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Glover NA, Ivanova O, Sathar F, Riess F, Shambhu RR, Mekota AM, Zurba L, Menezes C, Alexandra van Blydenstein S, Kalla I, Hoelscher M, Saathoff E, Charalambous S, Rachow A. Lung outcomes and related risk factors in patients after SARS-CoV-2 infection: a hospitalised single-centre cohort from Johannesburg, South Africa. EClinicalMedicine 2024; 71:102588. [PMID: 38623400 PMCID: PMC11016864 DOI: 10.1016/j.eclinm.2024.102588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Background Sequelae post-SARS-CoV-2 infection, including lung and functional impairment, pose a significant challenge post-recovery. We explored the burden and risk factors for post-COVID-19 sequelae in an African population with prevalent comorbidities including tuberculosis (TB) and HIV. Methods We conducted an observational cohort study on hospitalised adults with confirmed SARS-CoV-2 infection from 20 March to 06 October 2021 at Chris Hani Baragwanath Academic Hospital, South Africa. We collected data on comorbidities, and COVID-19 severity using the World Health Organization (WHO) clinical progression scale. Prospectively, we followed up all participants within 40-days post-discharge to assess body mass index (BMI), COVID-19 symptoms and quality of life using St George's Respiratory Questionnaire (SGRQ), 6-min walking-test (6MWT), and spirometry. A subsequent in-depth visit assessed plethysmography, diffusing capacity for the lung for carbon monoxide (DLCO), and high-resolution chest-CT. Findings We followed up 111 participants, where 65.8% were female, median age 50.5 years, and predominantly black-African (92.8%). Relevant comorbidities included TB disease (18.9%) and HIV infection (36%). SGRQ total scores were elevated in 78.9%, median 6MWT distance was reduced at 300 m (IQR 210-400), and nearly half (49.5%) exhibited spirometry findings below the lower limit of normal (LLN). In-depth pulmonary assessment for 61 participants revealed abnormalities in total lung capacity (31.6% <80% predicted), DLCO (53.4% <80% predicted), and chest-CT (86.7% abnormal). Significant risk factors for individual abnormal outcomes, adjusted for age and sex, were TB disease, HIV with CD4 <200 cells/mm3, BMI <18.5 kg/m2 and >35 kg/m2, and initial COVID-19 severity. Interpretation This study demonstrates substantial lung and functional morbidity within the first weeks post-COVID-19, particularly in individuals with pre-existing comorbidities including TB, HIV, and low or high BMI. Chest-CT and DLCO show best early potential at reflecting COVID-19-related pathologies. Funding The Bavarian State Ministry of Science and Arts.
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Affiliation(s)
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | | | - Friedrich Riess
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | - Rekha Rao Shambhu
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | - Anna-Maria Mekota
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | | | - Colin Menezes
- University of the Witwatersrand, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Sarah Alexandra van Blydenstein
- University of the Witwatersrand, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Ismail Kalla
- University of the Witwatersrand, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Unit Global Health, Helmholtz Zentrum München, German Research Centre for Environmental Health (HMGU), Neuherberg, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Unit Global Health, Helmholtz Zentrum München, German Research Centre for Environmental Health (HMGU), Neuherberg, Germany
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Abstract
SARS-CoV-2 infection has a wide range of both acute and long-term symptoms. Memory alterations have been frequently reported in studies that explore cognition. The main objective of the systematic review is to update and further analyze the existing evidence of objective memory impairments in long-COVID-19 considering sample and study design characteristics, as well as to explore associations between memory performance and their epidemiological, clinical, and pathological features. A total of 13 studies were identified by searching in PubMed, Web of Science, and PsycInfo databases up to May 6, 2022. Most studies evaluated verbal component of memory in the short-term and long-term recall up to 30 min and mainly performed a single assessment completed at 4-6 months after the infection. The samples mainly consisted of middle-aged adults that required hospitalization. Samples were not stratified by sex, age, and severity. Poor verbal learning was reported in most cases (6-58%), followed by deficits in long-term (4-58%) and short-term (4-37%) verbal memory. Visuospatial component of memory was studied less than verbal component, showing impairment of long-term retention of visual items (10-49%). COVID-19 severity in the acute stage was not systematically associated with poor memory performance. Verbal memory deficits were associated with anxiety and depression. The existing literature on objective memory assessment in long-COVID suggests further research is warranted to confirm memory dysfunction in association with epidemiological, pathological, and clinical factors, using both verbal and visuospatial tests, and exploring in deep long-term memory deficits.
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Affiliation(s)
- Tania Llana
- Department of Psychology, Faculty of Psychology, University of Oviedo, Oviedo, Spain
| | - Candela Zorzo
- Department of Psychology, Faculty of Psychology, University of Oviedo, Oviedo, Spain
- Faculty of Psychology, Neuroscience Institute of Principado de Asturias (INEUROPA), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario, Oviedo, Spain
| | - Magdalena Mendez-Lopez
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
- IIS Aragón, Zaragoza, Spain
| | - Marta Mendez
- Department of Psychology, Faculty of Psychology, University of Oviedo, Oviedo, Spain
- Faculty of Psychology, Neuroscience Institute of Principado de Asturias (INEUROPA), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario, Oviedo, Spain
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Bouwmans P, Malahe SRK, Messchendorp AL, Vart P, Imhof C, Sanders JSF, Gansevoort RT, de Vries APJ, Abrahams AC, Bemelman FJ, Vervoort JPM, Hilbrands LB, Ten Dam MAGJ, van den Dorpel RMA, Rispens T, Steenhuis M, Reinders MEJ, Hemmelder MH. Post COVID-19 condition imposes significant burden in patients with advanced chronic kidney disease: A nested case-control study. Int J Infect Dis 2024; 142:106990. [PMID: 38428480 DOI: 10.1016/j.ijid.2024.106990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The burden of post COVID-19 condition (PCC) is not well studied in patients with advanced kidney disease. METHODS A large prospective cohort of SARS-CoV-2 vaccinated patients with chronic kidney disease stages G4-G5 (CKD G4/5), on dialysis, and kidney transplant recipients (KTR) were included. Antibody levels were determined after vaccination. Presence of long-lasting symptoms was assessed in patients with and without prior COVID-19 and compared using logistic regression. In patients with prior COVID-19, PCC was defined according to the WHO definition. RESULTS Two hundred sixteen CKD G4/5 patients, 375 dialysis patients, and 2005 KTR were included. Long-lasting symptoms were reported in 204/853 (24%) patients with prior COVID-19 and in 297/1743 (17%) patients without prior COVID-19 (aOR: 1.45 (1.17-1.78)], P < 0.001). PCC was prevalent in 29% of CKD G4/5 patients, 21% of dialysis patients, and 24% of KTR. In addition, 69% of patients with PCC reported (very) high symptom burden. Odds of PCC was lower per 10-fold increase in antibody level after vaccination (aOR 0.82 [0.70-0.96], P = 0.01) and higher in case of COVID-19 related hospital admission (aOR 4.64 [2.61-8.25], P = 0.003). CONCLUSIONS CKD G4/5 patients, dialysis patients, and KTR are at risk for PCC with high symptom burden after SARS-CoV-2 vaccination, especially if antibody levels are low and in case of hospitalization due to COVID-19.
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Affiliation(s)
- Pim Bouwmans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands
| | - S Reshwan K Malahe
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A Lianne Messchendorp
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Priya Vart
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Céline Imhof
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Stephan F Sanders
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; Leiden Transplant Center, Leiden, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frederike J Bemelman
- Amsterdam UMC Location University of Amsterdam, Renal Transplant Unit, Amsterdam, The Netherlands; Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
| | - Johanna P M Vervoort
- Dutch Kidney Patients Association (NVN), Bussum, The Netherlands; Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc A G J Ten Dam
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Theo Rispens
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands; Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands
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Garmoe W, Rao K, Gorter B, Kantor R. Neurocognitive Impairment in Post-COVID-19 Condition in Adults: Narrative Review of the Current Literature. Arch Clin Neuropsychol 2024; 39:276-289. [PMID: 38520374 DOI: 10.1093/arclin/acae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 virus has, up to the time of this article, resulted in >770 million cases of COVID-19 illness worldwide, and approximately 7 million deaths, including >1.1 million in the United States. Although defined as a respiratory virus, early in the pandemic, it became apparent that considerable numbers of people recovering from COVID-19 illness experienced persistence or new onset of multi-system health problems, including neurologic and cognitive and behavioral health concerns. Persistent multi-system health problems are defined as Post-COVID-19 Condition (PCC), Post-Acute Sequelae of COVID-19, or Long COVID. A significant number of those with PCC report cognitive problems. This paper reviews the current state of scientific knowledge on persisting cognitive symptoms in adults following COVID-19 illness. A brief history is provided of the emergence of concerns about persisting cognitive problems following COVID-19 illness and the definition of PCC. Methodologic factors that complicate clear understanding of PCC are reviewed. The review then examines research on patterns of cognitive impairment that have been found, factors that may contribute to increased risk, behavioral health variables, and interventions being used to ameliorate persisting symptoms. Finally, recommendations are made about ways neuropsychologists can improve the quality of existing research.
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Affiliation(s)
- William Garmoe
- Director of Psychology, MedStar National Rehabilitation Network, Washington, DC, USA
| | - Kavitha Rao
- Clinical Neuropsychologist, MedStar Good Samaritan Hospital, Baltimore, MD, USA
| | - Bethany Gorter
- Neuropsychology Post-Doctoral Fellow, MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Rachel Kantor
- Neuropsychology Post-Doctoral Fellow, MedStar National Rehabilitation Hospital, Washington, DC, USA
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Hersh Z, Weisband YL, Bogan A, Leibovich A, Obolski U, Nevo D, Gilad-Bachrach R. Impact of Long-COVID in children: a large cohort study. Child Adolesc Psychiatry Ment Health 2024; 18:48. [PMID: 38622709 PMCID: PMC11020876 DOI: 10.1186/s13034-024-00736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/20/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The impact of long-term Coronavirus disease 2019 (COVID-19) on the pediatric population is still not well understood. This study was designed to estimate the magnitude of COVID-19 long-term morbidity 3-6 months after the date of diagnosis. METHODS A retrospective study of all Clalit Health Services members in Israel aged 1-16 years who tested positive for SARS-CoV-2 between April 1, 2020 and March 31, 2021. Controls, who had no previous diagnosis of COVID-19, were one-to-one matched to 65,548 COVID-19-positive children and teens, and were assigned the infection dates of their matches as their index date. Matching included age, sex, socio-economic score, and societal sector. Individuals were excluded from the study if they had severe medical conditions before the diagnosis such as cancer, diabetes, chronic respiratory diseases, and/or abnormal physiological development. Generalized Estimating Equations were used to estimate the associations between COVID-19 and the use of medical services. The analysis focused on the 3-6 months after the infection date. Adjustments were made for demographics and for the use of medical services 6-12 and 3-6 months before the infection date. The latter was necessary because of observed disparities in medical service utilization between the groups before the COVID-19 diagnosis, despite the matching process. RESULTS Statistically significant differences were only found for referrals for mental health services [adjusted relative-risk (RR) 1·51, 95%CI 1·15 - 1·96; adjusted risk-difference (RD) 0·001, 95%CI 0·0006 - 0·002], and medication prescriptions of any kind (RR 1·03, 95%CI 1·01-1·06; RD 0·01 95%CI 0·004 - 0·02). CONCLUSIONS The significant increase in medication prescriptions and mental health service referrals support the hypothesis that COVID-19 is associated with long-lasting morbidities in children and adolescents aged 1-16 years. However, the risk difference in both instances was small, suggesting a minor impact on medical services.
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Affiliation(s)
- Ziv Hersh
- Clalit Health Services, Tel-Aviv, Israel
| | - Yiska Loewenberg Weisband
- Clalit Health Services, Tel-Aviv, Israel
- Clalit Research Center, Innovation Division, Clalit Health Services, Tel Aviv, Israel
| | - Ariel Bogan
- Department of Biomedical Engineering, Tel Aviv University, Tel-Aviv, Israel
- Leadspace, Hod Hasharon, Israel
| | - Adir Leibovich
- Department of Biomedical Engineering, Tel Aviv University, Tel-Aviv, Israel
- Strauss Water Ltd, Or Yehuda, Israel
| | - Uri Obolski
- Department of Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Porter School of Environmental and Earth Sciences, Faculty of Exact Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Daniel Nevo
- Department of Statistics and Operations Research, Tel Aviv University, Tel-Aviv, Israel
| | - Ran Gilad-Bachrach
- Department of Biomedical Engineering, Tel Aviv University, Tel-Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel.
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Angulo-Aguado M, Carrillo-Martinez JC, Contreras-Bravo NC, Morel A, Parra-Abaunza K, Usaquén W, Fonseca-Mendoza DJ, Ortega-Recalde O. Next-generation sequencing of host genetics risk factors associated with COVID-19 severity and long-COVID in Colombian population. Sci Rep 2024; 14:8497. [PMID: 38605121 PMCID: PMC11009356 DOI: 10.1038/s41598-024-57982-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/24/2024] [Indexed: 04/13/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) was considered a major public health burden worldwide. Multiple studies have shown that susceptibility to severe infections and the development of long-term symptoms is significantly influenced by viral and host factors. These findings have highlighted the potential of host genetic markers to identify high-risk individuals and develop target interventions to reduce morbimortality. Despite its importance, genetic host factors remain largely understudied in Latin-American populations. Using a case-control design and a custom next-generation sequencing (NGS) panel encompassing 81 genetic variants and 74 genes previously associated with COVID-19 severity and long-COVID, we analyzed 56 individuals with asymptomatic or mild COVID-19 and 56 severe and critical cases. In agreement with previous studies, our results support the association between several clinical variables, including male sex, obesity and common symptoms like cough and dyspnea, and severe COVID-19. Remarkably, thirteen genetic variants showed an association with COVID-19 severity. Among these variants, rs11385942 (p < 0.01; OR = 10.88; 95% CI = 1.36-86.51) located in the LZTFL1 gene, and rs35775079 (p = 0.02; OR = 8.53; 95% CI = 1.05-69.45) located in CCR3 showed the strongest associations. Various respiratory and systemic symptoms, along with the rs8178521 variant (p < 0.01; OR = 2.51; 95% CI = 1.27-4.94) in the IL10RB gene, were significantly associated with the presence of long-COVID. The results of the predictive model comparison showed that the mixed model, which incorporates genetic and non-genetic variables, outperforms clinical and genetic models. To our knowledge, this is the first study in Colombia and Latin-America proposing a predictive model for COVID-19 severity and long-COVID based on genomic analysis. Our study highlights the usefulness of genomic approaches to studying host genetic risk factors in specific populations. The methodology used allowed us to validate several genetic variants previously associated with COVID-19 severity and long-COVID. Finally, the integrated model illustrates the importance of considering genetic factors in precision medicine of infectious diseases.
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Affiliation(s)
- Mariana Angulo-Aguado
- School of Medicine and Health Sciences, Center for Research in Genetics and Genomics (CIGGUR), Institute of Translational Medicine (IMT), Universidad Del Rosario, Bogotá, D.C, Colombia
| | - Juan Camilo Carrillo-Martinez
- School of Medicine and Health Sciences, Center for Research in Genetics and Genomics (CIGGUR), Institute of Translational Medicine (IMT), Universidad Del Rosario, Bogotá, D.C, Colombia
| | - Nora Constanza Contreras-Bravo
- School of Medicine and Health Sciences, Center for Research in Genetics and Genomics (CIGGUR), Institute of Translational Medicine (IMT), Universidad Del Rosario, Bogotá, D.C, Colombia
| | - Adrien Morel
- School of Medicine and Health Sciences, Center for Research in Genetics and Genomics (CIGGUR), Institute of Translational Medicine (IMT), Universidad Del Rosario, Bogotá, D.C, Colombia
| | | | - William Usaquén
- Populations Genetics and Identification Group, Institute of Genetics, Universidad Nacional de Colombia, Bogotá, D.C, Colombia
| | - Dora Janeth Fonseca-Mendoza
- School of Medicine and Health Sciences, Center for Research in Genetics and Genomics (CIGGUR), Institute of Translational Medicine (IMT), Universidad Del Rosario, Bogotá, D.C, Colombia
| | - Oscar Ortega-Recalde
- School of Medicine and Health Sciences, Center for Research in Genetics and Genomics (CIGGUR), Institute of Translational Medicine (IMT), Universidad Del Rosario, Bogotá, D.C, Colombia.
