Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Factors associated with asthma control in 121 preschool children

BACKGROUND AND OBJECTIVE

There are controversial data about risk factors for uncontrolled asthma in preschool children. Objective: This study aims to explore the association between clinical and functional parameters and the lack of asthma control in preschool children.

METHODS

Children 3-5 years-old with asthma and healthy controls were recruited. A questionnaire was used to identify the potential risk factors of uncontrolled asthma as defined by GINA (Global INitiative for Asthma) criteria. Lung function and bronchial reversibility were evaluated through impulse oscillometry (IOS) and spirometry. Adjusted odds ratios (OR) were estimated based on multivariable generalized additive regression models. The discriminative ability of the models was measured by the area under the receiver operating characteristic curve (AUC).

RESULTS

121 children were included, 107 of which had asthma and 14 were healthy controls. Fifty-three patients (50%) had uncontrolled asthma. After adjustment, the variables associated with an increased risk of lack of control were: "More than 3 flare-ups in last 12 months", "moderate to severe rhinitis", "relative variation in post-bronchodilator FVC and FEV1". The AUC of the final models that included variation of FVC or FEV1 were 0.82 and 0.81, respectively. R5-20, R5-20% and AX z-score values of the healthy group were lower than those of children with asthma.

CONCLUSION

In preschool children, clinical and functional parameters are associated with uncontrolled asthma. More studies are needed to confirm usefulness of the IOS.

Signaling pathways involved in the effect of follicle-stimulating hormone on chick embryo testis cell proliferation

The aim of the present study was to evaluate the signaling pathways involved in the follicle-stimulating hormone (FSH) regulated mitogenic activity. For this purpose, 18-d-old chick embryo testis cells were dissociated and cultured for 60 h on polycarbonate membranes. The culture medium was Dulbecco modified Eagle's medium with or without high pure human FSH (hFSH), human recombinant FSH, or different regulators of tyrosine kinase activity as herbimycin A and genistein, or serine/threonine kinases [cyclic adenosine monophosphate (cAMP)-dependent protein serine kinase and protein kinase C] as cAMP, phorbol myristate, and forskolin. In some experiments the regulators were added simultaneously with hFSH. The [3H]-thymidine incorporation was used as an indicator of DNA synthesis. In addition, fragments of chick embryo testis were cultured in the presence or absence of FSH or herbimycin A, and 5-bromo-2'-deoxy-uridine was added to identify the proliferating cell subpopulations. The effect of hFSH on [3H]-thymidine incorporation began at 24 h, and the increment was significant at 36 and 60 h of culture. The hFSH as well as human recombinant FSH significantly stimulated [3H]-thymidine incorporation to testicular cells. The 5-bromo-2'-deoxy-uridine technique showed a high signal in pericordonal and interstitial cells of the hFSH-treated groups, confirming the results obtained using [3H]-thymidine uptake. The treatment with the tyrosine kinase inhibitor herbimycin A increased the [3H]-thymidine uptake, but genistein did not. Regulators of PKA such as cAMP and forskolin, as well as PKC regulators and the phorbol ester phorbol myristate, did not influence cell proliferation. In summary, an inhibitor of tyrosine kinase, herbimycin A, induced per se an increment in chick embryo testis cell proliferation, a fact that strongly suggests that tyrosine kinase signaling pathway functions by inhibiting the proliferation of these cells. On the other hand, the cAMP-PKA pathway had no significant role during the embryonic stage of chick embryo testis. Our results also showed that the effect of FSH on chick embryo cell proliferation occurs mainly in pericordonal and interstitial testis cells.

Lung function and clinical risk factors for asthma in infants and young children with recurrent wheeze

BACKGROUND

Although several risk factors for asthma have been identified in infants and young children with recurrent wheeze, the relevance of assessing lung function in this group remains unclear. Whether lung function is reduced during the first 2 years in recurrently wheezy children, with and without clinical risk factors for developing subsequent asthma (ie, parental asthma, personal history of allergic rhinitis, wheezing without colds and/or eosinophil level >4%) compared with healthy controls was assessed in this study.

METHODS

Forced expiratory flows and volumes in steroid naïve young children with >or=3 episodes of physician confirmed wheeze and healthy controls, aged 8-20 months, were measured using the tidal and raised volume rapid thoracoabdominal compression manoeuvres.

