Tag: 2021

Risk Factors Associated with Development and Persistence of Long COVID: A Cross-Sectional Study

Abstract:

Background: Long coronavirus disease (COVID) has been a social concern. Though patient characteristics associated with the
development of long COVID are partially known, those associated with its persistence have not been identified.

Methods: We conducted a cross-sectional questionnaire survey of patients after COVID-19 recovery who visited the National
Center for Global Health and Medicine between February 2020 and March 2021. Demographic and clinical data and
data regarding the presence and duration of long COVID were obtained. We identified factors associated with the
development and persistence of long COVID using multivariate logistic and linear regression analysis, respectively.

Results: We analyzed 457 of 526 responses (response rate, 86.9%). The median age was 47 years, and 378 patients (84.4%)
had mild disease in the acute phase. The number of patients with any symptoms after 6 and 12 months after onset or
diagnosis were 120 (26.3%) and 40 (8.8%), respectively. Women were at risk for development of fatigue (odds ratio
[OR]: 2.03, 95% confidence interval [CI]: 1.31-3.14), dysosmia (OR: 1.91, 95% CI: 1.24-2.93), dysgeusia (OR: 1.56, 95% CI:
1.02-2.39), and hair loss (OR: 3.00, 95% CI: 1.77-5.09) and for persistence of any symptoms (coefficient: 38.0, 95% CI:
13.3-62.8). Younger age and low body mass index were risk factors for developing dysosmia (OR: 0.96, 95% CI: 0.94-
0.98 and OR: 0.94, 95% CI: 0.89-0.99, respectively) and dysgeusia (OR: 0.98, 95% CI: 0.96-1.00 and OR: 0.93, 95% CI:
0.88-0.98, respectively).

Conclusion: We identified risk factors for the development and persistence of long COVID. Many patients suffer from long-term
residual symptoms, even in mild cases.

Source: Yusuke Miyazato, Shinya Tsuzuki, Shinichiro Morioka, Mari Terda, Satoshi Kutsuna, Sho Saito, Yumiko Shimanishi, Kozue Takahashi, Mio Sanada, Masako Akashi, Chika Kuge, Yasuyo Osanai, Keiko Tanaka, Michiyo Suzuki, Kayoko Hayakawa, Norio Ohmagari. Risk Factors Associated with Development and Persistence of Long COVID: A Cross-Sectional Study.
doi: https://doi.org/10.1101/2021.09.22.21263998 https://www.medrxiv.org/content/10.1101/2021.09.22.21263998v1.full-text (Full text)

Who has long-COVID? A big data approach

Abstract:

Background Post-acute sequelae of SARS-CoV-2 infection (PASC), otherwise known as long-COVID, have severely impacted recovery from the pandemic for patients and society alike. This new disease is characterized by evolving, heterogeneous symptoms, making it challenging to derive an unambiguous long-COVID definition. Electronic health record (EHR) studies are a critical element of the NIH Researching COVID to Enhance Recovery (RECOVER) Initiative, which is addressing the urgent need to understand PASC, accurately identify who has PASC, and identify treatments.

Methods Using the National COVID Cohort Collaborative’s (N3C) EHR repository, we developed XGBoost machine learning (ML) models to identify potential long-COVID patients. We examined demographics, healthcare utilization, diagnoses, and medications for 97,995 adult COVID-19 patients. We used these features and 597 long-COVID clinic patients to train three ML models to identify potential long-COVID patients among (1) all COVID-19 patients, (2) patients hospitalized with COVID-19, and (3) patients who had COVID-19 but were not hospitalized.

Findings Our models identified potential long-COVID patients with high accuracy, achieving areas under the receiver operator characteristic curve of 0.91 (all patients), 0.90 (hospitalized); and 0.85 (non-hospitalized). Important features include rate of healthcare utilization, patient age, dyspnea, and other diagnosis and medication information available within the EHR. Applying the “all patients” model to the larger N3C cohort identified 100,263 potential long-COVID patients.

Interpretation Patients flagged by our models can be interpreted as “patients likely to be referred to or seek care at a long-COVID specialty clinic,” an essential proxy for long-COVID diagnosis in the current absence of a definition. We also achieve the urgent goal of identifying potential long-COVID patients for clinical trials. As more data sources are identified, the models can be retrained and tuned based on study needs.