- Departamento de Morfología, Facultad de Medicina e Instituto de Genética, Universidad Nacional de Colombia, Bogotá, D.C, Colombia.
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Appel KS, Nürnberger C, Bahmer T, Förster C, Polidori MC, Kohls M, Kraus T, Hettich-Damm N, Petersen J, Blaschke S, Bröhl I, Butzmann J, Dashti H, Deckert J, Dreher M, Fiedler K, Finke C, Geisler R, Hanses F, Hopff SM, Jensen BEO, Konik M, Lehnert K, de Miranda SMN, Mitrov L, Miljukov O, Reese JP, Rohde G, Scherer M, Tausche K, Tebbe JJ, Vehreschild JJ, Voit F, Wagner P, Weigl M, Lemhöfer C. Definition of the Post-COVID syndrome using a symptom-based Post-COVID score in a prospective, multi-center, cross-sectoral cohort of the German National Pandemic Cohort Network (NAPKON). Infection 2024:10.1007/s15010-024-02226-9. [PMID: 38587752 DOI: 10.1007/s15010-024-02226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score. METHODS The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)". Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12 months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L). RESULTS Six hundred three patients (mean 54.0 years, 60.6% male, 82.0% hospitalized) were included. Among those, 35.7% (215) had no and 64.3% (388) had mild, moderate, or severe PCS. PCS severity groups differed considering sex and pre-existing respiratory diseases. 3MFU PCS worsened with clinical severity of acute infection (p = .011), and number of comorbidities (p = .004). PCS severity was associated with poor QoL at the 3MFU and 12MFU (p < .001). CONCLUSION The PCS score correlated with patients' QoL and demonstrated to be instructive for clinical characterization and stratification across health care settings. Further studies should critically address the high prevalence, clinical relevance, and the role of comorbidities. TRAIL REGISTRATION NUMBER The cohort is registered at www. CLINICALTRIALS gov under NCT04768998.
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Affiliation(s)
- Katharina S Appel
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Carolin Nürnberger
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Christian Förster
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Maria Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Mirjam Kohls
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Tanja Kraus
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Nora Hettich-Damm
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Julia Petersen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Isabel Bröhl
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jana Butzmann
- Medical Faculty, Institute of Medical Microbiology and Hospital Hygiene, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Hiwa Dashti
- Practice for General Medicine Dashti, Eberswalde, Germany
| | - Jürgen Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Karin Fiedler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Carsten Finke
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - Ramsia Geisler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control an Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sina M Hopff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Margarethe Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Kristin Lehnert
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Susana M Nunes de Miranda
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lazar Mitrov
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Olga Miljukov
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
| | - Margarete Scherer
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Kristin Tausche
- Department of Internal Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Johannes J Tebbe
- Department of Gastroenterology and Infectious Diseases, Klinikum Lippe, Lippe, Germany
| | - Jörg Janne Vehreschild
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Patricia Wagner
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
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8
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Schirinzi T, Maftei D, Maurizi R, Albanese M, Simonetta C, Bovenzi R, Bissacco J, Mascioli D, Boffa L, Di Certo MG, Gabanella F, Francavilla B, Di Girolamo S, Mercuri NB, Passali FM, Lattanzi R, Severini C. Post-COVID-19 Hyposmia Does Not Exhibit Main Neurodegeneration Markers in the Olfactory Pathway. Mol Neurobiol 2024:10.1007/s12035-024-04157-w. [PMID: 38570429 DOI: 10.1007/s12035-024-04157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
The biological substrate of persistent post-COVID-19 hyposmia is still unclear. However, as many neurodegenerative diseases present with smell impairment at onset, it may theoretically reflect degeneration within the central olfactory circuits. However, no data still exist regarding the post-COVID-19 patients. As the olfactory neurons (ONs) mirror pathological changes in the brain, allowing for tracking the underlying molecular events, here, we performed a broad analysis of ONs from patients with persistent post-COVID-19 OD to identify traces of potential neurodegeneration. ONs were collected through the non-invasive brushing of the olfactory mucosa from ten patients with persistent post-COVID-19 hyposmia (lasting > 6 months after infection) and ten age/sex-matched controls. Immunofluorescence staining for protein quantification and RT-PCR for gene expression levels were combined to measure ONs markers of α-synuclein, amyloid-β, and tau pathology, axonal injury, and mitochondrial network. Patients and controls had similar ONs levels of oligomeric α-synuclein, amyloid-β peptide, tau protein, neurofilament light chain (NfL), cytochrome C oxidase subunit 3 (COX3), and the heat shock protein 60 (HSP60). Our findings thus did not provide evidence for synucleinopathy and amyloid-β mismetabolism or gross traces of neuronal injury and mitochondrial dysfunction within the olfactory system in the early phase of persistent post-COVID-19 hyposmia.
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Affiliation(s)
- Tommaso Schirinzi
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy.
| | - Daniela Maftei
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Riccardo Maurizi
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Maria Albanese
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Clara Simonetta
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Roberta Bovenzi
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Jacopo Bissacco
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Davide Mascioli
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Laura Boffa
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Maria Grazia Di Certo
- Department of Biochemistry and Cell Biology, National Research Council of Italy, Rome, Italy
| | - Francesca Gabanella
- Department of Biochemistry and Cell Biology, National Research Council of Italy, Rome, Italy
| | - Beatrice Francavilla
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Stefano Di Girolamo
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Nicola Biagio Mercuri
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - Francesco Maria Passali
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Roberta Lattanzi
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Cinzia Severini
- Department of Biochemistry and Cell Biology, National Research Council of Italy, Rome, Italy
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9
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Pink I, Hennigs JK, Ruhl L, Sauer A, Boblitz L, Huwe M, Fuge J, Falk CS, Pietschmann T, de Zwaan M, Prasse A, Kluge S, Klose H, Hoeper MM, Welte T. Blood T cell phenotypes correlate with fatigue severity in post-acute sequelae of COVID-19. Infection 2024; 52:513-524. [PMID: 37924472 PMCID: PMC10954951 DOI: 10.1007/s15010-023-02114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/09/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Post-acute sequelae of COVID-19 (PASC) affect approximately 10% of convalescent patients. The spectrum of symptoms is broad and heterogeneous with fatigue being the most often reported sequela. Easily accessible blood biomarkers to determine PASC severity are lacking. Thus, our study aimed to correlate immune phenotypes with PASC across the severity spectrum of COVID-19. METHODS A total of 176 originally immunonaïve, convalescent COVID-19 patients from a prospective cohort during the first pandemic phase were stratified by initial disease severity and underwent clinical, psychosocial, and immune phenotyping around 10 weeks after first COVID-19 symptoms. COVID-19-associated fatigue dynamics were assessed and related to clinical and immune phenotypes. RESULTS Fatigue and severe fatigue were commonly reported irrespective of initial COVID-19 severity or organ-specific PASC. A clinically relevant increase in fatigue severity after COVID-19 was detected in all groups. Neutralizing antibody titers were higher in patients with severe acute disease, but no association was found between antibody titers and PASC. While absolute peripheral blood immune cell counts in originally immunonaïve PASC patients did not differ from unexposed controls, peripheral CD3+CD4+ T cell counts were independently correlated with fatigue severity across all strata in multivariable analysis. CONCLUSIONS Patients were at similar risk of self-reported PASC irrespective of initial disease severity. The independent correlation between fatigue severity and blood T cell phenotypes indicates a possible role of CD4+ T cells in the pathogenesis of post-COVID-19 fatigue, which might serve as a blood biomarker.
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Affiliation(s)
- Isabell Pink
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany.
| | - Jan K Hennigs
- Division of Respiratory Medicine, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Louisa Ruhl
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), TTU-IICH, Hannover, Germany
| | - Andrea Sauer
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lennart Boblitz
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Marie Huwe
- Division of Respiratory Medicine, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Jan Fuge
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Christine S Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Thomas Pietschmann
- Institute of Experimental Virology, Hannover Medical School, TWINCORE Research Center, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Antje Prasse
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Hans Klose
- Division of Respiratory Medicine, II. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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10
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Lladós G, Massanella M, Coll-Fernández R, Rodríguez R, Hernández E, Lucente G, López C, Loste C, Santos JR, España-Cueto S, Nevot M, Muñoz-López F, Silva-Arrieta S, Brander C, Durà MJ, Cuadras P, Bechini J, Tenesa M, Martinez-Piñeiro A, Herrero C, Chamorro A, Garcia A, Grau E, Clotet B, Paredes R, Mateu L. Vagus nerve dysfunction in the post-COVID-19 condition: a pilot cross-sectional study. Clin Microbiol Infect 2024; 30:515-521. [PMID: 37984511 DOI: 10.1016/j.cmi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The post-COVID-19 condition (PCC) is a disabling syndrome affecting at least 5%-10% of subjects who survive COVID-19. SARS-CoV-2 mediated vagus nerve dysfunction could explain some PCC symptoms, such as dysphonia, dysphagia, dyspnea, dizziness, tachycardia, orthostatic hypotension, gastrointestinal disturbances, or neurocognitive complaints. METHODS We performed a cross-sectional pilot study in subjects with PCC with symptoms suggesting vagus nerve dysfunction (n = 30) and compared them with subjects fully recovered from acute COVID-19 (n = 14) and with individuals never infected (n = 16). We evaluated the structure and function of the vagus nerve and respiratory muscles. RESULTS Participants were mostly women (24 of 30, 80%), and the median age was 44 years (interquartile range [IQR] 35-51 years). Their most prevalent symptoms were cognitive dysfunction 25 of 30 (83%), dyspnea 24 of 30 (80%), and tachycardia 24 of 30 (80%). Compared with COVID-19-recovered and uninfected controls, respectively, subjects with PCC were more likely to show thickening and hyperechogenic vagus nerve in neck ultrasounds (cross-sectional area [CSA] [mean ± standard deviation]: 2.4 ± 0.97mm2 vs. 2 ± 0.52mm2 vs. 1.9 ± 0.73 mm2; p 0.08), reduced esophageal-gastric-intestinal peristalsis (34% vs. 0% vs. 21%; p 0.02), gastroesophageal reflux (34% vs. 19% vs. 7%; p 0.13), and hiatal hernia (25% vs. 0% vs. 7%; p 0.05). Subjects with PCC showed flattening hemidiaphragms (47% vs. 6% vs. 14%; p 0.007), and reductions in maximum inspiratory pressure (62% vs. 6% vs. 17%; p ≤ 0.001), indicating respiratory muscle weakness. The latter findings suggest additional involvement of the phrenic nerve. DISCUSSION Vagus and phrenic nerve dysfunction contribute to the complex and multifactorial pathophysiology of PCC.
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Affiliation(s)
- Gemma Lladós
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Marta Massanella
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain
| | - Roser Coll-Fernández
- Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Department of Rehabilitation, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Raúl Rodríguez
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Electra Hernández
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Giuseppe Lucente
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Cristina López
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain
| | - Cora Loste
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - José Ramón Santos
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain
| | - Sergio España-Cueto
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Maria Nevot
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Francisco Muñoz-López
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Sandra Silva-Arrieta
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Christian Brander
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Maria José Durà
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Rehabilitation, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Patricia Cuadras
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Jordi Bechini
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Montserrat Tenesa
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Alicia Martinez-Piñeiro
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Cristina Herrero
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Anna Chamorro
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Anna Garcia
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Eulalia Grau
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - Bonaventura Clotet
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - Roger Paredes
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain; Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lourdes Mateu
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain.
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11
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Epstein NK, Yelin D, Shitenberg D, Yahav D, Leibovici L, Daitch V, Margalit I. One-year follow-up of COVID-19 recoverees with impaired pulmonary function: A prospective cohort study. Infect Dis Now 2024; 54:104890. [PMID: 38499177 DOI: 10.1016/j.idnow.2024.104890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/02/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
Decreased diffusion capacity for carbon monoxide (DLCO) is the most prevalent pulmonary testing abnormality among COVID-19 recoverees. We prospectively followed 51 individuals with impaired DLCO at an average of ∼3 months following COVID-19 and re-examined them at one year. At follow-up, mean DLCO increased from 68.0 % to 72.6 % (p = 0.002); while 33 % of the cohort experienced a clinically significant rise (>10 points) in DLCO, only 29 % normalized their values. While DLCO change did not correlate with symptoms, lack of improvement was more prevalent among individuals with obesity. Regardless of COVID-19 severity, a substantial proportion continued to exhibit DLCO impairment at 1-year.
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Affiliation(s)
- Nitzan Karny Epstein
- Infectious Diseases Unit, Meir Medical Center, Kfar-Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dana Yelin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Dorit Shitenberg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pulmonology Unit, Rabin Medical Center, Petach-Tikva, Israel
| | - Dafna Yahav
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Leonard Leibovici
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Research Unit, Rabin Medical Center, Petach-Tikva, Israel
| | - Vered Daitch
- Department of Internal Medicine E, Rabin Medical Center, Petach-Tikva, Israel
| | - Ili Margalit
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
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12
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Franke C, Raeder V, Boesl F, Bremer B, Adam LC, Gerhard A, Eckert I, Quitschau A, Pohrt A, Burock S, Bruckert L, Scheibenbogen C, Prüß H, Audebert HJ. Randomized controlled double-blind trial of methylprednisolone versus placebo in patients with post-COVID-19 syndrome and cognitive deficits: study protocol of the post-corona-virus immune treatment (PoCoVIT) trial. Neurol Res Pract 2024; 6:16. [PMID: 38509608 PMCID: PMC10956230 DOI: 10.1186/s42466-024-00311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Post-COVID-19 Syndrome (PCS) includes neurological manifestations, especially fatigue and cognitive deficits. Immune dysregulation, autoimmunity, endothelial dysfunction, viral persistence, and viral reactivation are discussed as potential pathophysiological mechanisms. The post-corona-virus immune treatment (PoCoVIT) trial is a phase 2a randomized, controlled, double-blind trial designed to evaluate the effect of methylprednisolone versus placebo on cognitive impairment in PCS. This trial is designed based on the hypothesised autoimmunological pathogenesis and positive aberrations, employing a series of off-label applications. METHODS Recruitment criteria include a diagnosis of PCS, a minimum age of 18 years and self-reported cognitive deficits at screening. A total of 418 participants will be randomly assigned to either verum or placebo intervention in the first phase of the trial. The trial will consist of a first trial phase intervention with methylprednisolone versus placebo for six weeks, followed by a six-week treatment interruption period. Subsequently, an open second phase will offer methylprednisolone to all participants for six weeks. Outpatient follow-up visits will take place two weeks after each trial medication cessation. The third and final follow-up, at week 52, will be conducted through a telephone interview. The primary outcome measures an intra-patient change of 15 or more points in the memory satisfaction subscale of the Multifactorial Memory Questionnaire (MMQ) from baseline to follow-up 1 (week 8). Key secondary outcomes include long-term intra-patient changes in memory satisfaction from baseline to follow-up 2 (week 20), changes in other MMQ subscales (follow-up 1 and 2), and changes in neuropsychological and cognitive scores, along with assessments through questionnaires focusing on quality of life, fatigue, and mood over the same periods. Exploratory outcomes involve molecular biomarkers variations in serum and cerebrospinal fluid, as well as structural and functional brain magnetic resonance imaging (MRI) parameters changes related to cognition. PERSPECTIVE This trial aims to contribute novel evidence for treating patients with PCS, with a primary focus on those manifesting cognitive deficits. By doing so, it may enhance comprehension of the underlying pathophysiological mechanisms, thereby facilitating biomarker research to advance our understanding and treatment of patients with PCS.