RESULTS

Technically acceptable results were obtained in 50 wheezy children and 30 controls using tidal rapid thoracoabdominal compression, and 44 wheezy children and 29 controls with the raised volume technique. After adjustment for sex, age, body length at test and maternal smoking, significant reductions in z scores for forced expiratory volume at 0.5 s (mean difference (95% CI) -1.0 (-1.5 to -0.5)), forced expired flow after 75% forced vital capacity (FVC) has been exhaled (FEF(25)) (-0.6 (-1.0 to -0.2)) and average forced expired flow over the mid 50% of FVC (FEF(25-75)) (-0.8 (-1.2 to -0.4)) were observed in those with recurrent wheeze compared with controls. Wheezy children with risk factors for asthma (n = 15) had significantly lower z scores for FVC (-0.7 (-1.4 to -0.04)) and FEF(25-75) (-0.6 (-1.2 to -0.1)) than those without such risk factors (n = 29).

CONCLUSIONS

Compared with healthy controls, airway function is reduced in young children with recurrent wheeze, particularly those at risk for subsequent asthma. These findings provide further evidence for associations between clinical risk factors and impaired respiratory function in early life.

Insulin Stimulates Proliferation but Not 17β-Estradiol Production in Cultured Chick Embryo Ovarian Cells

The development of the chick embryo gonads is influenced by gonadotropins [follicle-stimulating hormone (FSH), luteinizing hormone, human chorionic gonadotropin (hCG)]. We have previously shown that insulin enhanced the production of androgens in the testis of the newly hatched chicken and increased the proliferation of chick embryo testis cells. In the present paper, we have studied the effect of insulin on embryonic chick embryo ovarian cells and compared them with those of human FSH and hCG. The ovaries of 18-d-old chick embryos were dissociated and cultured for different periods in Dulbecco's modified Eagle's medium in the presence and absence of insulin, human FSH, hCG, and combinations of them. 3H-thymidine incorporation was used as an indicator of cell proliferation; steroids were measured by radioimmunoassay. Results showed that insulin enhanced the proliferation of ovarian cells in a dose- and time-dependent manner. Gonadotropins did not affect significantly the ovarian cell proliferation. Insulin did not change 17beta-estradiol production. The combination of insulin and FSH or insulin and hCG decreased the stimulation of estrogen secretion caused by the addition of the gonadotropins. In some experiments, ovarian cells were cultured with or without insulin, and subpopulations were identified. The results showed that insulin but not human FSH or hCG increased the proliferation of germinal cells after 60 h in culture. Insulin and human FSH did stimulate the other 2 subpopulations. In summary, present results suggest that insulin is an important hormone in the development of the chick embryo ovary.

Proliferative and Steroidogenic Effects of Follicle-Stimulating Hormone on Cultured Chick Embryo Testis Cells

The present study evaluated the follicle-stimulating hormone (FSH) effect on cell proliferation and steroid production by chick embryo testis. Dissociated cells from 18-d-old embryos were cultured on polycarbonate membranes in defined media. In some experiments, cells were further separated by a metrizamide gradient, and 5 cellular subpopulations were recovered and cultured. [3H]thymidine was added to the culture media. When necessary, 17beta-estradiol, human FSH (hFSH), recombinant human FSH (rhFSH), or human chorionic gonadotropin (hCG) was added to the medium at the beginning of the culture. The total number of cells and the incorporation of [3H]thymidine increased when hFSH or rhFSH was added. No changes were produced by the addition of hCG or 17beta-estradiol. The dose-response curve to hFSH resulted in an ED50 of 0.25 IU/mL. The stimulatory effect of hFSH on total number of cells and on [3H]thymidine incorporation was significant at 36 h of culture and was maintained up to 60 h. Testosterone production increased with the addition of FSH or rhFSH, meanwhile estradiol production was below the limit of detection of RIA. The hFSH proliferative effect measured as [3H]thymidine incorporation was observed only in the F3, F4, and F5 fractions of the density gradient. Present results show that hFSH and rhFSH, but not hCG or estradiol, stimulate testis cell proliferation in a time- and dose-dependent manner. The combination of [3H]thymidine incorporation and testosterone production in fractions obtained from the metrizamide density gradients suggests that the cell fractions of the chick embryo testis show a differential response to FSH.

