commonly in undiagnosed HHT patients with PAVMs. Risk reduction could be improved.

Rhinosinusitis in children: the role of surgery

Indications and nature of surgery for chronic rhinosinusitis (CRS) have yet to be elucidated in children. After review of the literature and based on their experience, the authors suggest guidelines for the treatment of CRS in children. They suggest grouping children with rhinosinusitis into two groups: those with complicated acute rhinosinusitis and those with CRS. For the first group, the authors suggest an early surgical intervention because of the potential serious consequences and sometimes irreversible damage. For the second group, most agree that maximal medical management should be the first line of treatment with antibiotics, nasal lavage and as a last resort surgery. It is important to realize that surgery should be considered in these cases if medical treatment fails. Once surgery is recommended, the kind of surgery then becomes an issue between adenoidectomy, endoscopic sinus surgery or a combination of the two depending on the age and other conditions.

Analysis of aerobic bacterial strains found in chronic rhinosinusitis using the polymerase chain reaction

INTRODUCTION

Rhinosinusitis is a common disease affecting an estimated 14% of the population. Although there is general agreement in the literature regarding acute rhinosinusitis, chronic rhinosinusitis is not as well studied, and no consensus has been reached regarding the bacterial etiology. The goal of this study was to test chronic rhinosinusitis mucosal specimens using the polymerase chain reaction (PCR) for aerobic bacterial content and to compare the results with standard culture data.

RESULTS

Routine culture samples grew 50% aerobic bacteria, whereas PCR detected 62% aerobic bacteria contamination.

CONCLUSION

PCR detected more bacteria in mucosal samples than in standard culture, but standard culture of this mucosa reflects the general aerobic bacteria found in chronic rhinosinusitis, with no predominant species of aerobic bacteria.

SIGNIFICANCE

The analysis of chronic rhinosinusitis mucosa with the PCR method should give a more accurate picture of the bacteria found in chronic rhinosinusitis so that proper therapy can be instituted.

Redone endoscopic perforator surgery: feasibility and failure analysis

PURPOSE

In many hospitals and medical practices, subfascial endoscopic perforator surgery (SEPS) has become the treatment of choice in patients with incompetent perforator veins and active venous ulcers. A substantial number of surgeons consider SEPS to be an operation that can be performed only once because extensive scarring and narrowing of the subfascial space make a second endoscopic operation impossible. It is the purpose of this report to prove the feasibility, efficacy, and safety of a second SEPS procedure.

METHODS

Within a period of 30 months, 105 primary SEPS procedures were performed in patients with healed or still active ulcers. In addition to these cases, within a period of 30 months, a consecutive number of 19 patients were examined and scheduled for a second SEPS procedure. All patients were in class 5 with healed ulcers or in class 6 with still active ulcers. The CEAP classification of the American Venous Forum was used to evaluate the results and to calculate the clinical, disability, and outcome scores. The redone operation was performed by using CO(2) insufflation, a dual-port technique, and subfascial balloon dissection.

RESULTS

In two patients conversion to a conventional procedure was necessary. There were no major complications, but there was a 21% incidence of minor problems, such as hematoma or cellulitis. The mean total clinical score improved after surgery from 7.91 to 3.23 (P <.01), the disability score changed from 1.10 to 0.57 after surgery (P <.02), and the clinical outcome score was 1. 47 after surgery (P <.001). Cumulative ulcer healing could be achieved in 85.8% of class 6 patients. Failure analysis revealed that an incomplete subfascial dissection had been performed during the first endoscopic operation. A septum intermusculare medialis or an intact deep posterior fascia with incompetent Cockett II perforators were major factors contributing to the initial treatment failures. In addition to incompetent perforators, postthrombotic deep venous reflux was seen in eight (42.1%) patients, and four (21%) patients had a combination of secondary reflux and obstruction.