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Affiliation(s)
- Christiana Franke
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Vanessa Raeder
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Fabian Boesl
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Benno Bremer
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Lucas C Adam
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ameli Gerhard
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Irina Eckert
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Anneke Quitschau
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Anne Pohrt
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Susen Burock
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Clinical Trial Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Bruckert
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Clinical Trial Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Harald Prüß
- Department of Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany
| | - Heinrich J Audebert
- Department of Neurology and Experimental Neurology, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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13
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Santoro F, Núñez-Gil IJ, Viana-Llamas MC, Alfonso-Rodríguez E, Uribarri A, Becerra-Muñoz VM, Guzman GF, Di Nunno N, Lopez-Pais J, Cerrato E, Sinagra G, Mapelli M, Inciardi RM, Specchia C, Oriecuia C, Brunetti ND. Risk prediction of major cardiac adverse events and all-cause death following covid-19 hospitalization at one year follow-up: The HOPE-2 score. Eur J Intern Med 2024:S0953-6205(24)00096-7. [PMID: 38472045 DOI: 10.1016/j.ejim.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Long-term consequences of COVID-19 are still partly known. AIM OF THE STUDY To derive a clinical score for risk prediction of long-term major cardiac adverse events (MACE) and all cause death in COVID-19 hospitalized patients. METHODS 2573 consecutive patients were enrolled in a multicenter, international registry (HOPE-2) from January 2020 to April 2021 and identified as the derivation cohort. Five hundred and twenty-six patients from the Cardio-Covid-Italy registry were considered as external validation cohort. A long-term prognostic risk score for MACE and all cause death was derived from a multivariable regression model. RESULTS Out of 2573 patients enrolled in the HOPE-2 registry, 1481 (58 %) were male, with mean age of 60±16 years. At long-term follow-up, the overall rate of patients affected by MACE and/or all cause death was 7.8 %. After multivariable regression analysis, independent predictors of MACE and all cause death were identified. The HOPE-2 prognostic score was therefore calculated by giving: 1-4 points for age class (<65 years, 65-74, 75-84, ≥85), 3 points for history of cardiovascular disease, 1 point for hypertension, 3 points for increased troponin serum levels at admission and 2 points for acute renal failure during hospitalization. Score accuracy at ROC curve analysis was 0.79 (0.74 at external validation). Stratification into 3 risk groups (<3, 3-6, >6 points) classified patients into low, intermediate and high risk. The observed MACE and all-cause death rates were 1.9 %, 9.4 % and 26.3 % for low- intermediate and high-risk patients, respectively (Log-rank test p < 0.01). CONCLUSIONS The HOPE-2 prognostic score may be useful for long-term risk stratification in patients with previous COVID-19 hospitalization. High-risk patients may require a strict follow-up.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | | | | | | | - Nicola Di Nunno
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Enrico Cerrato
- San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCs, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Riccardo M Inciardi
- Department of Medical and Surgical Specialties, Radiologic Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Chiara Oriecuia
- Department of Clinical and Experimental Sciences, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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14
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Preßler H, Machule ML, Ufer F, Bünger I, Li LY, Buchholz E, Werner C, Beraha E, Wagner F, Metz M, Burock S, Bruckert L, Franke C, Wilck N, Krüger A, Reshetnik A, Eckardt KU, Endres M, Prüss H. IA-PACS-CFS: a double-blinded, randomized, sham-controlled, exploratory trial of immunoadsorption in patients with chronic fatigue syndrome (CFS) including patients with post-acute COVID-19 CFS (PACS-CFS). Trials 2024; 25:172. [PMID: 38454468 PMCID: PMC10919018 DOI: 10.1186/s13063-024-07982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severely debilitating condition which markedly restricts activity and function of affected people. Since the beginning of the COVID-19 pandemic ME/CFS related to post-acute COVID-19 syndrome (PACS) can be diagnosed in a subset of patients presenting with persistent fatigue 6 months after a mostly mild SARS-CoV-2 infection by fulfillment of the Canadian Consensus Criteria (CCC 2003). Induction of autoimmunity after viral infection is a mechanism under intensive investigation. In patients with ME/CFS, autoantibodies against thyreoperoxidase (TPO), beta-adrenergic receptors (ß2AR), and muscarinic acetylcholine receptors (MAR) are frequently found, and there is evidence for effectiveness of immunomodulation with B cell depleting therapy, cyclophosphamide, or intravenous immunoglobulins (IVIG). Preliminary studies on the treatment of ME/CFS patients with immunoadsorption (IA), an apheresis that removes antibodies from plasma, suggest clinical improvement. However, evidence from placebo-controlled trials is currently missing. METHODS In this double-blinded, randomized, sham-controlled, exploratory trial the therapeutic effect of five cycles of IA every other day in patients with ME/CFS, including patients with post-acute COVID-19 chronic fatigue syndrome (PACS-CFS), will be evaluated using the validated Chalder Fatigue Scale, a patient-reported outcome measurement. A total of 66 patients will be randomized at a 2:1 ratio: 44 patients will receive IA (active treatment group) and 22 patients will receive a sham apheresis (control group). Moreover, safety, tolerability, and the effect of IA on patient-reported outcome parameters, biomarker-related objectives, cognitive outcome measurements, and physical parameters will be assessed. Patients will be hospitalized at the clinical site from day 1 to day 10 to receive five IA treatments and medical visits. Four follow-up visits (including two visits at site and two visits via telephone call) at month 1 (day 30), 2 (day 60), 4 (day 120), and 6 (day 180; EOS, end of study visit) will take place. DISCUSSION Although ME/CFS including PACS-CFS causes an immense individual, social, and economic burden, we lack efficient therapeutic options. The present study aims to investigate the efficacy of immunoadsorption and to contribute to the etiological understanding and establishment of diagnostic tools for ME/CFS. TRIAL REGISTRATION Registration Number: NCT05710770 . Registered on 02 February 2023.
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Affiliation(s)
- Hannah Preßler
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- Excellence Cluster NeuroCure, Berlin, Germany
| | - Marie-Luise Machule
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Friederike Ufer
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Isabel Bünger
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Lucie Yuanting Li
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Emilie Buchholz
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Claudia Werner
- Clinical Research Organisation GmbH, Charitéplatz 1, Berlin, 10117, Germany
| | - Esther Beraha
- Clinical Research Organisation GmbH, Charitéplatz 1, Berlin, 10117, Germany
| | - Frank Wagner
- Clinical Research Organisation GmbH, Charitéplatz 1, Berlin, 10117, Germany
| | - Matthes Metz
- Department of Biostatistics, GCP-Service International Ltd. & Co. KG, Bremen, Germany
| | - Susen Burock
- Clinical Trial Office, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Lisa Bruckert
- Clinical Trial Office, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Christiana Franke
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Nicola Wilck
- Department of Nephrology and Medical Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center (ECRC), a cooperation of Charité - Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine (MDC), Berlin, 13125, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, 13125, Germany
| | - Anne Krüger
- Department of Nephrology and Medical Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Reshetnik
- Department of Nephrology and Medical Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Endres
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
- Excellence Cluster NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany.
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15
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Allwang C, Frank T, Bruckmann P, Dinkel A, Binneboese M, Wallis H, Elgner M, Giel KE, Schurr M, Gündel H, Wedekind L, Kuhn J, Lahmann C, Müller AM, Beckmann P, Massag J, Mikolajczyk R, Junne F. Addressing psychosocial needs in patients with Long-COVID (PsyLoCo-Study): study protocol of a pilot-study of a specialized modular intervention. Front Psychiatry 2024; 15:1305691. [PMID: 38510801 PMCID: PMC10951091 DOI: 10.3389/fpsyt.2024.1305691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction After an acute infection with the corona virus 10-20% of those affected suffer from ongoing or new symptoms. A causal therapy for the phenomenon known as Long/Post-COVID is still lacking and specific therapies addressing psychosocial needs of these patients are imperatively needed. The aim of the PsyLoCo-study is developing and piloting a psychotherapeutic manual, which addresses Long/Post-COVID-related psychosocial needs and supports in coping with persistent bodily symptoms as well as depressive or anxiety symptoms. Methods and analysis This pilot trial implements a multi-centre, 2-arm (N=120; allocation ratio: 1:1), parallel group, randomised controlled design. The pilot trial is designed to test the feasibility and estimate the effect of 1) a 12-session psychotherapeutic intervention compared to 2) a wait-list control condition on psychosocial needs as well as bodily and affective symptoms in patients suffering from Long/Post-COVID. The intervention uses an integrative, manualized, psychotherapeutic approach. The primary study outcome is health-related quality of life. Outcome variables will be assessed at three timepoints, pre-intervention (t1), post-intervention (t2) and three months after completed intervention (t3). To determine the primary outcome, changes from t1 to t2 are examined. The analysis will be used for the planning of the RCT to test the efficacy of the developed intervention. Discussion The pilot study will evaluate a 12-session treatment manual for Long/Post-COVID sufferers and the therapy components it contains. The analysis will provide insights into the extent to which psychotherapeutic treatment approaches improve the symptoms of Long/Post-COVID sufferers. The treatment manual is designed to be carried out by psychotherapists as well as people with basic training in psychotherapeutic techniques. This approach was chosen to enable a larger number of practitioners to provide therapeutic support for Long/Post-COVID patients. After completion of the pilot study, it is planned to follow up with a randomized controlled study and to develop a treatment guideline for general practitioners and interested specialists. Trial registration The pilot trial has been registered with the German Clinical Trials Register (Deutsches Register Klinischer Studien; Trial-ID: DRKS00030866; URL: https://drks.de/search/de/trial/DRKS00030866) on March 7, 2023.
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Affiliation(s)
- Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Tamara Frank
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Paul Bruckmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marius Binneboese
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Hannah Wallis
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Melanie Elgner
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Katrin E. Giel
- Department of Psychosomatic Medicine and Psychotherapy, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Marisa Schurr
- Department of Psychosomatic Medicine and Psychotherapy, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Lisa Wedekind
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Julia Kuhn
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Anne-Maria Müller
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Pauline Beckmann
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Janka Massag
- Medical Faculty, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Medical Faculty, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- German Center for Mental Health (DZPG), partner site Halle-Jena-Magdeburg, Halle, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- German Center for Mental Health (DZPG), partner Site Halle-Jena-Magdeburg, Magdeburg, Germany
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16
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Williams GP, Yu ED, Shapiro K, Wang E, Freuchet A, Frazier A, Lindestam Arlehamn CS, Sette A, da Silva Antunes R. Investigating viral and autoimmune T cell responses associated with post-acute sequelae of COVID-19. Hum Immunol 2024:110770. [PMID: 38433036 DOI: 10.1016/j.humimm.2024.110770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Post-acute sequelae of COVID-19 (PASC), or Long COVID, is a chronic condition following acute SARS-CoV-2 infection. Symptoms include exertion fatigue, respiratory issues, myalgia, and neurological manifestations such as 'brain fog,' posing concern for their debilitating nature and potential role in other neurological disorders. However, the underlying potential pathogenic mechanisms of the neurological complications of PASC is largely unknown. Herein, we investigated differences in antigen-specific T cell responses from the peripheral blood towards SARS-CoV-2, latent viruses, or neuronal antigens in 14 PASC individuals with neurological manifestations (PASC-N) versus 22 individuals fully recovered from COVID-19. We employed Activation Induced Marker (AIM), ICS and FluoroSpot assays to determine the specificity and magnitude of CD4+ and CD8+ T cell responses towards SARS-CoV-2 (Spike and rest of proteome), latent viruses (CMV, EBV), and several neuronal antigens. Overall, we observed similar antigen-specific T cell frequencies and cytokine effector T cell responses between PASC donors compared to recovered controls for all antigens tested (viral or autoantigen) in both CD4+ and CD8+ T cell compartments. Our findings suggest that PASC-N does not appear to be associated with changes in antigen-specific T cell responses towards a subset of disease-relevant targets, but more studies in a larger cohort are needed to confirm these unaltered responses.
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Affiliation(s)
- Gregory P Williams
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Esther Dawen Yu
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Kendra Shapiro
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Eric Wang
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Antoine Freuchet
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - April Frazier
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | | | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA; University of California San Diego School of Medicine, La Jolla, San Diego, CA, USA
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17
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Gamero-de-Luna EJ, Sánchez-Jaén MR. [Genetic factors associated with long COVID]. Semergen 2024; 50:102187. [PMID: 38277732 DOI: 10.1016/j.semerg.2023.102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION The variability in expression and evolution of COVID is not completely explained by clinical factors. In fact, genetic factors play an important role. Moreover, it is unknown whether the genetic factor that contribute to susceptibility and severity are also involved in the onset and evolution of long-COVID. The objective of this review is to gather information from literature to understand which genetic factors are involved in the onset of persistent COVID. MATERIAL AND METHODS Systematic review in PubMed and bioRxiv and medRxiv repositories based on MeSH-descriptors and MeSH-terms related to COVID and genetic factors. Using these terms 2715 articles were pooled. An initial screening performed by authors independently, selected 205 articles of interest. A final deeper screening a total of 85 articles were chosen for complete reading and summarized in this review. RESULTS Although ACE2 and TMPSS6 are involved in COVID susceptibility, their involvement in long-COVID has not been found. On the other hand, the severity of the disease and the onset of long-COVID has been associated with different genes involved in the inflammatory and immune response. Particularly interesting has been the association found with the FOXP4 locus. CONCLUSIONS Although studies on long-COVID are insufficient to fully comprehend the cause, it is clear that the current identified genetic factors do not fully explain the progression and onset of long-COVID. Other factors such as polygenic action, pleiotropic genes, the microbiota and epigenetic changes must be considered and studied.
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Affiliation(s)
- E J Gamero-de-Luna
- Medicina Familiar y Comunitaria, Centro de Salud El Juncal, Sevilla, España; GT Medicina Genómica Personalizada y Enfermedades Raras, SEMERGEN, España.
| | - M R Sánchez-Jaén
- GT Medicina Genómica Personalizada y Enfermedades Raras, SEMERGEN, España; Medicina Familiar y Comunitaria, Centro de Salud de Fabero, León, España
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18
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Sakib MN, Saragadam A, Santagata MC, Jolicoeur-Becotte M, Kozyr L, Burhan AM, Hall PA. rTMS for post-covid-19 condition: A sham-controlled case series involving iTBS-300 and iTBS-600. Brain Behav Immun Health 2024; 36:100736. [PMID: 38371381 PMCID: PMC10869745 DOI: 10.1016/j.bbih.2024.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/03/2024] [Accepted: 02/04/2024] [Indexed: 02/20/2024] Open
Abstract
Post-Covid-19 Condition (PCC) is a syndrome comprised of symptoms persisting 3 months or more beyond SARS-CoV-2 primary infection. It is typically characterized by fatigue, cognitive problems and psychiatric symptoms, as well as cardiac symptoms that contribute to exercise intolerance in many. Despite the high prevalence of PCC among those with a prior SARS-CoV-2 infection, there is currently no widely accepted rehabilitation strategy, and many conventional modalities are movement-based. Non-invasive brain stimulation methods such as repetitive transcranial magnetic stimulation (rTMS) may have some potential to alleviate the cognitive and affective symptoms of PCC without reliance on exercise. The purpose of the present study was to explore the feasibility and tolerability of using rTMS to treat symptoms of "brain fog" and affective disturbance among those living with PCC, using a case series design. We enrolled four individuals with PCC following a confirmed SARS-CoV-2 infection, at least 3 months after the resolution of the primary infection. Participants were randomized to 4 sessions of active and 2 sessions of sham intermittent theta-burst stimulation (iTBS); two intensities of iTBS were evaluated: iTBS-300 and iTBS-600. No adverse events occurred in active or sham stimulation; 2 participants reported tingling sensation on the scalp but no other tolerability issues. Trends in symptoms suggested improvements in cognitive interference, quality of life, and anxiety in the majority of participants. In summary, in this case series iTBS was well tolerated among 4 individuals with PCC; active stimulation was associated with positive trends in some primary symptom clusters as compared with sham stimulation. Future studies should examine the effects of iTBS on PCC symptoms in the context of experimental studies and randomized controlled trials.