Source: Pfaff ER, Girvin AT, Bennett TD, Bhatia A, Brooks IM, Deer RR, Dekermanjian JP, Jolley SE, Kahn MG, Kostka K, McMurry JA, Moffitt R, Walden A, Chute CG, Haendel MA, The N3C Consortium. (2021). Who has long-COVID? A big data approach [preprint]. UMass Center for Clinical and Translational Science Supported Publications. https://doi.org/10.1101/2021.10.18.21265168. Retrieved from https://escholarship.umassmed.edu/umccts_pubs/253

Viral diseases and the brain: Long COVID puts the spotlight on how viral infections affect the brain

Abstract:

Various viruses can affect the brain directly or indirectly. The specter of Long COVID has focused research on how respiratory viruses can cause infection and inflammation of brain cells.

Source: Hunter P. Viral diseases and the brain: Long COVID puts the spotlight on how viral infections affect the brain. EMBO Rep. 2021 Nov 29:e54342. doi: 10.15252/embr.202154342. Epub ahead of print. PMID: 34842325. https://pubmed.ncbi.nlm.nih.gov/34842325/

Long COVID from rheumatology perspective – a narrative review

Abstract:

Long-term sequel of acute COVID-19, commonly referred to as long COVID, has affected millions of patients worldwide. Long COVID patients display persistent or relapsing and remitting symptoms that include fatigue, breathlessness, cough, myalgia, arthralgia, sleep disturbance, cognitive impairment and skin rashes. Due to the shared clinical features, laboratory and imaging findings, long COVID could mimic rheumatic disease posing a diagnostic challenge. Our comprehensive literature review will help rheumatologist to be aware of long COVID manifestations and differentiating features from rheumatic diseases to ensure a timely and correct diagnosis is reached.

Source: Sapkota HR, Nune A. Long COVID from rheumatology perspective – a narrative review. Clin Rheumatol. 2021 Nov 30:1–12. doi: 10.1007/s10067-021-06001-1. Epub ahead of print. PMID: 34845562; PMCID: PMC8629735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629735/ (Full text)

Neurological, Psychological, and Cognitive Manifestations of Long-COVID

Abstract:

The terms “Post-COVID” or “Long-COVID” refer to a variety of physical and psychological symptoms that continue for weeks or months beyond the initial illness or develop as new-onset clinical manifestations after resolving of the acute phase. Moreover, these signs and symptoms are collectively referred to as post-acute sequelae of SARS-CoV-2 infection (PASC). Although the construction of solid epidemiological data is ongoing, the literature suggests that this phenomenon is a heterogeneous condition that can affect multiple organs and systems, with a potentially great impact on the quality of life. Furthermore, considering the millions of COVID-19 cases worldwide, these sequelae could have a high impact on health care systems.

In the context of long-COVID, many questions need to be answered. For example, it needs to be checked whether middle-aged women are at increased risk of developing debilitating long-term symptoms. To implement preventive and/or curative strategies, the data must be confirmed and the causes must be sought.

Neurological symptoms such as fatigue and muscle weakness, psychological conditions, including sleep disorders, anxiety, and depression, as well as neurocognitive problems can persist for months and can range from mild issues to serious and debilitating disorders. In particular, fatigue is one of the most common symptoms reported in the post-COVID-19 disease. It can affect up to 70% of patients and can last 6 months or more. Other neurological sequelae include smell and taste disorders (loss of smell or taste, altered sense of smell, and phantom smells), as well as dizziness, myalgia, joint pain, headache, blurred vision, and tinnitus. The incidence of each symptom and its duration after the acute phase vary greatly according to the type of study carried out, the timing, and the setting investigated.

About psychological consequences, if during the acute phase of the illness, fear, and the sense of abandonment, due to isolation at home or during hospitalization, are the most important psychological aspects of the disease, several problems of psychological distress may emerge after healing. Symptoms such as fear, mood changes, states of anxiety, depression, sleep disorders can occur alone or in combination by structuring, in turn, syndromes. Post-traumatic stress disorder and post-intensive care syndrome should not be underestimated. Likewise, potential neurocognitive sequelae need attention. What is the causal link between symptoms of cognitive impairment and the infection? The impact of the disease on mental health and cognitive performance will be well-elucidated in the coming years. To date, we can only speculate by referring to what has been observed about previous epidemics.

Taken together, data from the literature underline the need for longer follow-up studies and the organization of proper post-discharge care. In the meanwhile, the long-COVID issue requires a multiprofessional approach that involves neurologists, pain therapists, neurologists, nutritionists, neuroradiologists, physical therapists, otolaryngologists, and others. Follow-ups must be carefully scheduled in those who have suffered from the more severe forms of the disease and in individuals who have had mild or moderate COVID-19 acute manifestations. It is mandatory as, given the numbers of the pandemic, the public health implications could be considerable and the crashing wave of neurological and/or neuropsychiatric sequelae of COVID can have the effect of a tsunami.