CONCLUSION

Subfascial endoscopic procedures can be redone safely. In addition to exploring the superficial posterior compartment, the deep posterior compartment must be opened to prevent recurrent symptoms in patients with incompetent perforator veins.

The costs and benefits of getting the ISO 9000 certification in the manufacturing sector in Saudi Arabia

Many Saudi companies, in their journey to improve quality, efficiency and competitiveness, are pursuing and obtaining the ISO 9000 certificate. Many studies have evaluated how to implement ISO 9000 in different sectors, but none have analyzed the effectiveness of ISO 9000 certification (costs and benefits) on improving the overall quality and on meeting expectations. This study addressed these issues by investigating manufacturing organizations in Saudi Arabia that have the ISO 9000 certification. A survey questionnaire was distributed to firms throughout the kingdom. Thirty-two firms participated in the study. Results indicate that increased consistency of operations, improved service, and product quality are among the top motivators for pursuing the ISO certificate. The benefits most often experienced were improved awareness of procedural problems, better management control, keeping existing customers, increased customer satisfaction, and improved customer service. Difficulties experienced during the certification process involved time and cost, but these were not considered to be major problems. A high volume of paperwork was the main problem experienced following initial certification. Respondents in general said that the ISO 9000 certification met their expectations and that their level of satisfaction regarding the impact of ISO 9000 was high. Most recommended that other organizations pursue the certificate.

Congenital nasal pyriform aperture (bony inlet) stenosis

Congenital nasal pyriform aperture stenosis should be considered in the differential diagnosis of infants with nasal airway obstruction. It can occur as an isolated anomaly or it can be associated with other congenital anomalies. A history of cyclical respiratory distress and cyanosis often associated with feeding and relieved by crying is characteristic. On examination, the nasal airway is narrowed anteriorly. CT is the study of choice to make the diagnosis and rule out other causes of nasal obstruction. Conservative management is recommended, sometimes with the use of a McGovern nipple for feeding. Severe cases or those in which conservative management fails should be considered for surgery.

Catecholamines in Drosophila melanogaster (wild type and ebony mutant) decuticalarized retinas and brains

The concentrations of catecholamines were determined in the decuticalarized retinas and brains at different ages in wildtype and ebony Drosophila melanogaster using the HPLC-technique with an electrochemical detector. L-Dopa, dopamine (DA), alpha-methyldopa (alpha-MD) and unidentified compounds X1, X2 and X3 were found in decuticalarized retinas and brains of wildtype and ebony at different ages. Retinas and brains of the mutant ebony have higher concentrations of L-Dopa, DA and alpha-MD than the wildtype. In both wildtype and ebony, the concentrations of X1, X2 and X3 were found to be higher in decuticalarized retinas than in brains. The identity and importance of X1, X2 and X3 are still unknown.

Double traumatic rupture of the thoracic aorta

A 23-year-old woman was involved in an automobile accident and sustained a double traumatic rupture of the aorta, at the isthmus distal to the left subclavian artery and at the base of the innominate artery. A successful repair was accomplished within 4 hours of the injury using profound hypothermia and total circulatory arrest. To our knowledge, this case represents the first successful surgical repair of a double traumatic rupture of the aorta. Followup at 2 years showed an excellent postoperative recovery and the patient gainfully employed.

Rectal carcinoma with solitary cerebral metastasis: report of a case and review of the literature

A 54-year-old man underwent abdominoperineal resection for carcinoma of the rectum. Three months later, neurologic signs and symptoms developed. A brain scan, as well as angiographic studies, demonstrated a space-occupying lesion in the right parietal area. A solitary tumor was removed at craniotomy. Histologic examination revealed a metastatic adenocarcinoma with a rectal primary tumor. For two years the patient remained well, but then signs of local perineal recurrence developed. Treatment with cobalt irradiation and chemotherapy was unsuccessful. Autopsy revealed local recurrence with numerous distant metastases; however, examination of the brain failed to show a recurrent metastatic focus.