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Affiliation(s)
- Mohammad Nazmus Sakib
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Ashish Saragadam
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Mariella C. Santagata
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Marie Jolicoeur-Becotte
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Lena Kozyr
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Amer M. Burhan
- Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Peter A. Hall
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, Ontario, Canada
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19
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Mourelatos P, Vrettou CS, Diamantopoulos A, Vassiliou AG, Jahaj E, Angelousi A, Pratikaki M, Katsaounou P, Kotanidou A, Vassiliadi DA, Dimopoulou I. A prospective study on endocrine function in patients with long-COVID symptoms. Hormones (Athens) 2024; 23:59-67. [PMID: 37996650 DOI: 10.1007/s42000-023-00511-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To investigate hormonal status in patients with long-COVID and explore the interrelationship between hormone levels and long-COVID symptoms. DESIGN Prospective observational study. PARTICIPANTS Patients who visited our long-COVID outpatients' clinic due to long-COVID symptoms from February 2021 to December 2022. MEASUREMENTS Total triiodothyronine, free thyroxine, thyrotropin, thyroglobulin, anti-thyroperoxidase, and antithyroglobulin autoantibodies were measured for thyroid assessment. Other hormones measured were growth hormone, insulin-like growth factor 1 (IGF-1), adrenocorticotropic hormone (ACTH), serum cortisol, dehydroepiandrosterone sulfate (DHEA-S), total testosterone, plasma insulin, and C-peptide. Blood glucose and glycosylated hemoglobin were also measured. To assess adrenal reserve, an ACTH stimulation test was performed. The fatigue assessment scale (FAS) was used to evaluate fatigue severity. RESULTS Eighty-four adult patients were included. Overall, 40.5% of the patients had at least one endocrine disorder. These included prediabetes (21.4%), low DHEA-S (21.4%), subclinical hypothyroidism (3.6%), non-specific thyroid function abnormality (7.1%), thyroid autoimmunity (7.1%), low testosterone in males (6.6%), and low IGF-1 (3.6%). All patients had normal adrenal reserve. Long-COVID-19 symptoms were present in all patients and the most commonly reported symptom was fatigue (89.3%). The FAS score was higher than normal (≥ 22) in 42.8% of patients. There were no associations between patients' symptoms and hormone levels. Diabetic patients reported confusion (p = 0.020) and hair loss (p = 0.040) more often than non-diabetics. CONCLUSIONS The evaluation of endocrine function 3 months after a positive SARS-CoV2 test revealed only subclinical syndromes. The vast majority of patients reported mainly fatigue, among other symptoms, which were unrelated, however, to endocrine function.
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Affiliation(s)
- Panagiotis Mourelatos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Charikleia S Vrettou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
| | - Aristidis Diamantopoulos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Alice G Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Anna Angelousi
- Unit of Endocrinology, First Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pratikaki
- Biochemical Department, Evangelismos Hospital, Athens, Greece
| | - Paraskevi Katsaounou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Dimitra A Vassiliadi
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
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20
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Sadat Larijani M, Banifazl M, Karami A, Ramezani A. Long-term rheumatoid manifestations as a consequence of COVID-19 and/or vaccination: A case report after a 2-year follow-up. Heliyon 2024; 10:e24982. [PMID: 38317942 PMCID: PMC10840001 DOI: 10.1016/j.heliyon.2024.e24982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/07/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
COVID-19 is now established as a multi-organ involvement disease with a broad range of manifestations. Identification of post-acute COVID-19 incidence is critical according to increasing number of late symptoms reports. Hereby, we report a case with a past history of COVID-19 who presented different manifestations including osteoarticular and neurological involvement within a long-term follow-up. The organs involvement initiated lately after primary vaccinations (with inactivated vaccine) and lasted few months without any pre-existing medical condition. However, upon the completion of the vaccine schedule and receiving a protein subunit vaccine, PastoCovac Plus, as a booster, the symptoms improved substantially and resolved, though in the reinfection episode partial, reoccurrence was recorded. This presentation can be a challenging issue owing to the fact that the majority of global population are vaccinated and also experience COVID-19 in this era and sometimes differentiation between consequences of the virus as post COVID-19 or the vaccination side effects is difficult.
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Affiliation(s)
| | - Mohammad Banifazl
- Iranian Society for Support of Patients with Infectious Disease, Tehran, Iran
| | - Afsaneh Karami
- Department of Infectious Disease, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amitis Ramezani
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran
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21
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Laguarta-Val S, Varillas-Delgado D, Lizcano-Álvarez Á, Molero-Sánchez A, Melian-Ortiz A, Cano-de-la-Cuerda R, Jiménez-Antona C. Effects of Aerobic Exercise Therapy through Nordic Walking Program in Lactate Concentrations, Fatigue and Quality-of-Life in Patients with Long-COVID Syndrome: A Non-Randomized Parallel Controlled Trial. J Clin Med 2024; 13:1035. [PMID: 38398348 PMCID: PMC10889227 DOI: 10.3390/jcm13041035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Long-COVID syndrome comprises a variety of signs and symptoms that develop during or after infection with COVID-19 which may affect the physical capabilities. However, there is a lack of studies investigating the effects of Long-COVID syndrome in sport capabilities after suffering from COVID-19 infection. The purpose of the study was to evaluate and compare lactate concentration and quality of life (QoL) in patients with Long-COVID with those who have not developed non-Long-COVID during Nordic walking exercise therapy. METHODS Twenty-nine patients (25.5 ± 7.1 years) took part in a non-randomized controlled trial, divided into two groups: a Long-COVID group (n = 16) and a non-Long-COVID control (n = 13). Patients were confirmed as having Long-COVID syndrome if they experienced fatigue or tiredness when performing daily activities and worsening of symptoms after vigorous physical or mental activity. All participants underwent a 12-week Nordic Walking program. Lactate concentration after exercise and distance covered during all sessions were measured. Pre- and Long-Nordic Walking program, the Modified Fatigue Impact Scale (MFIS), the Short Form 36 Health Survey (SF-36), and EURO QoL-5D (EQ-ED) were administered to assess fatigue and quality of life, respectively. RESULTS There was a lactate concentration effect between groups (F = 5.604; p = 0.024). However, there was no significant effect as a result of the session (F = 3.521; p = 0.121) with no interaction of group × session (F = 1.345; p = 0.414). The group main effect (F = 23.088; p < 0.001), time effect (F = 6.625; p = 0.026), and group × time (F = 4.632; p = 0.002) interaction on the SF-36 scale were noted. Also, there were a significant group main effect (F = 38.372; p < 0.001), time effect (F = 12.424; p = 0.005), and group × time interaction (F = 4.340; p = 0.014) on EQ-5D. However, there was only a significant group main effect (F = 26.235; p < 0.001) with no effect on time (F = 2.265; p = 0.160) and group × time (F = 1.584; p = 0.234) interaction on the MFIS scale. CONCLUSIONS The Long-COVID group showed higher lactate concentration compared with the control group during the 12 weeks of the Nordic Walking program. The Long-COVID group presented a decrease in fatigue with respect to the control group according to the MFIS scale, as well as improvement in quality of life after aerobic exercise therapy.
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Affiliation(s)
- Sofía Laguarta-Val
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain; (S.L.-V.); (A.M.-S.); (R.C.-d.-l.-C.); (C.J.-A.)
| | - David Varillas-Delgado
- Department of Exercise and Sport Science, Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo, Spain
| | - Ángel Lizcano-Álvarez
- Department of Nursing and Stomatology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain;
| | - Alberto Molero-Sánchez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain; (S.L.-V.); (A.M.-S.); (R.C.-d.-l.-C.); (C.J.-A.)
| | - Alberto Melian-Ortiz
- Faculty of Nursing and Physiotherapy, Universidad Pontificia de Salamanca, 28015 Madrid, Spain;
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain; (S.L.-V.); (A.M.-S.); (R.C.-d.-l.-C.); (C.J.-A.)
| | - Carmen Jiménez-Antona
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain; (S.L.-V.); (A.M.-S.); (R.C.-d.-l.-C.); (C.J.-A.)
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22
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Zhang Y, Romieu-Hernandez A, Boehmer TK, Azziz-Baumgartner E, Carton TW, Gundlapalli AV, Fearrington J, Nagavedu K, Dea K, Moyneur E, Cowell LG, Kaushal R, Mayer KH, Puro J, Rasmussen SA, Thacker D, Weiner MG, Saydah S, Block JP. Association between SARS-CoV-2 infection and select symptoms and conditions 31 to 150 days after testing among children and adults. BMC Infect Dis 2024; 24:181. [PMID: 38341566 PMCID: PMC10859007 DOI: 10.1186/s12879-024-09076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31- to 150-day following a SARS-CoV-2 test among adults and children with positive and negative test results. METHODS We conducted a retrospective cohort study using electronic health record (EHR) data from 43 PCORnet sites participating in a national COVID-19 surveillance program. This study included 3,091,580 adults (316,249 SARS-CoV-2 positive; 2,775,331 negative) and 675,643 children (62,131 positive; 613,512 negative) who had a SARS-CoV-2 laboratory test during March 1, 2020-May 31, 2021 documented in their EHR. We used logistic regression to calculate the odds of having a symptom and Cox models to calculate the risk of having a newly diagnosed condition associated with a SARS-CoV-2 positive test. RESULTS After adjustment for baseline covariates, hospitalized adults and children with a positive test had increased odds of being diagnosed with ≥ 1 symptom (adults: adjusted odds ratio[aOR], 1.17[95% CI, 1.11-1.23]; children: aOR, 1.18[95% CI, 1.08-1.28]) or shortness of breath (adults: aOR, 1.50[95% CI, 1.38-1.63]; children: aOR, 1.40[95% CI, 1.15-1.70]) 31-150 days following a SARS-CoV-2 test compared with hospitalized individuals with a negative test. Hospitalized adults with a positive test also had increased odds of being diagnosed with ≥ 3 symptoms or fatigue compared with those testing negative. The risks of being newly diagnosed with type 1 or type 2 diabetes (adjusted hazard ratio[aHR], 1.25[95% CI, 1.17-1.33]), hematologic disorders (aHR, 1.19[95% CI, 1.11-1.28]), or respiratory disease (aHR, 1.44[95% CI, 1.30-1.60]) were higher among hospitalized adults with a positive test compared with those with a negative test. Non-hospitalized adults with a positive test also had higher odds or increased risk of being diagnosed with certain symptoms or conditions. CONCLUSIONS Patients with SARS-CoV-2 infection, especially those who were hospitalized, were at higher risk of being diagnosed with certain symptoms and conditions after acute infection.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | | | - Tegan K Boehmer
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Adi V Gundlapalli
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia Fearrington
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA
| | - Kshema Nagavedu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA
| | | | | | - Lindsay G Cowell
- Peter O-Donnell Jr. School of Public Health, Department of Immunology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Kenneth H Mayer
- Fenway Institute, Fenway Health, Harvard Medical School, Boston, MA, USA
| | | | - Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, Delaware, USA
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sharon Saydah
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, USA.
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23
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Poyatos P, Luque N, Sabater G, Eizaguirre S, Bonnin M, Orriols R, Tura-Ceide O. Endothelial dysfunction and cardiovascular risk in post-COVID-19 patients after 6- and 12-months SARS-CoV-2 infection. Infection 2024:10.1007/s15010-024-02173-5. [PMID: 38324145 DOI: 10.1007/s15010-024-02173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION SARS-CoV-2 infection causes severe endothelial damage, an essential step for cardiovascular complications. Endothelial-colony forming cells (ECFCs) act as a biomarker of vascular damage but their role in SARS-CoV-2 remain unclear. The aim of this study was to assess whether the number of ECFCs and angiogenic biomarkers remained altered after 6 and 12-months post-infection and whether this imbalance correlated with the presence of long-COVID syndrome and other biological parameters measured. METHODS Seventy-two patients were recruited at different time-points after overcoming COVID-19 and thirty-one healthy controls. All subjects were matched for age, gender, BMI, and comorbidities. ECFCs were obtained from peripheral blood and cultured with specific conditions. RESULTS The results confirm the presence of a long-term sequela in post-COVID-19 patients, with an abnormal increase in ECFC production compared to controls (82.8% vs. 48.4%, P < 0.01) that is maintained up to 6-months (87.0% vs. 48.4%, P < 0.01) and 12-months post-infection (85.0% vs. 48.4%, P < 0.01). Interestingly, post-COVID-19 patients showed a significant downregulation of angiogenesis-related proteins compared to controls indicating a clear endothelial injury. Troponin, NT-proBNP and ferritin levels, markers of cardiovascular risk and inflammation, remained elevated up to 12-months post-infection. Patients with lower numbers of ECFC exhibited higher levels of inflammatory markers, such as ferritin, suggesting that ECFCs may play a protective role. Additionally, long-COVID syndrome was associated with higher ferritin levels and with female gender. CONCLUSIONS These findings highlight the presence of vascular sequela that last up to 6- and 12-months post-infection and point out the need for preventive measures and patient follow-up.
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Affiliation(s)
- Paula Poyatos
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Neus Luque
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
| | - Gladis Sabater
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Saioa Eizaguirre
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Marc Bonnin
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Ramon Orriols
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain.
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Olga Tura-Ceide
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital de Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190, Girona, Spain.
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain.
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid, Spain.
- Department of Pulmonary Medicine, Servei de Pneumologia, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
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24
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Lee JS, Choi Y, Joung JY, Son CG. Clinical and Laboratory Characteristics of Fatigue-dominant Long-COVID subjects: A Cross-Sectional Study. Am J Med 2024:S0002-9343(24)00057-3. [PMID: 38331137 DOI: 10.1016/j.amjmed.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Long-COVID is defined by persistent symptoms following COVID-19 infection. Approximately 71% of individuals with long-COVID experience ongoing fatigue, post-exertional malaise, and cognitive impairments, which share pathological similarities with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This similarity has prompted studies to explore the characteristics of long-COVID to gain a better understanding of ME/CFS. To gain insights, we investigated the clinical and laboratory characteristics of individuals with fatigue-dominant long-COVID. METHODS We enrolled 100 subjects (36 males, 64 females) with long-COVID who had a higher score than 60 in modified Korean version of the Chalder Fatigue Scale (mKCFQ11) and higher than 5 in fatigue-focused Visual Analogue Scale (VAS). To investigate fatigue symptoms, the mKCFQ11, the Multidimensional Fatigue Inventory (MFI-20), and VAS for fatigue and brain-fog, along with the Short Form Survey (SF-12) were employed. We also measured three cytokines and cortisol levels for immunological and endocrinological indicators. As a cross-sectional observational study, the data were collected at a single point in time. RESULTS The mean scores on the measurements showed severe fatigue, and these scores were significantly correlated, with no differences based on sex, the post-COVID period, or age. Among the laboratory tests, plasma cortisol levels had a significant negative correlation with fatigue scores and a positive correlation with living quality. The negative correlation between cortisol levels and mKCFQ11 scores appeared to be more specific to mental fatigue than physical, which conflicted with other measurements. CONCLUSION Our findings provide the first insights into the characteristics of fatigue in individuals with long-COVID, particularly in terms of fatigue severity and cortisol levels. These results serve as valuable reference data for clinicians dealing with fatigue symptoms in long-COVID patients and for researchers exploring post-viral fatigue symptoms, including ME/CFS, in the future.
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Affiliation(s)
- Jin-Seok Lee
- Institute of Bioscience & Integrative Medicine, Daejeon University, Daehak-ro 75, Daejeon, 35235, Republic of Korea; Department of Korean Medicine, Korean Medical College of Daejeon University, Daehak-ro 62, Dong-gu, Daejeon, 34520, Republic of Korea
| | - Yujin Choi
- Department of Internal Medicine, College of Korean Medicine, Se-Myung University, Jecheon-si, 27136, Republic of Korea
| | - Jin-Yong Joung
- Department of Korean Medicine, Korean Medical College of Daejeon University, Daehak-ro 62, Dong-gu, Daejeon, 34520, Republic of Korea; Department of Internal Medicine, Daejeon Good-morning Oriental Hospital, 21, Dunsan-ro 123beon-gil, Seo-gu, Daejeon, 35240, Republic of Korea
| | - Chang-Gue Son
- Department of Internal Medicine, College of Korean Medicine, Se-Myung University, Jecheon-si, 27136, Republic of Korea; Department of Korean Medicine, Korean Medical College of Daejeon University, Daehak-ro 62, Dong-gu, Daejeon, 34520, Republic of Korea.