Proliferative and steroidogenic effects of follicle-stimulating hormone during chick embryo gonadal development

The aim of this study was to evaluate the in vitro effect of human follicle-stimulating hormone (hFSH) on cellular proliferation and steroid hormone secretion in the left ovary, the right ovary, and the testis of the chick embryo. Gonads from 8- to 18-day-old chick embryo were cultured in a defined medium during 60 h under basal and hFSH-stimulated conditions (0.5 IU/ml of culture medium). At the end of the culture, the incorporation of ¿(3)Hthymidine and the total number of cells were measured to estimate gonadal cell proliferation. The secretion of 17beta-estradiol and testosterone in the culture medium was radioimmunologically assayed in order to evaluate the steroidogenic function of the cultured gonadal cells. The response to hFSH stimulation was observed in the left ovary, the right ovary, and the testis from the 8-day-old chick embryo. In the left ovary, cellular proliferation was not augmented by hFSH in the 8-, 10-, and 13-day-old chick embryo; meanwhile, the proliferative stimulus of hFSH was observed in the 15- and 18-day-old embryos. In the same ovary, 17beta-estradiol and testosterone secretion were stimulated after hFSH treatment at all evaluated stages (8-18 days of chick embryo development). In the right ovary, an increment in proliferation and steroidogenesis was induced by hFSH in the 8-, 10-, and 13-day-old chick embryo. Afterward, the right gonad did not respond to hFSH. Testis cells displayed hFSH response as an increment in cell proliferation at all embryonic ages (8-18 days of chick embryo development). There was a transient lack of response to hFSH in testosterone secretion at 10 and 13 days of development. The in vitro effect of hFSH on cell proliferation and steroid hormone secretion changed in the ovary and the testis according to the age of the embryo. These changes could be attributed to the growth of the left ovary and the testis and the regression of the right ovary. Probably, paracrine factors modulated the gonadotropin effect on the target cells during embryonic development of chick embryo gonads.

Minerals content of Paraguayan yerba mate (Ilex paraguariensis, S.H.)

Minerals content (Fe, Ca, Mn, Mg, Na, K, Zn and Cu) of the leaves of Paraguayan yerba mate (Ilex paraguariensis, S.H.) as well as of commercial products has been determined by atomic absorption spectrophotometry. Considerable amounts of iron and calcium and remarkably high content of magnesium and potassium have been found both in the leaves and in the commercial products. Highly significant difference between the Fe content of the leaves and that of the commercial products has been found. Also, highly significant difference has been found between the Fe and Ca content of the higher quality-greater sale reputed commercial products and that of the lower quality-smaller sale reputed ones. Seasonal and soil linked variations are also presented. The nutritional and quality control significance of these findings for the MERCOSUR (Southern South America Economical Community) are discussed.

Proliferative effect in vitro of follicle-stimulating hormone on the left ovary of the chick embryo

The purpose of the present study was to evaluate the effect of human follicle-stimulating hormone (hFSH) on cellular proliferation in the chick embryo ovary. Left ovaries from 18-day-old chick embryos (Babcock B300) were dissociated by trypsin (0.25%) treatment. In some experiments, dissociated ovarian cells were further separated by a continuous metrizamide gradient (0-20%). Four cellular subpopulations were recovered from the density gradient: (a) typical steroidogenic cells (F1, density 1.026 g/ml), (b) primary oocytes (F2, 1.048 g/ml), (c) pregranulosa cells, and (d) poorly differentiated epithelial cells (both cellular types were found in F3, 1.059 g/ml, and F4, 1.071 g/ml). Samples (5 x 10(5) cells) of dissociated cells of the whole ovary and of the four cellular subpopulations obtained from the density gradient were cultured on polycarbonate membranes in a defined medium with 0.1 microCi of [3H]thymidine for 60 hr. When necessary, 17beta-estradiol, hFSH, recombinant human FSH, and hCG were added to the medium at the begining of the culture. The total number of cells and the incorporation of [3H]thymidine to the ovarian cell aggregate at the end of the culture increased when hFSH and recombinant hFSH (0.5 IU/ml) were added. No changes were produced with hCG (2.0 IU/ml) and 17beta-estradiol (200 ng/ml) treatments. The secretion of 17beta-estradiol by cultured ovarian cells was stimulated in the hFSH-, recombinant hFSH-, and hCG-treated groups. The dose-response curve to hFSH resulted in an ED50 of 0.03 IU/ml. In the temporal curve, the stimulatory effect of hFSH on the total number of cells and the [3H]thymidine incorporation were observed at 36 hr of culture and maintained up to 60 hr. The proliferative effect of hFSH measured as [3H]thymidine incorporation was observed only in the F4 fraction of the density gradient, which includes poorly differentiated epithelial cells and pregranulosa cells from the ovarian medulla and cortex, respectively. Present results demonstrate a dose-dependent stimulation of DNA synthesis by hFSH in the inmature ovary of the 18-day-old chick embryo. Either pregranulosa cells or poorly differentiated epithelial cells or both subpopulations would be the target cells for the proliferative effect of the gonadotropin.