Category: Overlapping Illnesses

Postural balance and its association with functionality and quality of life in non-hospitalized patients with post-acute COVID-19 syndrome

Abstract:

Background and objectives: The neuromuscular system is responsible for performing adequate muscle activities to maintain postural balance. Since COVID-19 can cause damage to this system, long-term sequelae might alter control of postural stability. This study aimed to evaluate the postural balance of patients with post-acute COVID-19 syndrome (PCS) who were not hospitalized and to evaluate the correlations of changes in postural balance with general fatigue, muscle strength, and quality of life (QoL).

Methods: This was a cross-sectional study in which 40 patients with PCS and 40 controls underwent balance assessment through the Berg Balance Scale (BBS) and Tinetti Balance Scale (TBS). They were evaluated for general fatigue by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, handgrip strength (HGS), and quality of life (QoL) by the Short Form-36 (SF-36).

Results: When compared to controls, patients with PCS had lower BBS and TBS scores (p = 0.001 for both). The FACIT-F score was lower in PCS patients (p = 0.0001). HGS was slightly lower in the PCS patients, but not statistically significant (p = 0.09). Regarding QoL, PCS patients showed worse evaluations in five dimensions of the SF-36 (physical functioning, physical role limitations, bodily pain, general health perceptions, and mental health). Both the BBS and TBS scores had statistically significant positive correlations with the FACIT-F score, HGS, and two SF-36 dimensions (physical role limitations and emotional role limitations).

Conclusions: Patients with PCS show worse postural balance than controls, which is associated with general fatigue, lower HGS, and poor QoL. Postural balance assessment should be considered in the follow-up and rehabilitation of PCS.

Source: de Sousa KCA, Gardel DG, Lopes AJ. Postural balance and its association with functionality and quality of life in non-hospitalized patients with post-acute COVID-19 syndrome. Physiother Res Int. 2022 Jul 17:e1967. doi: 10.1002/pri.1967. Epub ahead of print. PMID: 35842844. https://onlinelibrary.wiley.com/doi/10.1002/pri.1967 (Full text)

Spectrum of neurological manifestations among acute COVID-19 and long COVID-19 – A retrospective observational study

Abstract:

Objective. Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological symptoms. To compare the clinical features, imaging and treatments in patients with and without COVID 19. To compare the mortality and in-hospital stay among patients with and without COVID 19 and negative patients.

Materials and methods:In this retrospective, single-center study, we included all the patients who attended the department of neurology with neurologic symptoms with confirmed COVID-19 and long COVID-19 from June 2020 to January 2021. Data on clinical signs, diagnosis, laboratory findings were collected and analyzed from the records for positive patients and compared with neurologic patients without COVID-19 admitted in the same period.

Statistical analysis: The mean values between study groups were compared using an independent sample t-test and Mann Whitney u test. Categorical outcomes were compared using the Chi square test. Data was analyzed using coGuide software.

Results: Headache was the common neurologic manifestation present in COVID positive patients compared to COVID negative patients (39.13%). There was no statistically significant difference between the two groups in baseline parameters. Laboratory parameters like CRP, Serum Ferritin, LDH, D-dimer, ESR, and IL-6 showed a significant increase in COVID positive patients (P <0.05). In-hospital mortality was more in COVID positive patients than COVID negative patients (P <0.011).

Conclusion:The study showed varied neurologic symptoms in COVID patients, with headache as the common symptom. Hospital stay, morbidity, mortality, and inflammatory parameters were more in COVID positive patients compared to COVID negative patients.

Source: Pooja Dugani, Anish Mehta, Sunil V Furtado, R. Pradeep, Mahendra Javali, Purushottam Acharya, Vijayashree Thyagaraj, R. Srinivasa. Spectrum of neurological manifestations among acute COVID-19 and long COVID-19 – A retrospective observational study. Ref: Ro J Neurol. 2022;21(2) DOI: 10.37897/RJN.2021.2.14.  https://rjn.com.ro/articles/2022.2/RJN_2022_2_Art-14.pdf (Full text)

Long COVID and its Management

Abstract:

The pandemic of COVID-19 is the biggest public health crisis in 21st Century. Besides the acute symptoms after infection, patients and society are also being challenged by the long-term health complications associated with COVID-19, commonly known as long COVID. While health professionals work hard to find proper treatments, large amount of knowledge has been accumulated in recent years. In order to deal with long COVID efficiently, it is important for people to keep up with current progresses and take proactive actions on long COVID. For this purpose, this review will first introduce the general background of long COVID, and then discuss its risk factors, diagnostic indicators and management strategies. This review will serve as a useful resource for people to understand and prepare for long COVID that will be with us in the foreseeable future.