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25
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Ashktorab H, Challa SR, Singh G, Nanduri S, Ibrahim M, Martirosyan Z, Whitsell P, Chirumamilla LG, Shayegh N, Watson K, Smith T, Ogwo V, Kolawole O, Littleton M, Morrison N, Nair V, Byer D, Dawodu DO, Lexima P, Rashid M, Deverapalli M, Atluri SM, Nezamloo A, Nasrin F, Kim RJA, Sherif Z, Oskrochi G, Carethers JM, Brim H. Gastrointestinal Manifestations and Their Association with Neurologic and Sleep Problems in Long COVID-19 Minority Patients: A Prospective Follow-Up Study. Dig Dis Sci 2024; 69:562-569. [PMID: 38135813 DOI: 10.1007/s10620-023-08176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Long-COVID is a condition post SARS-CoV-2 infection with persistent or recurring symptoms affecting multiple organs, and may involve viral persistence, changes to the microbiome, coagulopathies, and alterations to neuro-immune interactions. These factors can disrupt the Gut-Brain Axis, which is a complex system involving bidirectional communication between the central nervous system and the gastrointestinal (GI) system. As a result of these disruptions, individuals with long-COVID may develop post-infectious functional GI disorders, which can cause a range of symptoms affecting the digestive system. AIM To understand frequency of GI manifestations of Long-COVID and to determine association with sleep or neurological symptoms in a predominantly minority population. METHODS We included patients with positive SARS-CoV-2 PCR (n = 747) who were hospitalized from Feb. 2020 to May 2021 at Howard University Hospital and followed between 6 and 12 months from discharge. GI, sleep, and neurological symptoms (via the Montreal Cognitive Assessment (MoCA) scoring system) were assessed using a standardized questionnaire. Linear regression analysis, χ2 and Fisher's exact test were utilized to determine the statistical significance of correlations of GI/Neuro/COVID. RESULTS The mean age of patients was 58, with 51.6% females and a predominant African American ethnicity (73.6%, n = 550). A total of 108 patients died during their initial hospital stay, with the remaining 639 patients followed-up. Three hundred fifty (350) patients responded to the questionnaire (57 patients died during the follow-up period). Overall, 39 (13.3%) patients reported GI-related symptoms, out of which 19 (6.4%) had persistent symptoms and 20 (6.8%) developed new onset GI symptoms. Nausea and vomiting were the most common 24/39 (61.5%), followed by abdominal pain 7/39 (18%), diarrhea 5/39 (12.8%), and others 3/39 (7.6%). Patients who presented with vomiting during acute SARS-CoV-2 infection were more likely to have Long-COVID GI manifestations (P = 0.023). Use of ACE inhibitors, abnormal lymphocyte count and elevated ferritin are other variables that showed significant associations with Long-COVID GI manifestations (P = 0.03, 0.006 and 0.03, respectively). During follow-up, a total of 28 (9.5%) patients reported difficulty with sleep and 79 (27%) patients had abnormal MoCA assessment. With further analysis, there was a trend between presentation of GI symptoms on admission with abnormal MoCA assessment, and an association between abnormal LFTs and history of liver disease during hospitalization with subsequent sleep problems. Baseline characteristics, clinical comorbidities, other laboratory values, hospital length of stay, mechanical ventilation, medications during hospitalization, re-admission and Flu or COVID-19 vaccination have not shown any association with Long-COVID GI symptoms in our cohort. CONCLUSION Dyspeptic symptoms were common GI manifestations in the acute and post COVID periods. GI symptoms, abnormal LFTs and a history of liver disease during the acute infectious phase associates with abnormal MoCA and sleep problems during follow-up. Further large population studies are needed to determine if COVID-19 leads to a GI symptoms-associated Long-COVID phenotypes and other symptoms through the Gut-Brain-Axis.
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Affiliation(s)
- Hassan Ashktorab
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA.
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA.
| | | | - Gagan Singh
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Sumant Nanduri
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Malika Ibrahim
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Zara Martirosyan
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA
| | - Peter Whitsell
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA
| | - Lakshmi G Chirumamilla
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Nader Shayegh
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Kyra Watson
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Tori Smith
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Valarie Ogwo
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, USA
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
- Division of Gastroenterology & Hepatology, Department of Medicine and Moores Cancer Center, UC San Diego, San Diego, USA
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Oluwapelumi Kolawole
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Megan Littleton
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Nicole Morrison
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Vaisakh Nair
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Danae Byer
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Dideolu O Dawodu
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Patrice Lexima
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Mudasir Rashid
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Mrinalini Deverapalli
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Swetha Mynedi Atluri
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Ali Nezamloo
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Farjana Nasrin
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Rachel Ji-Aeh Kim
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Zaki Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, USA
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
| | - John M Carethers
- Division of Gastroenterology & Hepatology, Department of Medicine and Moores Cancer Center, UC San Diego, San Diego, USA
| | - H Brim
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
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Rigo S, Barbic F, Khalaf K, Bisoglio A, Pani M, Minonzio M, Rinaldi L, Ciccarelli M, Bordoni MG, Verzeletti P, Badilini F, Bonovas S, Piovani D, Shiffer D, Furlan R. The Long-COVID autonomic syndrome in hospitalized patients: A one-year prospective cohort study. Eur J Intern Med 2024; 120:38-45. [PMID: 37652756 DOI: 10.1016/j.ejim.2023.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
Long-COVID syndrome is characterized by fatigue, orthostatic intolerance, tachycardia, pain, memory difficulties, and brain fog, which may be associated with autonomic nervous system abnormalities. We aimed to evaluate the short and long-term course of COVID-19 autonomic symptoms and quality of life (QoL) after SARS-CoV-2 infection through a one-year follow-up combined with validated questionnaires. Additionally, we aimed to identify patients with worsening autonomic symptoms at 6 and 12 months by dividing the patient cohort into two sub-groups: the Post-COVID healed Control sub-group (total score<16.4) and the Long-COVID autonomic syndrome sub-group (total score>16.4). This prospective cohort studied 112 SARS-CoV-2 positive patients discharged from Humanitas Research Hospital between January and March 2021. Autonomic symptoms and QoL were assessed using the composite autonomic symptom scale 31 (COMPASS-31) and Short Form Health Survey (SF-36) questionnaires at various time points: before SARS-CoV-2 infection (PRE), at hospital discharge (T0), and at 1 (T1), 3 (T3), 6 (T6), and 12 (T12) months of follow-up. COMPASS-31 total score, Orthostatic Intolerance and Gastrointestinal function indices, QoL, physical functioning, pain, and fatigue scores worsened at T0 compared to PRE but progressively improved at T1 and T3, reflecting the acute phase of COVID-19. Unexpectedly, these indices worsened at T6 and T12 compared to T3. Subgroup analysis revealed that 47% of patients experienced worsening autonomic symptoms at T6 and T12, indicating Long-COVID autonomic syndrome. Early rehabilitative and pharmacological therapy is recommended for patients at the T1 and T3 stages after SARS-CoV-2 infection to minimize the risk of developing long-term autonomic syndrome.
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Affiliation(s)
- Stefano Rigo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Franca Barbic
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Internal Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Kareem Khalaf
- Department of Gastroenterology, Saint Michael's Hospital, University of Toronto, Toronto, Canada
| | - Andrea Bisoglio
- Department of Neurosurgery, University Vita e Salute S. Raffaele, Milan, Italy
| | - Margherita Pani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Maura Minonzio
- Internal Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Luca Rinaldi
- Occupational Medicine, IRCCS Salvatore Maugeri, University of Pavia, Pavia, Italy
| | - Michele Ciccarelli
- Internal Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Maria Grazia Bordoni
- Vascular Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | | | | | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Internal Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Internal Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
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Fernández-de-Las-Peñas C, Torres-Macho J, Catahay JA, Macasaet R, Velasco JV, Macapagal S, Caldararo M, Henry BM, Lippi G, Franco-Moreno A, Notarte KI. Is antiviral treatment at the acute phase of COVID-19 effective for decreasing the risk of long-COVID? A systematic review. Infection 2024; 52:43-58. [PMID: 38113020 DOI: 10.1007/s15010-023-02154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Preliminary evidence suggests a potential effect of antiviral medication used during the acute COVID-19 phase for preventing long-COVID. This review investigates if having received pharmacological treatment during acute SARS-CoV-2 infection may reduce the risk of long-COVID. METHODS MEDLINE, CINAHL, PubMed, EMBASE, Web of Science databases, as well as medRxiv/bioRxiv preprint servers were searched up to July 15th, 2023. Articles comparing the presence of long-COVID symptoms between individuals who received or not a specific medication, particularly antivirals, during the acute phase of SARS-CoV-2 infection were included. Methodological quality was assessed using the Newcastle-Ottawa Scale or Cochrane's Risk of Bias (Rob) tool. RESULTS From 517 studies identified, 6 peer-reviewed studies and one preprint met all inclusion criteria. The sample included 2683 (n = 4) hospitalized COVID-19 survivors and 307,409 (n = 3) non-hospitalized patients. The methodological quality was high in 71% of studies (n = 5/7). Two studies investigating the effects of Nirmaltrevir/Ritonavir and three studies the effect of Remdesivir reported conflicting results on effectiveness for preventing long-COVID. Three studies investigating the effects of other medication such as Dexamethasone (n = 2) or Metformin (n = 1) found positive results of these medications for preventing long-COVID. CONCLUSION Available evidence about the effect of medication treatment with antivirals during acute COVID-19 and reduced risk of developing long-COVID is conflicting. Heterogeneous evidence suggests that Remdesivir or Nirmaltrevir/Ritonavir could have a potential protective effect for long-COVID. A limited number of studies demonstrated a potential benefit of other medications such as Dexamethasone or Metformin, but more studies are needed.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Universidad Rey Juan Carlos, Avenida de Atenas S/N, 28922, Alcorcón, Madrid, Spain.
| | - Juan Torres-Macho
- Department of Internal Medicine, Hospital Universitario Infanta Leonor-Virgen de La Torre, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Raymart Macasaet
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA
| | | | - Sharina Macapagal
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Mario Caldararo
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Brandon Michael Henry
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Ana Franco-Moreno
- Department of Internal Medicine, Hospital Universitario Infanta Leonor-Virgen de La Torre, Madrid, Spain
| | - Kin Israel Notarte
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Besteher B, Rocktäschel T, Garza AP, Machnik M, Ballez J, Helbing DL, Finke K, Reuken P, Güllmar D, Gaser C, Walter M, Opel N, Rita Dunay I. Cortical thickness alterations and systemic inflammation define long-COVID patients with cognitive impairment. Brain Behav Immun 2024; 116:175-184. [PMID: 38036270 DOI: 10.1016/j.bbi.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023] Open
Abstract
As the heterogeneity of symptoms is increasingly recognized among long-COVID patients, it appears highly relevant to study potential pathophysiological differences along the different subtypes. Preliminary evidence suggests distinct alterations in brain structure and systemic inflammatory patterns in specific groups of long-COVID patients. To this end, we analyzed differences in cortical thickness and peripheral immune signature between clinical subgroups based on 3 T-MRI scans and signature inflammatory markers in n = 120 participants comprising healthy never-infected controls (n = 30), healthy COVID-19 survivors (n = 29), and subgroups of long-COVID patients with (n = 26) and without (n = 35) cognitive impairment according to screening with Montreal Cognitive Assessment. Whole-brain comparison of cortical thickness between the 4 groups was conducted by surface-based morphometry. We identified distinct cortical areas showing a progressive increase in cortical thickness across different groups, starting from healthy individuals who had never been infected with COVID-19, followed by healthy COVID-19 survivors, long-COVID patients without cognitive deficits (MoCA ≥ 26), and finally, long-COVID patients exhibiting significant cognitive deficits (MoCA < 26). These findings highlight the continuum of cortical thickness alterations associated with COVID-19, with more pronounced changes observed in individuals experiencing cognitive impairment (p < 0.05, FWE-corrected). Affected cortical regions covered prefrontal and temporal gyri, insula, posterior cingulate, parahippocampal gyrus, and parietal areas. Additionally, we discovered a distinct immunophenotype, with elevated levels of IL-10, IFNγ, and sTREM2 in long-COVID patients, especially in the group suffering from cognitive impairment. We demonstrate lingering cortical and immunological alterations in healthy and impaired subgroups of COVID-19 survivors. This implies a complex underlying pathomechanism in long-COVID and emphasizes the necessity to investigate the whole spectrum of post-COVID biology to determine targeted treatment strategies targeting specific sub-groups.
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Affiliation(s)
- Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany.
| | - Tonia Rocktäschel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Alejandra P Garza
- Institute of Inflammation and Neurodegeneration, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marlene Machnik
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany
| | - Johanna Ballez
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany
| | - Dario-Lucas Helbing
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Kathrin Finke
- Department of Neurology, Jena University Hospital, Germany
| | - Philipp Reuken
- Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Germany
| | - Daniel Güllmar
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Germany
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany; Department of Neurology, Jena University Hospital, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Ildiko Rita Dunay
- German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany; Institute of Inflammation and Neurodegeneration, Otto-von-Guericke-University, Magdeburg, Germany
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Fagevik Olsén M, Lannefors L, Johansson EL, Persson HC. Variations in respiratory and functional symptoms at four months after hospitalisation due to COVID-19: a cross-sectional study. BMC Pulm Med 2024; 24:63. [PMID: 38297244 PMCID: PMC10829323 DOI: 10.1186/s12890-024-02866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Much remains unknown about complex respiratory symptoms after COVID-19. Here we aimed to describe and analyse patients' various respiratory symptoms 4 months after discharge from hospitalisation for COVID-19, focusing on sex, previous pulmonary disease, and prolonged mechanical ventilation. METHODS This cross-sectional study involved five hospitals and included 52 patients with self-assessed respiratory dysfunction at 4 months after discharge from hospitalisation for severe COVID-19. Their average age was 63 years, 38% were women, 15 had a previous diagnosed pulmonary disease, and 29 were current or previous smokers. Additionally, 31 had required intensive care-among whom 21 were intubated and 11 needed mechanical ventilation for ≥20 days. Respiratory function was tested concerning lung volumes, expiratory flow, muscle strength, physical capacity (including concurrent oxygen saturation), thoracic expansion, and respiratory movements. RESULTS Among 52 patients, 47 (90%) had one or several objectively measured respiratory function abnormalities. Decreased thoracic expansion was observed in 32 patients (62%), abnormal respiratory movements in 30 (58%), decreased vital capacity in 21 (40%), low physical function in 13 (26%), and desaturation during the test in 9 (17%). Respiratory inspiratory muscle strength was more commonly diminished than expiratory strength (27% vs. 8%). We did not observe differences between men and women, or between patients with versus without diagnosed pulmonary disease, except that those with pulmonary disease had significantly lower physical capacity assessed with 6MWD (70% vs. 88% predicted, p = 0.013). Compared to those who did not, patients who required ≥20 days of mechanical ventilation performed similarly on most tests, except that all thoracic breathing movements were significantly smaller (p < 0.05). The numbers and combinations of abnormal findings varied widely, without clear patterns. CONCLUSION Patients with remaining respiratory symptoms 4 months after discharge from hospitalization due to COVID-19 may suffer from various abnormal breathing functions, and dysfunctional breathing that is not detected using traditional measurements. These patients may benefit from multidimensional measuring of breathing movement, thoracic expansion, and respiratory muscle strength, along with traditional measurements, to assess their symptoms and enable prescription of optimal treatment interventions and rehabilitation. TRIAL REGISTRATION FoU i Sverige (Research & Development in Sweden, Registration number: 274476, registered 2020-05-28).
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Box 455, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, SE, Sweden.
- Department of Physiotherapy, Sahlgrenska University Hospital, 413 45, Gothenburg, SE, Sweden.
| | - Louise Lannefors
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Box 455, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, SE, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, 413 45, Gothenburg, SE, Sweden
| | - Ewa-Lena Johansson
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Box 455, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, SE, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, 413 45, Gothenburg, SE, Sweden
| | - Hanna C Persson
- Department of Physiotherapy, Sahlgrenska University Hospital, 413 45, Gothenburg, SE, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ghoreshi ZAS, Abbasi-Jorjandi M, Asadikaram G, Sharif-Zak M, Haddad MK, Afgar A, Arefinia N, Dabiri S, Rosen C. Time Course of Biochemical and Metabolic Parameters During and After COVID-19. Curr Med Chem 2024; 31:CMC-EPUB-138002. [PMID: 38284721 DOI: 10.2174/0109298673282210231220115719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Long COVID is characterized by the persistence of symptoms among individuals who are infected with the SARS-CoV-2 virus. The enduring impact of these long-term effects on the health and well-being of those affected cannot be denied. METHOD About 470 patients with SARS-CoV-2 were consecutively recruited in this longitudinal study. The participants were entered into moderate, severe, and critical groups. 235 out of 470 participants were female. The levels of fasting blood sugar (FBS), alanine transaminase (SGPT), aspartate aminotransferase (SGOT), alkaline phosphatase (ALP), creatinine (Cr), urea, uric acid (UA), and total protein (TP) were measured during hospitalization and again at one and three months after infection. The levels of Zn and hemoglobin A1c (HbA1c) were also measured only during hospitalization. RESULT COVID-19 severity was associated with high levels of glucose, urea, Cr, ALT, AST, ALP, and HbA1c, and low levels of Zn, UA, and TP. There were significant sex differences for these markers at all three-time points. Glucose, urea, Cr, ALT, AST, and ALP all decreased three months after infection, whereas the levels of UA and TP returned towards normal. CONCLUSION COVID-19 infection affects the levels of multiple biochemical factors in a gender-dependent manner. The biochemical changes become more tangible with increasing disease severity, and several of these predict mortality. Levels begin to return to normal after the acute phase of the disease, but in some individuals, at three months, several markers were still not within the normal range. Whether the trajectory of these changes can predict long COVID requires further testing.