Source:

Experiences Among School Personnel and School Nurses on Educational Adaptations for Students With CFS/ME: A Qualitative Interview Study

Abstract:

Introduction: Chronic fatigue syndrome (CFS/ME) is a disabling disease severely impacting school attendance, education, and social life in young students. Uncertainties surrounding CFS/ME etiology may impact the interpretation of CFS/ME in schools. Thus, school personnel need information from health care providers to make adequate adaptations to education and social life at school for these students.

Objectives: To explore teachers, counselors, and school nurses’ experiences with adapting education for students with CFS/ME aged 13-19 in secondary and high schools.

Design: A qualitative study with focus group interviews and individual interviews performed face-to-face or digitally between November 2020 and March 2021. Data were analyzed using Systematic text condensation.

Participants: Six teachers, two counselors, and four school nurses in secondary and high school participated.

Results: Adapting education for students with CFS/ME was challenging, especially before the students received a diagnosis. The challenges were related to identifying the students’ adaptational needs, maintaining a teacher-student relationship due to school absence, difficulties in maintaining continuity of education, and uncertainty regarding the diagnosis. Successful adaptations were related to quickly reacting to school absence, early referral to educational, psychological services, a close collaboration with the school management, and the development of digital teaching for students with CFS/ME. Interdisciplinary collaboration and a clear, constructive plan with adaptive measures, including maintained teacher-student communication and educational and social adaptations, may be useful in preventing the losses, young people, with CFS/ME experience.

Conclusion: Early interdisciplinary collaboration to adapt education and social life at school for students with CFS/ME, may support teachers, counselors, and school nurses in their efforts to adapt education and prevent losses related to academic and social development in students with CFS/ME.

Source: Similä WA, Rø TB, Nøst TH. Experiences Among School Personnel and School Nurses on Educational Adaptations for Students With CFS/ME: A Qualitative Interview Study. Front Pediatr. 2021 Nov 11;9:756963. doi: 10.3389/fped.2021.756963. PMID: 34858906; PMCID: PMC8632258. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8632258/ (Full text)

Boosting Health Recovery by Food Supplements: The Case of ME/CFS versus Post-Covid-19 Syndrome

Abstract:

Background and objectives: Other than the direct impact of cardiopulmonary sequelae, COVID-19 disease may cause persistent signs and symptoms describes as post-COVID syndrome or long COVID. The clinical presentation and neuroimaging aspects of patients suffering from this condition are remarkably similar to those seen in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Inflammation, immune disorder and oxidative damage have been documented to cause metabolic deregulation with decreased glycolysis and impaired mitochondrial function.

Purpose of the study: It is suggested that these alterations may be improved by the oral administration of a nutraceutical, Meldonium and sodium dichloroacetate (group designated as “oral treatment”; n=79) or intermittent intravenous infusions of magnesium sulphate together with multivitamins and essential amino acids (group designated as “infusion treatment”, n=18).

Materials and methods: 97 patients suffering from ME/CFS (n=79) or post-COVID syndrome (n=9) were included in a pragmatic prospective open-label trial using either oral or infusion therapy for 1 month, and the effect of treatment was assessed by the Fatigue Severity Scale (FSS).

Results: Upon interim analysis of 97 cases of ME/CFS and/or Post-COVID-19 syndrome therapeutic approach by either the oral or the infusion therapy was found to result in a reduction of the Fatigue Severity Scale (FSS) in two thirds of patients. The quotient of FSS after treatment divided by the FSS before treatment decreased by an average for all 97 cases by 14% within one month, with no difference between oral and infusion therapy (P=0.70), nor between the ME/CFS patient (mean quotient: 0.85, SD: 0.16) and the post-COVID cases (quotient: 0.87, SD: 0.16). Among the successful cases the FSS decreased by an average of 31%.

Conclusion: Preliminary results of the oral and the infusion therapy suggest a similar beneficial effect on fatigue in a substantial proportion of patients suffering from ME/CFS or Post-COVID syndrome. The result should be confirmed in a controlled trial, while the long-term efficacy is presently being investigated in a larger group of patients.

Source: Frank Comhaire and Jan Pen. Boosting Health Recovery by Food Supplements: The Case of ME/CFS versus Post-Covid-19 Syndrome. J Clin Pharmacol Ther. 2021;2(3):JCPT-02-1022. http://www.medtextpublications.com/open-access/boosting-health-recovery-by-food-supplements-the-case-of-me-947.pdf (Full text)

Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post–Coronavirus Disease

Abstract:

Objectives: The authors used cardiopulmonary exercise testing (CPET) to define unexplained dyspnea in patients with post-acute sequelae of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection (PASC). We assessed participants for criteria to diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Background: Approximately 20% of patients who recover from coronavirus disease (COVID) remain symptomatic. This syndrome is named PASC. Its etiology is unclear. Dyspnea is a frequent symptom.