Source: Koc HC, Xiao J, Liu W, Li Y, Chen G. Long COVID and its Management. Int J Biol Sci 2022; 18(12):4768-4780. doi:10.7150/ijbs.75056. Available from https://www.ijbs.com/v18p4768.htm (Full text)

Improvement in Long-COVID Symptoms Using Acupuncture: A Case Study

Abstract:

Background: The long-COVID syndrome (LCS), defined by residual symptoms from acute COVID-19 for <60 days, affects about one-third of all COVID survivors and is an emerging public health challenge. Empirical data about the range of symptoms or the utility of acupuncture alone for the LCS are very limited.

Case: This observational case study of a 46-year-old male with LCS was conducted to preliminarily define the range of symptoms, a Traditional Chinese Medicine (TCM) diagnostic structure, and evaluate the potential utility of prescribed acupuncture for LCS.

Results: The primary TCM diagnostic patterns from this patient’s LCS presentation included Lung Qi and Yin Deficiency, Qi and Blood Stagnation, and Spleen Qi Deficiency with dampness. Acupuncture for this patient was associated with reduced symptoms and signs of LCS.

Conclusion: A preliminary TCM diagnostic structure for LCS was defined. Acupuncture appears to have been helpful for a patient with LCS. Further research is needed to demonstrate the efficacy of acupuncture and/or other TCM modalities for LCS.

Source: Hollifield M, Cocozza K, Calloway T, Lai J, Caicedo B, Carrick K, Alpert R, Hsiao AF. Improvement in Long-COVID Symptoms Using Acupuncture: A Case Study. Med Acupunct. 2022 Jun 1;34(3):172-176. doi: 10.1089/acu.2021.0088. Epub 2022 Jun 16. PMID: 35832108; PMCID: PMC9248334. https://www.liebertpub.com/doi/10.1089/acu.2021.0088 (Full text)

The Role of Acupuncture for Long COVID: Mechanisms and Models

Abstract:

Objective: To establish an evidence-based role for acupuncture as a safe and effective treatment for managing Long COVID in the integrative medical setting.

Background: COVID-19 progresses to a chronic state, termed Long COVID, in about 30% of cases with estimates as high as 40% for prolonged illness. Symptoms are diverse and range over several body systems, including unrelenting fatigue, persistent malaise, chronic pain, and mood changes. Early clinical reports suggest acupuncture can effectively address both symptoms and the underlying causes of Long COVID.

Evidence: Historically, acupuncture is well defined in Traditional Chinese Medicine writings to treat influenza-like febrile illnesses. Contemporary scientific literature and case studies support the value of acupuncture for symptoms associated with acute and chronic respiratory viral infections, such as influenza, including SARS and COVID-19. Recent reports provide early evidence of acupuncture’s effectiveness in managing Long COVID symptoms and may also have disease-modifying benefits.

Conclusion: Acupuncture is a viable adjunctive health care modality as part of a multidisciplinary approach for symptom control and disease management to improve quality of life in Long COVID patients. Since acupuncture may favorably modify the length and outcome of this condition, the model of acupuncture presented in this article warrants broader use in the integrative clinical setting and for further research.

Source: Williams JE, Moramarco J. The Role of Acupuncture for Long COVID: Mechanisms and Models. Med Acupunct. 2022 Jun 1;34(3):159-166. doi: 10.1089/acu.2021.0090. Epub 2022 Jun 16. PMID: 35832109; PMCID: PMC9248327. https://www.liebertpub.com/doi/10.1089/acu.2021.0090 (Full text)

Conceptualizing a Traditional Chinese Medicine and Pathology of Arousal Diagnostic and Pathophysiological Framework for Postacute Sequelae of COVID-19

Abstract:

Introduction: The postacute sequelae of COVID-19 (PASC) is a serious heterogeneous condition that affects a significant minority of those who endured COVID-19. PASC involves multiple body systems and an illness trajectory that has stages now being identified in medical research.

Objective: Traditional Chinese Medicine (TCM) and acupuncture are well suited to conceptualize and treat PASC and other postviral conditions. No description of TCM theory and its relationship with modern medical theory about PASC and its illness trajectory currently exists.