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Affiliation(s)
- Zohreh-Al-Sadat Ghoreshi
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
- School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran
- Applied Cellular and Molecular Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mojtaba Abbasi-Jorjandi
- Applied Cellular and Molecular Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Clinical Biochemistry, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Gholamreza Asadikaram
- Applied Cellular and Molecular Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Clinical Biochemistry, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Sharif-Zak
- Department of Clinical Biochemistry, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Khaksari Haddad
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Afgar
- Department of Parasitology and Mycology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Nasir Arefinia
- School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Shahriar Dabiri
- Department of Pathology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Clifford Rosen
- MaineHealth Institue for Research, Scarborough, Maine USA 04074
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31
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Sauer MC, Barlow PB, Comellas AP, Garg A. Anxiety and depression symptoms among patients with long COVID: a retrospective cohort study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01740-5. [PMID: 38231397 DOI: 10.1007/s00406-023-01740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
Patients suffering from post-acute sequelae of COVID-19 (PASC) have a higher prevalence of anxiety and depression than the general population. The long-term trajectory of these sequelae is still unfolding. To assess the burden of anxiety and depression among patients presenting to the University of Iowa Hospitals and Clinics (UIHC) post-COVID-19 clinic, we analyzed how patient factors influenced Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores. In this retrospective cohort study, the GAD-7 and PHQ-9 questionnaire scores of patients presenting to the UIHC post-COVID clinic between March 2021-February 2022 (N = 455) were compared to the scores of a sample of patients presenting to the general internal medicine (GIM) clinic during the same period (N = 94). Our analysis showed that patients with an absent history of depression on their electronic medical record (EMR) problem list scored significantly higher on the GAD-7 (mean difference -1.62, 95% CI -3.12 to -0.12, p = 0.034) and PHQ-9 (mean difference -4.45, 95% CI -5.53 to -3.37, p < 0.001) questionnaires compared to their similar counterparts in the GIM clinic. On the other hand, patients with an absent history of anxiety on their EMR problem list scored significantly higher on the GAD-7 (mean difference -2.90, 95% CI -4.0 to -1.80, p < 0.001) but not on the PHQ-9 questionnaire (p = 0.196). Overall, patients with PASC may have experienced a heavier burden of newly manifest anxiety and depression symptoms compared to patients seen in the GIM clinic. This suggests that the mental health impacts of PASC may be more pronounced in patients with no prior history of anxiety or depression.
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Affiliation(s)
- Michael C Sauer
- Department of Internal Medicine, University of Iowa Division of General Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Patrick B Barlow
- Department of Internal Medicine, University of Iowa Division of General Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Alejandro P Comellas
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Alpana Garg
- Department of Internal Medicine, University of Iowa Division of General Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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Ma Y, Zhang L, Wei R, Dai W, Zeng R, Luo D, Jiang R, Zhuo Z, Yang Q, Li J, Leung FW, Duan C, Sha W, Chen H. Risks of digestive diseases in long COVID: evidence from a population-based cohort study. BMC Med 2024; 22:14. [PMID: 38195495 PMCID: PMC10777515 DOI: 10.1186/s12916-023-03236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND In the post-pandemic era, a wide range of COVID-19 sequelae is of growing health concern. However, the risks of digestive diseases in long COVID have not been comprehensively understood. To investigate the long-term risk of digestive diseases among COVID patients. METHODS In this large-scale retrospective cohort study with up to 2.6 years follow-up (median follow-up: 0.7 years), the COVID-19 group (n = 112,311), the contemporary comparison group (n = 359,671) and the historical comparison group (n = 370,979) predated the COVID-19 outbreak were built using UK Biobank database. Each digestive outcome was defined as the diagnosis 30 days or more after the onset of COVID-19 infection or the index date. Hazard ratios (HRs) and corresponding 95% confidence intervals (CI) were computed utilizing the Cox regression models after inverse probability weighting. RESULTS Compared with the contemporary comparison group, patients with previous COVID-19 infection had higher risks of digestive diseases, including gastrointestinal (GI) dysfunction (HR 1.38 (95% CI 1.26 to 1.51)); peptic ulcer disease (HR 1.23 (1.00 to 1.52)); gastroesophageal reflux disease (GERD) (HR 1.41 (1.30 to 1.53)); gallbladder disease (HR 1.21 (1.06 to 1.38)); severe liver disease (HR 1.35 (1.03 to 1.76)); non-alcoholic liver disease (HR 1.27 (1.09 to 1.47)); and pancreatic disease (HR 1.36 (1.11 to 1.66)). The risks of GERD were increased stepwise with the severity of the acute phase of COVID-19 infection. Even after 1-year follow-up, GERD (HR 1.64 (1.30 to 2.07)) and GI dysfunction (HR 1.35 (1.04 to 1.75)) continued to pose risks to COVID-19 patients. Compared to those with one SARS-CoV-2 infection, reinfected patients were at a higher risk of pancreatic diseases (HR 2.57 (1.23 to 5.38)). The results were consistent when the historical cohort was used as the comparison group. CONCLUSIONS Our study provides insights into the association between COVID-19 and the long-term risk of digestive system disorders. COVID-19 patients are at a higher risk of developing digestive diseases. The risks exhibited a stepwise escalation with the severity of COVID-19, were noted in cases of reinfection, and persisted even after 1-year follow-up. This highlights the need to understand the varying risks of digestive outcomes in COVID-19 patients over time, particularly those who experienced reinfection, and develop appropriate follow-up strategies.
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Affiliation(s)
- Yuying Ma
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Lijun Zhang
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Rui Wei
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Weiyu Dai
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Ruijie Zeng
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- Shantou University Medical College, Shantou, 515000, Guangdong, China
| | - Dongling Luo
- Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Cardiovascular Institute, Southern Medical University, Guangzhou, 510080, China
| | - Rui Jiang
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Zewei Zhuo
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Qi Yang
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Jingwei Li
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Felix W Leung
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90024, USA.
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, 91343, USA.
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Weihong Sha
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Shantou University Medical College, Shantou, 515000, Guangdong, China.
| | - Hao Chen
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Shantou University Medical College, Shantou, 515000, Guangdong, China.
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Caamano E, Velasco L, Garcia MV, Asencio JM, Piñeiro P, Hortal J, Garutti I. Prognostic factors for deterioration of quality of life one year after admission to ICU for severe SARS-COV2 infection. Qual Life Res 2024; 33:123-132. [PMID: 37615735 DOI: 10.1007/s11136-023-03503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Patients with COVID-19 present long-term symptoms collectively known as "post-COVID syndrome". Long-term manifestations are more frequent in patients requiring admission to Intensive Care Units (ICU), but the risk factors for their development are still unknown. This study explores the quality of life of patients with severe COVID-19 one year after their discharge from ICU. METHODS Prospective observational study including 106 patients admitted to the ICU of a tertiary care hospital between March and August 2020. We analysed quality of life using the EuroQol-5D index (EQ-5D). We evaluated as possible risk factors associated with a worse value of the EQ-5D index the medical record, the clinical situation at hospital admission, the clinical situation at ICU admission and evolution in the ICU. As a secondary objective, we explored the presence of other frequent symptoms. RESULTS Most patients (55.4%) reported that their quality of life worsened one year after admission. The mean perceived health status, on the EQ-VAS scale (0-100), was 70.4, with a median of 70 (RI 60-90). The median EQ-5D index was 0.91 (RI 0.76-1). The factors independently related to lower quality of life were female sex and duration of mechanical ventilation. Almost all (91%) of the patients had sequelae one year after discharge from the ICU. The most frequent manifestations were neuropsychiatric (71%). CONCLUSIONS Critically ill COVID-19 patients worsen their quality of life more than one year after discharge. Female sex and duration of mechanical ventilation predict a lower quality of life assessed by the EQ-5D index.
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Affiliation(s)
- E Caamano
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain.
| | - L Velasco
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - M V Garcia
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - J M Asencio
- Department of General Surgery, Gregorio Maranon National Hospital, Madrid, Spain
| | - P Piñeiro
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - J Hortal
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - I Garutti
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
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Boesl F, Goereci Y, Gerhard A, Bremer B, Raeder V, Schweitzer F, Hoppmann U, Behrens J, Bellmann-Strobl J, Paul F, Wildemann B, Jarius S, Prüss H, Audebert HJ, Warnke C, Franke C. Cerebrospinal fluid findings in patients with neurological manifestations in post-COVID-19 syndrome. J Neurol 2024; 271:59-70. [PMID: 37999770 PMCID: PMC10769962 DOI: 10.1007/s00415-023-12092-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Information on cerebrospinal fluid (CSF) findings in patients with neurological manifestations in post-COVID-19 syndrome is scarce. METHODS Retrospective evaluation of 84 CSF samples in patients fulfilling post-COVID-19 criteria in two neurological post-COVID-19 outpatient clinics. RESULTS In 68% of samples, all CSF parameters were normal. The most frequent pathological CSF finding was elevation of total protein (median total protein 33.3 mg/dl [total range 18.5-116.2]) in 20 of 83 (24%) samples. The second most prevalent pathological finding was a blood-CSF barrier dysfunction as measured by elevation of QAlb (median QAlb 4.65 [2.4-13.2]) in 11/84 (13%). Pleocytosis was found in only 5/84 (6%) samples and was mild in all of them. CSF-restricted oligoclonal bands were found in 5/83 (6%) samples. Anti-neuronal autoantibodies in CSF were negative in most cases, whilst 12/68 (18%) samples were positive for anti-myelin autoantibodies in serum. PCR for herpesviridae (HSV-1/-2, VZV, EBV, CMV, HHV6) showed, if at all, only weakly positive results in CSF or EDTA whole blood/plasma. CONCLUSIONS The majority of samples did not show any pathologies. The most frequent findings were elevation of total protein and blood-CSF barrier dysfunction with no signs of intrathecal inflammation. CSF analysis still keeps its value for exclusion of differential diagnoses.
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Affiliation(s)
- Fabian Boesl
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany.
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ameli Gerhard
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Benno Bremer
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Vanessa Raeder
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Finja Schweitzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Uta Hoppmann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Janina Behrens
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Harald Prüss
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Heinrich J Audebert
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christiana Franke
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
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Freda MF, Scandurra C, Auriemma E, Guarino A, Lemmo D, Martino ML, Nunziata F, Maldonato NM, Continisio GI. Long-COVID in children: An exploratory case-control study from a bio-psycho-social perspective. J Psychosom Res 2024; 176:111564. [PMID: 38100898 DOI: 10.1016/j.jpsychores.2023.111564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE This study aimed to determine psychosocial differences between children with Long-COVID Syndrome (LCS) and two control groups (i.e., children who did not have COVID-19 and children who had previously had COVID-19 but did not develop LCS) from a bio-psycho-social and psychosomatic perspective. To classify children in these three groups, we examined the percentage of children meeting criteria for LCS, the type, frequency, perceived severity of symptoms, and their prevalence compared with children who never had SARS-CoV-2 infection. METHODS Data were collected from 198 Italian mothers of children aged 4 to 13 years using a cross-sectional web-based case-control survey. Of these, 105 were mothers of children who had contracted SARS-CoV-2 and 94 were mothers of children who had previously had COVID-19. Information was collected on the type and frequency of symptoms commonly referred to as "Long-COVID symptoms" and psychosocial dimensions (i.e., maternal and child health anxiety, COVID-19 anxiety, adjustment, and child deprivation). Descriptive analyses, chi-square tests, Student's T-Test, and analyses of variance were performed. RESULTS 29 children (15% of the total sample) developed LCS, mostly in the neurological/neuropsychiatric domain (59%), and of mild intensity. Regarding psychosocial and psychological dimensions, maternal health anxiety, child deprivation, and fear of SARS-CoV-2 infection differed between groups, with the first two dimensions higher in children with LCS than in controls and the latter lower in children with LCS than in controls. CONCLUSION This study sheds light on the need of integrating a psychosocial approach into the medical care of children with LCS and their caregivers.
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Affiliation(s)
- Maria Francesca Freda
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy.
| | - Cristiano Scandurra
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy.
| | - Ersilia Auriemma
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, University of Naples Federico II - Via Sergio Pansini 5, Napoli 80131, Italy.
| | - Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy.
| | - Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy.
| | - Francesco Nunziata
- Department of Translational Medical Sciences, University of Naples Federico II - Via Sergio Pansini 5, Napoli 80131, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II - Via Sergio Pansini 5, Napoli 80131, Italy.
| | - Grazia Isabella Continisio
- Department of Translational Medical Sciences, University of Naples Federico II - Via Sergio Pansini 5, Napoli 80131, Italy.
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Fujita K, Iwata T, Kanai O, Hata H, Tanaka H, Imakita T, Oi I, Odagaki T, Aoyama A, Sawai S, Mio T. Clinical features of pneumothorax associated with COVID-19: A retrospective analysis of two centres. Respir Investig 2024; 62:137-141. [PMID: 38113577 DOI: 10.1016/j.resinv.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Pneumothorax is a known sequela of coronavirus disease 2019 (COVID-19). However, the clinical features of pneumothorax associated with COVID-19 have not been fully elucidated. METHODS Patients who developed pneumothorax within 6 months of being diagnosed with COVID-19 were retrospectively analysed at two institutions. We investigated the background factors, COVID-19 severity and treatment, timing of pneumothorax onset, treatment modalities, treatment duration, and prognosis of these patients. RESULTS A total of 21 patients were diagnosed with pneumothorax within 6 months of COVID-19 diagnosis. The combined incidence rate of pneumothorax at two institutions was 0.89 %. The mean age of these patients was 72.5 years, and they were predominantly male (90.5 %), with a history of smoking (76.1 %). The most frequent comorbidity was hypertension, followed by type 2 diabetes mellitus, COPD, and malignancy. Approximately 76 % of the patients had moderate or severe disease requiring oxygenation. Moreover, 90.5 % of these patients were taking antiviral drugs; 52.4 %, immunosuppressant agents (baricitinib/tocilizumab); and 66.7 % were on dexamethasone. The median time to the onset of pneumothorax was 15.0 days, and 86 % of cases occurred within 1 month of COVID-19 diagnosis. Bilateral pneumothorax and pneumomediastinum were noted in one patient each. Chest drainage was performed in 71.4 % of the patients. The mean treatment duration for pneumothorax was 14.1 days, and the 30-day mortality rate was 28.6 %. CONCLUSION Pneumothorax associated with COVID-19 was more common in patients with moderate or severe disease requiring oxygenation, and occurred within 1 month of COVID-19 diagnosis. Pneumothorax associated with COVID-19 is a serious complication with a high mortality rate and clinicians should pay attention to it.
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Affiliation(s)
- Kohei Fujita
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Infectious Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
| | - Toshiyuki Iwata
- Department of Respiratory Medicine, Kyoto Katsura Hospital, Kyoto, Japan
| | - Osamu Kanai
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Infectious Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroaki Hata
- Department of Infectious Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan; Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroyuki Tanaka
- Department of Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takuma Imakita
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Issei Oi
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takao Odagaki
- Department of Infectious Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Satoru Sawai
- Department of Thoracic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tadashi Mio
- Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Taenzer M, Löffler-Ragg J, Schroll A, Monfort-Lanzas P, Engl S, Weiss G, Brigo N, Kurz K. Urine Metabolite Analysis to Identify Pathomechanisms of Long COVID: A Pilot Study. Int J Tryptophan Res 2023; 16:11786469231220781. [PMID: 38144169 PMCID: PMC10748708 DOI: 10.1177/11786469231220781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/28/2023] [Indexed: 12/26/2023] Open
Abstract
Background Around 10% of people who had COVID-9 infection suffer from persistent symptoms such as fatigue, dyspnoea, chest pain, arthralgia/myalgia, sleep disturbances, cognitive dysfunction and impairment of mental health. Different underlying pathomechanisms appear to be involved, in particular inflammation, alterations in amino acid metabolism, autonomic dysfunction and gut dysbiosis. Aim As routine tests are often inconspicuous in patients with Long COVID (LC), similarly to patients suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), accessible biomarkers indicating dysregulation of specific pathways are urgently needed to identify underlying pathomechanisms and enable personalized medicine treatment. Within this pilot study we aimed to proof traceability of altered metabolism by urine analysis. Patients and Methods Urine metabolome analyses were performed to investigate the metabolic signature of patients with LC (n = 25; 20 women, 5 men) in comparison to healthy controls (Ctrl, n = 8; 7 women, 1 man) and individuals with ME/CFS (n = 8; 2 women, 6 men). Concentrations of neurotransmitter precursors tryptophan, phenylalanine and their downstream metabolites, as well as their association with symptoms (fatigue, anxiety and depression) in the patients were examined. Results and Conclusion Phenylalanine levels were significantly lower in both the LC and ME/CFS patient groups when compared to the Ctrl group. In many LC patients, the concentrations of downstream metabolites of tryptophan and tyrosine, such as serotonin, dopamine and catecholamines, deviated from the reference ranges. Several symptoms (sleep disturbance, pain or autonomic dysfunction) were associated with certain metabolites. Patients experiencing fatigue had lower levels of kynurenine, phenylalanine and a reduced kynurenine to tryptophan ratio (Kyn/Trp). Lower concentrations of gamma-aminobutyric acid (GABA) and higher activity of kynurenine 3-monooxygenase (KMO) were observed in patients with anxiety. Conclusively, our results suggest that amino acid metabolism and neurotransmitter synthesis is disturbed in patients with LC and ME/CFS. The identified metabolites and their associated dysregulations could serve as potential biomarkers for elucidating underlying pathomechanisms thus enabling personalized treatment strategies for these patient populations.