Methods: The authors performed CPET and symptom assessment for ME/CFS in 41 patients with PASC 8.9 ± 3.3 months after COVID. All patients had normal pulmonary function tests, chest X-ray, and chest computed tomography scans. Peak oxygen consumption (peak VO2), slope of minute ventilation to CO2 production (VE/VCO2 slope), and end tidal pressure of CO2 (PetCO2) were measured. Ventilatory patterns were reviewed with dysfunctional breathing defined as rapid erratic breathing.

Results: Eighteen men and 23 women (average age: 45 ± 13 years) were studied. Left ventricular ejection fraction was 59% ± 9%. Peak VO2 averaged 20.3 ± 7 mL/kg/min (77% ± 21% predicted VO2). VE/VCO2 slope was 30 ± 7. PetCO2 at rest was 33.5 ± 4.5 mm Hg. Twenty-four patients (58.5%) had a peak VO2 <80% predicted. All patients with peak VO2 <80% had a circulatory limitation to exercise. Fifteen of 17 patients with normal peak VO2 had ventilatory abnormalities including peak respiratory rate >55 (n = 3) or dysfunctional breathing (n = 12). For the whole cohort, 88% of patients (n = 36) had ventilatory abnormalities with dysfunctional breathing (n = 26), increased VE/VCO2 (n = 17), and/or hypocapnia PetCO2 <35 (n = 25). Nineteen patients (46%) met criteria for ME/CFS.

Conclusions: Circulatory impairment, abnormal ventilatory pattern, and ME/CFS are common in patients with PASC. The dysfunctional breathing, resting hypocapnia, and ME/CFS may contribute to symptoms. CPET is a valuable tool to assess these patients.

Source: Mancini DM, Brunjes DL, Lala A, Trivieri MG, Contreras JP, Natelson BH. Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post-Coronavirus Disease. JACC Heart Fail. 2021 Dec;9(12):927-937. doi: 10.1016/j.jchf.2021.10.002. PMID: 34857177; PMCID: PMC8629098. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629098/ (Full text)

Survey of people with Myalgic Encephalomyelitis (ME) to explore their use and experiences of physiotherapy services in the UK

Abstract:

250,000 people live with Myalgic Encephalitis (ME) in the UK, this compares to 100,000 living with Multiple Sclerosis. In 2019, a survey by MEAction of 1906 people with ME, identified that over 50% of people who attended specialists ME clinics, employing physiotherapists, were unsatisfied with the services. People with ME (PwME) are also seen in regular musculoskeletal, community, neurological and paediatric physiotherapy services but the views of PwME related to these services are not known. The aim of this present survey, therefore, was to identify the experiences of PwME of physiotherapy services throughout all areas of physiotherapy practice.

Source: Clague-Baker N, Bull, M, Lesile K, Hilliard N. Survey of people with Myalgic Encephalomyelitis (ME) to explore their use and experiences of physiotherapy services in the UK. Physiotherapy, P076, VOLUME 113, SUPPLEMENT 1, E101-E102, DECEMBER 01, 2021. https://www.physiotherapyjournal.com/article/S0031-9406(21)00164-4/fulltext

Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies

Abstract:

The effects of coronavirus disease 2019 (COVID-19), a highly transmissible infectious respiratory disease that has initiated an ongoing pandemic since early 2020, do not always end in the acute phase. Depending on the study referred, about 10%-30% (or more) of COVID-19 survivors may develop long-COVID or post-COVID-19 syndrome (PCS), characterised by persistent symptoms (most commonly fatigue, dyspnoea, and cognitive impairments) lasting for 3 months or more after acute COVID-19. While the pathophysiological mechanisms of PCS have been extensively described elsewhere, the subtypes of PCS have not. Owing to its highly multifaceted nature, this review proposes and characterises six subtypes of PCS based on the existing literature.

The subtypes are non-severe COVID-19 multi-organ sequelae (NSC-MOS), pulmonary fibrosis sequelae (PFS), myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), post-intensive care syndrome (PICS) and medical or clinical sequelae (MCS). Original studies supporting each of these subtypes are documented in this review, as well as their respective symptoms and potential interventions. Ultimately, the subtyping proposed herein aims to provide better clarity on the current understanding of PCS.

Source: Yong SJ, Liu S. Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies. Rev Med Virol. 2021 Dec 9:e2315. doi: 10.1002/rmv.2315. Epub ahead of print. PMID: 34888989. https://pubmed.ncbi.nlm.nih.gov/34888989/