Conclusion: The authors provide an overview of the potential value of TCM for conceptualizing and treating PASC with a few examples and clarify directions for research.

Source: Calloway T, Hsiao AF, Brand M, Lai J, Geise C, Caceido B, Alpert R, Hollifield M. Conceptualizing a Traditional Chinese Medicine and Pathology of Arousal Diagnostic and Pathophysiological Framework for Postacute Sequelae of COVID-19. Med Acupunct. 2022 Jun 1;34(3):167-171. doi: 10.1089/acu.2022.0022. Epub 2022 Jun 16. PMID: 35832113; PMCID: PMC9248333. https://www.liebertpub.com/doi/10.1089/acu.2022.0022 (Full text)

Can aquatic exercises contribute to the improvement of the gait stereotype function in patients with Long COVID outcomes?

Abstract:

A variety of rehabilitation programmes can be offered to Long COVID patients, specifically physical training. Indeed 90% of these patients reports impairments of verticalization, stability and spatial orientation, making difficult exercise in the gym. The aim of our study was to assess the effectiveness and safety of aquatic exercise techniques as part of a comprehensive rehabilitation program for patients with Long COVID.

The first of a two-stage program involved development of aquatic exercises technique, which was evaluated in 12 patients with impaired upright posture control before and after exercising by “Habilect” video gait analysis system. During the second phase, effectiveness and safety of aqua exercises were tested in water pool as part of a comprehensive rehabilitation programme conducted in 23 patients with Long COVID outcomes. Physical examination, 6-minute step test, Euro-QL-5D questionnaire, Borg scale, laser Doppler flowmetry, cardiointervalography, and spirometry were performed before and after the aquatic exercises program.

After the training with aquatic exercises, indices of deviations of the main body axes of the head and the body mass centre ameliorated, as well as direction of body movement vector decreased (p<0.05). This study demonstrated a statistically significant improvement in exercise tolerance in both groups, as measured by the 6-minute step test after rehabilitation. The comparison group averaged 236.7 metres [126; 380] (T=8, p=0.047) after the rehabilitation course and the intervention group averaged 233.71 metres [150; 320] (T=8.0, p=0.047). When tested with the Euro-QL-5D questionnaire, a post-treatment improvement was noted in the comparison group on the anxiety/depression subscale (3 [3;3] (T=0, p=0.043)).

In the intervention group, laser Doppler flowmetry revealed a statistically significant increase in microcirculation (6.36 standard units after rehabilitation) [5.54; 8.17] (T=7.0, p=0.004), and a decrease of oxidative metabolism index of 6.89 standard units. [4.76; 6.96] (T=4.0, p=0.03). No serious adverse events were reported. In conclusion, the developed aquatic exercises technique seems to contribute to recovery of impaired upright posture and motor function, normalizing the walking pattern.

Source: Lobanov AA, Irina A Grishechkina, Andronov SV, Gleb N Barashkov, Andrey I Popov, Anatoliy D Fesyun, Elena P Ivanova, Maccarone MC, Stefano Masiero. Can aquatic exercises contribute to the improvement of the gait stereotype function in patients with Long COVID outcomes? Eur J Transl Myol. 2022 Jul 14. doi: 10.4081/ejtm.2022.10698. Epub ahead of print. PMID: 35833897.  https://pubmed.ncbi.nlm.nih.gov/35833897/ (Full text: Follow link on page)

Long-COVID in immunocompromised children

Abstract:

Coronavirus disease 2019 (COVID-19) can lead to an illness characterized by persistent symptoms which affect various organs and systems, known as long-COVID. This study aimed to assess the prevalence and clinical characteristics of long-COVID in children with immunodeficiency, in comparison to those without. A self-constructed questionnaire was created, which included questions regarding the child’s general health, the course of their COVID-19, their symptoms of long-COVID and its impact on their daily functioning, the diagnosis of multisystem inflammatory syndrome (MIS-C), and vaccination status. The questionnaire was completed by parents of 147 children – 70 children with a diagnosis of immunodeficiency (47.6%) and 77 who were immunocompetent (52.4%).