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Affiliation(s)
- Maja Taenzer
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Schroll
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Pablo Monfort-Lanzas
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine Engl
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Natascha Brigo
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Kurz
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
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Punj M, Desai A, Hashash JG, Farraye FA, Castillo PR. COVID-19 breakthrough infections and sleep disorders: A population-based propensity matched analysis. Sleep Med X 2023; 6:100089. [PMID: 37881352 PMCID: PMC10594631 DOI: 10.1016/j.sleepx.2023.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
Objectives Examine risks for breakthrough COVID-19 infections in vaccinated patients with selected sleep disorders. Methods Real-time search and analysis using the TriNetX platform to evaluate risk of COVID-19 breakthrough infections (BTI) for patients having ICD-10 diagnoses relating to insomnia, circadian rhythm disorders, and inadequate sleep. The sleep disorder and control cohorts underwent propensity matching including factors for age, gender, race, ethnicity, and multiple co-morbid conditions. Results Of 24,720 patients identified as having a sleep disturbance relating to insomnia, circadian rhythm disorder, or inadequate sleep, 815 (3.2 %) were found to have a developed a BTI. There was a significant increased risk of BTI noted between the sleep disorder and control cohorts (adjusted odds ratio (aOR) of 1.40, 95 % confidence interval (CI) of 1.23-1.58). Subgroup analysis showed an elevated risk for BTI receiving two doses (aOR 1.53, 95 % CI 1.24-1.89) versus three doses (aOR 1.45, 95 % CI 1.24-1.69). Patients with the sleep disturbance were not found to be at an increased risk of hospitalization, intubation, death, or composite outcome of death and intubation. Conclusion The presence of having a diagnosis of insomnia, circadian rhythm disorder, or inadequate sleep was associated with increased risk of COVID-19 breakthrough infection.
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Affiliation(s)
| | - Aakash Desai
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Jana G. Hashash
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Francis A. Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Pablo R. Castillo
- Department of Allergy, Pulmonary, and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA
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Peterson BM, Unger I, Sun S, Park JY, Kim J, Gunasekera RS, Wilson J, Galbadage T. The vital role of exercise and nutrition in COVID-19 rehabilitation: synergizing strength. Front Sports Act Living 2023; 5:1305175. [PMID: 38143784 PMCID: PMC10748488 DOI: 10.3389/fspor.2023.1305175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Since the outset of the COVID-19 pandemic, the global healthcare community has faced the challenge of understanding and addressing the ongoing and multi-faceted SARS-CoV-2 infection outcomes. As millions of individuals worldwide continue to navigate the complexities of post-hospitalization recovery, reinfection rates, and the increasing prevalence of Long-COVID symptoms, comprehensive COVID-19 rehabilitation strategies are greatly needed. Previous studies have highlighted the potential synergy between exercise and nutrition, suggesting that their integration into patient rehabilitation programs may yield improved clinical outcomes for survivors of COVID-19. Our group aimed to consolidate existing knowledge following the implementation of patient, intervention, comparison, and outcome (PICO) search strategies on the distinct and combined impacts of exercise and nutrition interventions in facilitating the recovery of COVID-19 patients following hospitalization, with a specific focus on their implications for both public health and clinical practice. The incorporation of targeted nutritional strategies alongside exercise-based programs may expedite patient recovery, ultimately promoting independence in performing activities of daily living (ADLs). Nonetheless, an imperative for expanded scientific inquiry remains, particularly in the realm of combined interventions. This mini-review underscores the compelling prospects offered by an amalgamated approach, advocating for the seamless integration of exercise and nutrition as integral components of post-hospitalization COVID-19 rehabilitation. The pursuit of a comprehensive understanding of the synergistic effects and effectiveness of exercise and nutrition stands as a crucial objective in advancing patient care and refining recovery strategies in the wake of this enduring global health crisis.
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Affiliation(s)
- Brent M. Peterson
- Department of Kinesiology and Public Health, Biola University, La Mirada, CA, United States
| | - Isabelle Unger
- Department of Kinesiology and Public Health, Biola University, La Mirada, CA, United States
| | - Sunny Sun
- Department of Kinesiology and Public Health, Biola University, La Mirada, CA, United States
| | - Ji-Yeun Park
- Department of Kinesiology and Public Health, Biola University, La Mirada, CA, United States
| | - Jinsil Kim
- Department of Biological Sciences, Biola University, La Mirada, CA, United States
| | - Richard S. Gunasekera
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
| | - Jason Wilson
- Department of Mathematics and Computer Science, Biola University, La Mirada, CA, United States
| | - Thushara Galbadage
- Department of Kinesiology and Public Health, Biola University, La Mirada, CA, United States
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Kuchler T, Hausinger R, Braunisch MC, Günthner R, Wicklein R, Knier B, Bleidißel N, Maier M, Ribero A, Lech M, Adorjan K, Stubbe H, Kotilar K, Heemann U, Schmaderer C. All eyes on PCS: analysis of the retinal microvasculature in patients with post-COVID syndrome-study protocol of a 1 year prospective case-control study. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01724-5. [PMID: 38041762 DOI: 10.1007/s00406-023-01724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
Since widespread vaccination against COVID-19, the development of effective antiviral drugs, and the decreasing number of patients with COVID-19 in intensive care, the risk from SARS-CoV-2 infection appears less threatening. However, studies show that a significant number of patients suffer from long-term sequelae, even months after SARS-CoV-2 infection. The so-called post-COVID syndrome (PCS) often presents a diagnostic and treatment challenge for physicians. This study protocol describes the "All Eyes on PCS" study, which aims to investigate the retinal microvasculature in PCS patients and COVID-19-recovered patients to provide new insights into the pathophysiology of PCS. "All Eyes on PCS" is a prospective, case-control study with the primary objective of detecting endothelial dysfunction (ED) in patients with PCS. Therefore, we intend to recruit patients with PCS, fully SARS-CoV-2-infection-recovered (CR) participants, and SARS-CoV-2-infection-naïve (CN) participants. Baseline measurements will include: (1) patient-specific characteristics, (2) biochemistry, (3) retinal vessel analysis (RVA), (4) survey questionnaires as patient-reported outcomes measurements (PROMs), (5) optical coherence tomography (OCT), OCT angiography (OCTA), and adaptive optics (AO), (6) blood pressure recordings, (7) handgrip strength test. After 6 months, baseline measurements will be repeated in the PCS cohort, and after 1 year, a telephone query will be conducted to assess residual symptoms and treatment needs. The aim of this study is to gain insight into the pathophysiology of PCS and to provide an objective biomarker for diagnosis and treatment, while also creating a comprehensive clinical database of PCS patients.ClinicalTrials.gov Identifier: NCT05635552; Date: 2.12.2022.
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Affiliation(s)
- Timon Kuchler
- Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Renate Hausinger
- Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias C Braunisch
- Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nathalie Bleidißel
- Department of Ophthalmology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias Maier
- Department of Ophthalmology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andrea Ribero
- Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Medizinische Klinik und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Maciej Lech
- Medizinische Klinik und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Hans Stubbe
- Medizinische Klinik und Poliklinik II, LMU University Hospital Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Konstantin Kotilar
- Aachen University of Applied Sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Gremme Y, Derlien S, Katzer K, Reuken PA, Stallmach A, Lewejohann JC, Lemhöfer C. Visualizing exertional dyspnea in a post-COVID patient using electrical impedance tomography. Infection 2023; 51:1841-1845. [PMID: 37322387 PMCID: PMC10665229 DOI: 10.1007/s15010-023-02062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE AND METHOD Many post-COVID patients suffer from dyspnea on exertion. To visualize exercise-induced dyspnea, a post-COVID patient and a healthy volunteer underwent an exercise test on a treadmill under stress relevant to everyday life monitored by electrical impedance tomography (EIT). RESULTS The lung-healthy volunteer showed an even ventilation distribution throughout the assessment, a large ventilated area, and a butterfly-like lung shape with a convex lung rim. The post-COVID patient showed clear differences in the ventilated area compared to the control subject. During exercise, a constantly changing picture of differently ventilated areas is shown. However, especially the anterior regions were under-ventilated and larger areas were partially absent from ventilation. Overall, uncoordinated breathing and an uneven distribution of ventilation dominated the findings. CONCLUSION EIT is suitable for visualizing disturbed ventilation of the lungs, both at rest and under stress. The potential as a diagnostic tool in dyspnea assessment should be investigated.
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Affiliation(s)
- Yvonne Gremme
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-Universität Jena, Jena, Germany.
| | - Steffen Derlien
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Katrin Katzer
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Philipp A Reuken
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-Universität Jena, Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Jan-Christoph Lewejohann
- Department of Emergency Medicine, Jena University Hospital/Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-Universität Jena, Jena, Germany
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Li X, Zhang C, Bao Z. Mast cell activation may contribute to adverse health transitions in COVID-19 patients with frailty. Emerg Microbes Infect 2023; 12:2251589. [PMID: 37606034 PMCID: PMC10469413 DOI: 10.1080/22221751.2023.2251589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/30/2023] [Accepted: 08/20/2023] [Indexed: 08/23/2023]
Abstract
A prominent aspect of the post-coronavirus disease-2019 (post-COVID-19) era is long-COVID. Therefore, precise patient classification and exploration of the corresponding factors affecting long-COVID are crucial for tailored treatment strategies. Frailty is a common age-related clinical syndrome characterized by deteriorated physiological functions of multiple organ systems, which increases susceptibility to stressors. Herein, we performed an inclusion and exclusion analysis (definite COVID-19 infection diagnosis, clear underlying disease information, ≥60 years old, and repeated sampling of clinical cases) of 10,613 blood samples and identified frailty cases for further investigation. RNA-Seq data were used for differential gene expression and functional and pathway analyses. The results revealed that patients with frailty were more prone to poor health conversions and more sequelae, and the blood transcriptome had obvious disturbances in pathways associated with immune regulation, metabolism, and stress response. These adverse health transitions were significantly associated with mast cell activation. Additionally, NCAPG, MCM10, and CDC25C were identified as hub genes in the peripheral blood differential gene cluster, which could be used as diagnostic markers of poor health conversion. Our results indicate that healthcare measures should be prioritized to mitigate adverse health outcomes in this vulnerable patient group, COVID-19 patients with frailty, in post-COVID era.
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Affiliation(s)
- Xiangqi Li
- Department of Endocrinology and Metabolism, Gongli Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Chaobao Zhang
- Shanghai Key Laboratory of Clinical Geriatric Medicine; Department of Geriatric Medicine, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine; Department of Geriatric Medicine, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
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Panzeri A, DeVita M, Di Rosa E, Bottesi G, Brundisini V, Guarrera C, Ravelli A, Ponza I, Cattelan A, Volpe B, Iannizzi P, Ghisi M, Schiavo R, Mapelli D. Trauma Shaping the Psychopathological Correlates of Patients with Long-COVID: A 6-Months Longitudinal Study with Repeated Measures Mixed Models. Psychiatry Res 2023; 330:115609. [PMID: 38006716 DOI: 10.1016/j.psychres.2023.115609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
This research aimed at investigating how the experience of trauma can influence the psychological correlates of long-COVID over time in a clinical sample of patients hospitalized because of COVID-19. Through a longitudinal research design, 70 post-acute patients with COVID-19 were followed-up after hospital discharge in 3-time points up to 6 months and completed the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Symptoms Checklist-90-Revised (SCL-90 R). Repeated measures mixed models with random intercept were used to evaluate the effect of trauma (yes/no) over time (T1, T2, T3) on the SCL-90-R scales. Results showed that patients with trauma display significantly worse psychological outcomes in all the SCL-90-R dimensions [all padj < .05 for the principal effects of trauma(y)], especially in symptoms of depression [time 2 vs time 1*trauma(y): b = -3.86, 95%CI (-7.18, -0.53), padj = .035; time 3 vs time 1*trauma(y): b = -4.77, 95%CI (-8.10, -1.45), padj = .011], anxiety [time 3 vs time 1*trauma(y): b = -4.54, 95%CI (-7.72, -1.37), padj = .011], and obsessive-compulsive difficulties [time 3 vs time 1*trauma(y): b = -4.03, 95%CI (-7.20, -0.86), padj = .027]. These findings shed light on the long-term psychological consequences of COVID-19 among hospitalized patients and highlight the key role of trauma, suggesting its assessment to tailor psychological interventions.
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Affiliation(s)
- Anna Panzeri
- Department of General Psychology, University of Padua, Italy.
| | - Maria DeVita
- Department of General Psychology, University of Padua, Italy; Geriatrics Division, Department of Medicine, University of Padua, Italy
| | - Elisa Di Rosa
- Department of General Psychology, University of Padua, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padua, Italy
| | - Virginia Brundisini
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Claudia Guarrera
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Adele Ravelli
- Geriatrics Division, Department of Medicine, University of Padua, Italy
| | - Isabella Ponza
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Biancarosa Volpe
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | | | - Marta Ghisi
- Department of General Psychology, University of Padua, Italy; Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Rossana Schiavo
- Unità Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Daniela Mapelli
- Department of General Psychology, University of Padua, Italy
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Rouen A, Taïeb J, Caetano G, Pitron V, Elbaz M, Salmon D, Leger D. Polysomnographic parameters in long-COVID chronic insomnia patients. Dialogues Clin Neurosci 2023; 25:43-49. [PMID: 37390849 DOI: 10.1080/19585969.2023.2222714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/19/2023] [Accepted: 06/02/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION While COVID-19 is predominantly considered to be an acute self-remitting disease, it has been pointed out that a variety of symptoms can linger for several months, a phenomenon identified as long-COVID. Insomnia is particularly prevalent in long-COVID. In the present study, we aimed at confirming and characterising insomnia in long-COVID patients through polysomnography and to identify whether its parameters differ from patients with chronic insomnia and no long-COVID history. MATERIALS AND METHODS We conducted a case-control study, including 17 long-COVID patients with insomnia symptoms (cases), and 34 2:1 matched controls with a diagnostic of chronic insomnia and no history of long-COVID. All underwent a one-night polysomnography (PSG). RESULTS First, we observed that long-COVID patients with insomnia complaints have altered PSG parameters, in favour of the diagnosis of chronic insomnia. Second, we show that insomnia related to long-COVID PSG parameters was not significantly different from regular chronic insomnia PSG parameters. DISCUSSION Our results indicate that even though it is one of the most prevalent symptoms of long-COVID, its related insomnia resembles typical chronic insomnia, based on PSG studies. Even though additional studies are warranted, our results suggest that the pathophysiology and therapeutic options should be similar to those recommended for chronic insomnia.
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Affiliation(s)
- Alexandre Rouen
- Université Paris Cité, VIFASOM, ERC 7330, Paris, France
- AP-HP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
- Unité INSERM U933, Sorbonne Université, Paris, France
- Département de Génétique Médicale, Hôpital Armand-Trousseau, AP-HP, unité INSERM U933, Paris, France
| | - Jonathan Taïeb
- Université Paris Cité, VIFASOM, ERC 7330, Paris, France
- AP-HP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Gabriela Caetano
- Université Paris Cité, VIFASOM, ERC 7330, Paris, France
- AP-HP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Victor Pitron
- Université Paris Cité, VIFASOM, ERC 7330, Paris, France
- AP-HP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Maxime Elbaz
- Université Paris Cité, VIFASOM, ERC 7330, Paris, France
- AP-HP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Dominique Salmon
- Université de Paris Cité, Paris, France
- Service Maladies Infectieuses et Tropicales, Hôpital Cochin Hôtel Dieu, AP-HP, Paris, France
| | - Damien Leger
- Université Paris Cité, VIFASOM, ERC 7330, Paris, France
- AP-HP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France
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Pooladgar P, Sakhabakhsh M, Soleiman-Meigooni S, Taghva A, Nasiri M, Darazam IA. The effect of donepezil hydrochloride on post-COVID memory impairment: A randomized controlled trial. J Clin Neurosci 2023; 118:168-174. [PMID: 37952347 DOI: 10.1016/j.jocn.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Post-Coronavirus Disease (COVID-19) condition, known as "post-COVID syndrome," is associated with a range of complications persisting even after recovery. Among these complications, cognitive dysfunction, including memory impairment, has been relatively common observed, impacting executive function and quality of life. To date, no approved treatment exists for this specific complication. Therefore, the present clinical trial aimed to investigate the impact of Donepezil Hydrochloride on post-COVID memory impairment. METHODS A randomized, controlled trial (Approval ID: IRCT20210816052203N1) was conducted, enrolling 25 patients with post-COVID memory impairment. Participants with a history of hospitalization were randomly assigned to either the drug group (n = 10) or the control group (n = 15). Memory indices were assessed at baseline, one month, and three months later using the Wechsler Memory Scale-Revised test. SPSS software and appropriate statistical tests were employed for data analysis. RESULTS The statistical analysis revealed no significant difference in WMS-R subtest and index scores between the drug and control groups at the 4-week and 12-week follow-up periods. However, within the drug group, there was a notable increase in the visual reproduction I and verbal paired associates II subtests during the specified time intervals. CONCLUSION While donepezil 5 mg did not exhibit a significant overall increase in memory scales compared to the control group over time, our findings suggest that this medication may exert a positive effect on specific memory subtests. Further research and exploration are warranted to better understand the potential benefits of donepezil in managing post-COVID-related memory impairment. TRIAL REGISTRATION The study was approved by the Research Ethics Committee of Aja University of Medical Sciences (Approval ID: IR.AJAUMS.REC.1400.125) and registered in the Iranian Registry of Clinical Trials (IRCT) (Approval ID: IRCT20210816052203N1).
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Affiliation(s)
- Parham Pooladgar
- Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehdi Sakhabakhsh
- Head of Department of Neurology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran.
| | | | - Arsia Taghva
- Cognitive Science and Behavioral Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Basic Science Department, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yang L, Wu Y, Jin W, Mo N, Ye G, Su Z, Tang L, Wang Y, Li Y, Du J. The potential role of ferroptosis in COVID-19-related cardiovascular injury. Biomed Pharmacother 2023; 168:115637. [PMID: 37844358 DOI: 10.1016/j.biopha.2023.115637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a global health threat in 2019. An important feature of the disease is that multiorgan symptoms of SARS-CoV-2 infection persist after recovery. Evidence indicates that people who recovered from COVID-19, even those under the age of 65 years without cardiovascular risk factors such as smoking, obesity, hypertension, and diabetes, had a significantly increased risk of cardiovascular disease for up to one year after diagnosis. Therefore, it is important to closely monitor individuals who have recovered from COVID-19 for potential cardiovascular damage that may manifest at a later stage. Ferroptosis is an iron-dependent form of non-apoptotic cell death characterized by the production of reactive oxygen species (ROS) and increased lipid peroxide levels. Several studies have demonstrated that ferroptosis plays an important role in cancer, ischemia/reperfusion injury (I/RI), and other cardiovascular diseases. Altered iron metabolism, upregulation of reactive oxygen species, and glutathione peroxidase 4 inactivation are striking features of COVID-19-related cardiovascular injury. SARS-CoV-2 can cause cardiovascular ferroptosis, leading to cardiovascular damage. Understanding the mechanism of ferroptosis in COVID-19-related cardiovascular injuries will contribute to the development of treatment regimens for preventing or reducing COVID-19-related cardiovascular complications. In this article, we go over the pathophysiological underpinnings of SARS-CoV-2-induced acute and chronic cardiovascular injury, the function of ferroptosis, and prospective treatment approaches.
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Affiliation(s)
- Lei Yang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yunyi Wu
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Weidong Jin
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Nan Mo
- Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Gaoqi Ye
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zixin Su
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Lusheng Tang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ying Wang
- Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Yanchun Li
- Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Jing Du
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Lin M, Cao K, Xu F, Wu X, Shen Y, Lu S, Kuang Z, Ding H, Yuan S, Shao M, Gu G, Xing L, Gu T, Chen S, Sun J, Zhu J, Zhang X, Yang Y, Zhao G, Huang L, Xu J, Song Z. A follow-up study on the recovery and reinfection of Omicron COVID-19 patients in Shanghai, China. Emerg Microbes Infect 2023; 12:2261559. [PMID: 37732336 PMCID: PMC10563605 DOI: 10.1080/22221751.2023.2261559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
Limited follow-up data is available on the recovery of Omicron COVID-19 patients after acute illness. It is also critical to understand persistence of neutralizing antibody (NAb) and of T-cell mediated immunity and the role of hybrid immunity in preventing SARS-CoV-2 reinfection. This prospective cohort study included Omicron COVID-19 individuals from April to June 2022 in Shanghai, China, during a large epidemic caused by the Omicron BA.2 variant. A total of 8945 patients from three medical centres were included in the follow up programme from November 2022 to February 2023. Of 6412 individuals enrolled for the long COVID analysis, 605 (9.4%) individuals experienced at least one sequelae, mainly had fatigue and mental symptoms specific to Omicron BA.2 infection compared with other common respiratory tract infections. During the second-visit, 548 (12.1%) cases of Omicron reinfection were identified. Hybrid immunity with full and booster vaccination had reduced risk of SARS-CoV-2 reinfection by 0.29-fold (95% CI: 0.63-0.81) and 0.23-fold (95% CI: 0.68-0.87), respectively. For 469 participants willing to the hospital during the first visit, those who received full (72 [IQR, 36-156]) or booster (64 [IQR, 28-132]) vaccination had significantly higher neutralizing antibody titers than those with incomplete vaccination (36 [IQR, 16-79]). Moreover, non-reinfection cases had higher neutralizing antibody titers (64 [IQR, 28-152]) compared to reinfection cases (32 [IQR, 20-69]).
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Affiliation(s)
- Mengna Lin
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Kangli Cao
- Clinical Center for Bio-Therapy, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Feixiang Xu
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xueling Wu
- Department of Respiratory Medicine, Renji hospital, Shanghai jiaotong University, School of medicine, 160 Pujian Road, Shanghai, China
| | - Yao Shen
- Department of Respiratory and Critical Care Medicine, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Su Lu
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Zhongshu Kuang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Hailin Ding
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Shuyun Yuan
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Mian Shao
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Guorong Gu
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Lingyu Xing
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Tianwen Gu
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Shaodie Chen
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jian Sun
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jiamin Zhu
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiaoyan Zhang
- Clinical Center for Bio-Therapy, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yilin Yang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Guoping Zhao
- State Key Laboratory of Genetic Engineering, Fudan Microbiome Center, School of Life Sciences, Fudan University, Shanghai, People’s Republic of China
- Bio-Med Big Data Center, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Lihong Huang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jianqing Xu
- Clinical Center for Bio-Therapy, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Zhenju Song
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, People’s Republic of China
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Guo B, Zhao C, He MZ, Senter C, Zhou Z, Peng J, Li S, Fitzpatrick AL, Lindström S, Stebbins RC, Noppert GA, Li C. Identifying patterns of reported findings on long-term cardiac complications of COVID-19: a systematic review and meta-analysis. BMC Med 2023; 21:468. [PMID: 38017426 PMCID: PMC10685580 DOI: 10.1186/s12916-023-03162-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION Prior reviews synthesized findings of studies on long-term cardiac complications of COVID-19. However, the reporting and methodological quality of these studies has not been systematically evaluated. Here, we conducted a systematic review and meta-analysis on long-term cardiac complications of COVID-19 and examined patterns of reported findings by study quality and characteristics. METHODS We searched for studies examining long-term cardiac complications of COVID-19 that persisted for 4 weeks and over. A customized Newcastle-Ottawa scale (NOS) was used to evaluate the quality of included studies. Meta-analysis was performed to generate prevalence estimates of long-term cardiac complications across studies. Stratified analyses were further conducted to examine the prevalence of each complication by study quality and characteristics. The GRADE approach was used to determine the level of evidence for complications included in the meta-analysis. RESULTS A total number of 150 studies describing 57 long-term cardiac complications were included in this review, and 137 studies reporting 17 complications were included in the meta-analysis. Only 25.3% (n = 38) of studies were of high quality based on the NOS quality assessment. Chest pain and arrhythmia were the most widely examined long-term complications. When disregarding study quality and characteristics, summary prevalence estimates for chest and arrhythmia were 9.79% (95% CI 7.24-13.11) and 8.22% (95% CI 6.46-10.40), respectively. However, stratified analyses showed that studies with low-quality scores, small sample sizes, unsystematic sampling methods, and cross-sectional design were more likely to report a higher prevalence of complications. For example, the prevalence of chest pain was 22.17% (95% CI 14.40-32.55), 11.08% (95% CI 8.65-14.09), and 3.89% (95% CI 2.49-6.03) in studies of low, medium, and high quality, respectively. Similar patterns were observed for arrhythmia and other less examined long-term cardiac complications. CONCLUSION There is a wide spectrum of long-term cardiac complications of COVID-19. Reported findings from previous studies are strongly related to study quality, sample sizes, sampling methods, and designs, underscoring the need for high-quality epidemiologic studies to characterize these complications and understand their etiology.
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Affiliation(s)
- Boya Guo
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Chenya Zhao
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mike Z He
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Camilla Senter
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Zhenwei Zhou
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Jin Peng
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Song Li
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Annette L Fitzpatrick
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Sara Lindström
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rebecca C Stebbins
- Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Grace A Noppert
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Chihua Li
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA.
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
- Department of Epidemiology, School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Hoeggerl AD, Nunhofer V, Lauth W, Badstuber N, Held N, Zimmermann G, Grabmer C, Weidner L, Jungbauer C, Lindlbauer N, Neureiter H, Ortner T, Flamm M, Osterbrink J, Rohde E, Laner-Plamberger S. Epstein-Barr virus reactivation is not causative for post-COVID-19-syndrome in individuals with asymptomatic or mild SARS-CoV-2 disease course. BMC Infect Dis 2023; 23:800. [PMID: 37968601 PMCID: PMC10652630 DOI: 10.1186/s12879-023-08820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 11/17/2023] Open
Abstract
PURPOSE Post-COVID-19-Syndrome (PCS) frequently occurs after an infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, the understanding of causative mechanisms is still limited. Aim of this study was to determine the PCS rate among SARS-CoV-2 seropositive blood donors as representatives of supposedly healthy adults, who had experienced an asymptomatic or mild COVID-19 disease course, and to examine whether Epstein-Barr virus (EBV) is reactivated in individuals reporting PCS. METHODS The PCS rate was determined using questionnaires that included questions about infection and persistent symptoms. Pre-pandemic blood samples and samples collected at regular, pre-defined times after a SARS-CoV-2 infection were analysed for neopterin, a marker for antiviral immune responses, by an enzyme-linked immunosorbent assay (ELISA). Additionally, we determined the rate of SARS-CoV-2 anti-N total antibodies using an electrochemiluminescence immunoassay (ECLIA). Furthermore, quantitative real-time polymerase chain reaction (qPCR) to detect EBV DNA and ECLIA screening for EBV viral capsid-antigen (VCA) IgM, IgG and EBV nuclear antigen 1 (EBNA) IgG were performed. RESULTS Our data reveal that 18% of all infections result in PCS, with symptoms lasting for up to one year. In individuals reporting PCS, no elevated levels of neopterin were detected, indicating no persisting pro-inflammatory, antiviral immune response. SARS-CoV-2 antibody levels were declining in all participants in comparable manner over time, pointing to a successful virus clearance. In individuals with PCS, no EBV DNA could be detected. Furthermore, no differences in EBV specific antibody levels could be shown in PCS groups compared to non-PCS groups. CONCLUSION Our data suggest that PCS in per se healthy, immunocompetent adults cannot be ascribed to a reactivation of EBV.
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Affiliation(s)
- Alexandra Domnica Hoeggerl
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Verena Nunhofer
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Wanda Lauth
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, PMU Salzburg, Strubergasse 16, Salzburg, 5020, Austria
- Research and Innovation Management, PMU Salzburg, Strubergasse 16, Salzburg, 5020, Austria
| | - Natalie Badstuber
- Department of Psychological Assessment, Institute of Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Nina Held
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, PMU Salzburg, Strubergasse 16, Salzburg, 5020, Austria
- Research and Innovation Management, PMU Salzburg, Strubergasse 16, Salzburg, 5020, Austria
| | - Christoph Grabmer
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Lisa Weidner
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Wiedner Hauptstraße 32, Vienna, 1040, Austria
| | - Christof Jungbauer
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Wiedner Hauptstraße 32, Vienna, 1040, Austria
| | - Nadja Lindlbauer
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Heidrun Neureiter
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Tuulia Ortner
- Department of Psychological Assessment, Institute of Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, PMU Salzburg, Strubergasse 21, Salzburg, 5020, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, PMU Salzburg, Strubergasse 21, Salzburg, 5020, Austria
| | - Eva Rohde
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
- Spinal Cord Injury and Tissue Regeneration Centre Salzburg, PMU Salzburg, Strubergasse 21, Salzburg, 5020, Austria
| | - Sandra Laner-Plamberger
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria.
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Liu TH, Ho CH, Chen DTL, Wu JY, Huang PY, Lai CC, Hsieh KY, Su KP. Omega-3 polyunsaturated fatty acids and the psychiatric post-acute sequelae of COVID-19: A one-year retrospective cohort analysis of 33,908 patients. Brain Behav Immun 2023; 114:453-461. [PMID: 37716377 DOI: 10.1016/j.bbi.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Early prevention and management of psychiatric symptoms in long COVID (or post-COVID-19 conditions) are crucial for reducing long-term disability. Existing clinical guidelines recommend the use of omega-3 polyunsaturated fatty acids (PUFAs) as a promising therapeutic approach for various common psychiatric disorders due to their anti-inflammatory and neuroprotective characteristics. This study aims to investigate the potential efficacy of omega-3 PUFAs in alleviating the psychiatric sequelae following COVID-19. METHODS This 1-year retrospective cohort study used the TriNetX electronic health records network to examine the effects of omega-3 PUFAs supplements on psychiatric sequelae in adults diagnosed with COVID-19. Using propensity-score matching, the study compared those who used omega-3 PUFAs supplements with those who did not, assessing outcomes including depression, anxiety disorders, insomnia, and other somatic conditions up to a year after COVID-19 diagnosis. RESULTS In 16,962 patients who received omega-3 PUFAs supplements and 2,248,803 who did not, omega-3 supplementation significantly reduced the risk of developing psychiatric sequelae post-COVID-19 diagnosis (HR, 0.804; 95% CI, 0.729 to 0.888). Specifically, the risks for depression (HR, 0.828; 95% CI, 0.714 to 0.960), anxiety disorders (HR, 0.833; 95% CI, 0.743 to 0.933), and insomnia (HR, 0.679; 95% CI, 0.531 to 0.869) were reduced in the omega-3 group. This effect was consistent across sex, race, 18-59 age group, and patients with less than two doses of the COVID-19 vaccine. The omega-3 group also had a lower risk of cough and myalgia, but no significant difference was noted for other symptoms like chest pain, abnormal breathing, abdominal issues, fatigue, headache, and cognitive symptoms. CONCLUSION Omega-3 PUFAs may require re-evaluation as a preventive strategy against adverse mental health outcomes post-COVID-19 in placebo-controlled clinical trials.
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Affiliation(s)
- Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Daniel Tzu-Li Chen
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedicine, College of Medicine, China Medical University, Taichung
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Kuang-Yang Hsieh
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuan-Pin Su
- Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; King's College London, London, UK; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
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