Immunocompetent children were more significantly affected by long-COVID than those immunocompromised. Its prevalence in the first 12-week post-infection was 60.0% and 35.7% in these groups, respectively. Beyond this period, these percentages had dropped to 34.6% and 11.43%, respectively. Children who were immunocompetent reported more often symptoms of fatigue, reduced exercise tolerance, and difficulty concentrating. Meanwhile, there was a slight increase in complaints of gastrointestinal symptoms in immunocompromised patients. The risk of developing long-COVID increased with age and COVID-19 severity in both groups. Furthermore, the daily activities of immunocompetent children were limited more frequently (41.8%) than for those who were immunocompromised (25%).

Conclusions: Although immunocompromised children experienced long-COVID, its prevalence and impact on daily functioning were significantly lower than among immunocompetent children. However, as the pathomechanisms of long-COVID are not yet fully understood, it is not currently possible to fully explain these findings.

What is known: • Long COVID is characterized by persistent symptoms following COVID-19, which can affect various tissues and organs, as well as mental health. • Due to the similar course of COVID-19 – mainly mild or asymptomatic – among children with and without immunodeficiency, the question arises, over whether the prevalence and severity of long-COVID is also similar in both groups.

What is new: • Immunocompromised children also suffer from long-COVID, but the prevalence is significantly lower than in the immunocompetent group of children. • The potential causes of less frequent and milder long-COVID in this group may be the milder course of COVID-19 and the state of reduced immunity protecting against neuroinflammation.

Source: Kuczborska K, Buda P, Książyk J. Long-COVID in immunocompromised children. Eur J Pediatr. 2022 Jul 14:1–9. doi: 10.1007/s00431-022-04561-1. Epub ahead of print. PMID: 35834042; PMCID: PMC9281224.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9281224/ (Full text)

Orbito-Frontal Cortex Hypometabolism in Children With Post-COVID Condition (Long COVID): A Preliminary Experience

Abstract:

We describe 3 children with new-onset neurocognitive problems after coronavirus disease 2019 (COVID-19), that showed, at the brain [18F]-fluorodeoxyglucose positron emission tomography/computed tomography, hypometabolism in the left orbito-frontal region. The voxel-wise analysis confirmed a cluster of hypometabolic voxels in this region with a peak at -18/46/-4mm (179 voxels, T-Score 8.1). These findings may explain neurocognitive symptoms that some children develop after COVID-19 and require further investigations.

Source: Cocciolillo F, Di Giuda D, Morello R, De Rose C, Valentini P, Buonsenso D. Orbito-Frontal Cortex Hypometabolism in Children With Post-COVID Condition (Long COVID): A Preliminary Experience. Pediatr Infect Dis J. 2022 Aug 1;41(8):663-665. doi: 10.1097/INF.0000000000003578. Epub 2022 Jul 13. PMID: 35839175.  https://pubmed.ncbi.nlm.nih.gov/35839175/

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

Abstract:

Background: Post COVID-19 syndrome (PC-19S) appears to be independent of acute illness severity and humoral response. The involvement of the autonomic nervous system (ANS), expressed by dysautonomia, has been hypothesized as a contributor. Several studies have associated the therapeutic effects of local anesthetics (LA) to their action on the ANS. To the best of our knowledge, this is the first report of therapeutic injections with LA linked to clinical improvement in a patient with PC-19S.

Patient concerns and diagnoses: This was a 54-year-old-man with postCOVID-19 symptoms lasting 14 weeks, including fatigue, breathlessness, diarrhea, muscle pain, and emotional lability.

Interventions and outcome: Injections of 0.5% procaine in the stellate ganglion (SG) and sphenopalatine ganglion (SPG), and in clinically relevant points in the scalp, thorax, and abdomen were performed 3 times over 3 months. The patient reported progressive improvement and was asymptomatic upon completing the treatment. Prescribed medications were discontinued. The 36-Item Short Form Health Survey (SF-36) score showed significant improvement across all SF-36-domains.

Conclusion: Subanesthetic doses of LA injected in clinically relevant points led to rapid and complete symptom resolution in this patient with PC-19S. Targeted LA injections may have therapeutic benefits in PC-19S and in other chronic diseases linked to stress and inflammation.

Source: Vinyes D, Muñoz-Sellart M, Caballero TG. Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report. Medicine (Baltimore). 2022 Jul 15;101(28):e29358. doi: 10.1097/MD.0000000000029358. PMID: 35839020. https://journals.lww.com/md-journal/Fulltext/2022/07150/Local_anesthetics_as_a_therapeutic_tool_for_post.33.aspx (Full text)