Tag: covid-19

Nirmatrelvir/ritonavir and risk of long COVID symptoms: a retrospective cohort study

Abstract:

We conducted a retrospective cohort study to assess whether treatment with nirmatrelvir/ritonavir was associated with a reduced risk of long COVID. We enrolled 500 adults with confirmed SARS-CoV-2 who were eligible for nirmatrelvir/ritonavir; 250 who took nirmatrelvir/ritonavir and 250 who did not. The primary outcome was the development of one or more of eleven prespecified long COVID symptoms, assessed through a structured telephone interview four months after the positive SARS-CoV-2 test. Multivariable logistic regression models controlled for age, sex, race/ethnicity, chronic conditions, and COVID-19 vaccination status.

We found that participants who took nirmatrelvir/ritonavir were no less likely to develop long COVID symptoms, compared to those who did not take the medication (44% vs. 49.6%, p = 0.21). Taking nirmatrelvir/ritonavir was associated with a lower odds of two of the eleven long COVID symptoms, brain fog (OR 0.58, 95% CI 0.38-0.88) and chest pain/tightness (OR 0.51, 95% CI 0.28-0.91). Our finding that treatment with nirmatrelvir/ritonavir was not associated with a lower risk of developing long COVID is different from prior studies that obtained data only from electronic medical records.

Source: Congdon S, Narrowe Z, Yone N, Gunn J, Deng Y, Nori P, Cowman K, Islam M, Rikin S, Starrels J. Nirmatrelvir/ritonavir and risk of long COVID symptoms: a retrospective cohort study. Sci Rep. 2023 Nov 11;13(1):19688. doi: 10.1038/s41598-023-46912-4. PMID: 37951998; PMCID: PMC10640584. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10640584/ (Full text)

Post-COVID-19 and Irritable Bowel Syndrome: A Literature Review

Abstract:

The emergence of post-COVID-19 syndrome (PCS), a complex and multifactorial condition that follows the acute COVID-19 infection, has raised serious concerns within the global medical community. Concurrently, Irritable Bowel Syndrome (IBS), a widespread chronic gastrointestinal (GI) dysfunction, is considered to be one of the most common disorders of gut–brain interaction (DGBI) that significantly affects the quality of life and social functioning of patients. PCS presents a wide range of symptoms and GI manifestations, including IBS.
This review aims to analyze the GI involvement and the prolonged symptoms of COVID-19 infection as part of PCS, in order to explore the potential development of post-infection IBS (PI-IBS) in COVID-19 patients. Irritating factors such as enteric infection, psychosocial conditions, food antigens, and antibiotics may lead to abnormalities in the physiological function of the GI system and could be involved in the development of PI-IBS. Through the presentation of the pathophysiological mechanisms and epidemiological studies that assessed the prevalence of IBS as part of PCS, we attempted to provide a better understanding of the long-term consequences of COVID-19 and the pathogenesis of PI-IBS.
Even though PI-IBS is becoming a global challenge, there are only a few studies about it and therefore limited knowledge. Currently, the majority of the existing treatment options are referred to non-COVID-19-associated DGBIs. Forthcoming studies may shed light on the mechanisms of PI-IBS that could be targeted for treatment development. Paramythiotis D, Karlafti E, Didagelos M, Fafouti M, Veroplidou K, Protopapas AA, Kaiafa G, Netta S, Michalopoulos A, Savopoulos C. Post-COVID-19 and Irritable Bowel Syndrome: A Literature Review. Medicina. 2023; 59(11):1961. https://doi.org/10.3390/medicina59111961 https://www.mdpi.com/1648-9144/59/11/1961 (Full text)
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Autonomic Manifestations of Long-COVID Syndrome

Abstract:

Purpose of review: Long-COVID is a novel condition emerging from the COVID-19 pandemic. Long-COVID is characterized by symptoms commonly seen in autonomic disorders including fatigue, brain fog, light-headedness, and palpitations. This article will critically evaluate recent findings and studies on Long-COVID and its physiological autonomic manifestations.

Recent findings: Studies have reported on the prevalence of different symptoms and autonomic disorders in Long-COVID cohorts. Autonomic nervous system function, including both the parasympathetic and sympathetic limbs, has been studied using different testing techniques in Long-COVID patients. While numerous mechanisms may contribute to Long-COVID autonomic pathophysiology, it is currently unclear which ones lead to a Long-COVID presentation. To date, studies have not tested treatment options for autonomic disorders in Long-COVID patients. Long-COVID is associated with autonomic abnormalities. There is a high prevalence of clinical autonomic disorders among Long-COVID patients, with limited knowledge of the underlying mechanisms and the effectiveness of treatment options.

Source: Hira R, Karalasingham K, Baker JR, Raj SR. Autonomic Manifestations of Long-COVID Syndrome. Curr Neurol Neurosci Rep. 2023 Nov 10. doi: 10.1007/s11910-023-01320-z. Epub ahead of print. PMID: 37947962. https://pubmed.ncbi.nlm.nih.gov/37947962/

Analysis of the correlation between heart rate variability and palpitation symptoms in female patients with long COVID

Abstract:

Objectives: To analyze the correlation between heart rate variability (HRV) and palpitation symptoms in female patients with long COVID.

Methods: A total of 272 female healthcare workers who were infected with SARS-CoV-2 for the first time in December 2022 at Fuzhou First Hospital affiliated with Fujian Medical University, were selected as study subjects. These subjects were divided into three groups based on their symptoms: a group with palpitations (70 cases), a group without palpitations but with other symptoms (124 cases), and a group consisting of asymptomatic cases (78 cases). The study compared the general information, COMPASS-31 scores, quality of life scores, and HRV parameters among the three groups. Furthermore, it analyzed the factors influencing palpitation symptoms in female patients with long COVID.

Results: Compared to the other two groups, the HRV parameters SDNN, HRVIndex, LF, and TP were significantly reduced in the group with palpitations (p < 0.05). Multivariate analysis revealed that HRVIndex (p = 0.016; OR: 0.966, 95% CI: 0.940∼0.994) had a significant impact on palpitation symptoms in female patients with long COVID.

Conclusions: The symptoms of palpitations in female patients with long COVID were found to be related to HRV parameters. Autonomic dysfunction may be connected to the occurrence of palpitation symptoms in long COVID.

Source: Jiang Yu, Cheng Yan, Xiao Jingwen, Wang Yicheng, Chen Geng, Zhang Yan. Analysis of the correlation between heart rate variability and palpitation symptoms in female patients with long COVID. Frontiers in Cardiovascular Medicine, 10, 2023 DOI=10.3389/fcvm.2023.1273156 ISSN=2297-055X  https://www.frontiersin.org/articles/10.3389/fcvm.2023.1273156 (Full text)

Long COVID with Persistent High Fever as the Main Manifestation: A Case Report

Abstract:

Background COVID-19, caused by SARS-CoV-2, has had a profound global impact, affecting millions of people. Long COVID, also known as Post-Acute Sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent symptoms following acute COVID-19, affecting more than 65 million individuals worldwide. In this case report, we highlight a rare occurrence of Long COVID with high fever, underlining its clinical significance.

Case presentation A 34-year-old female with a 24-day history of recurrent fever, initially reaching 37.5°C, accompanied by headache, fatigue, and joint pain, was admitted with a diagnosis of “fever of unknown origin.” Extensive testing, including negative nucleic acid tests for the novel coronavirus, negative blood cultures, and normal imaging, prompted the use of blood Next-Generation Sequencing (NGS) to detect COVID-19. Despite repeated negative nucleic acid tests, elevated COVID-19 antibody levels indicated the presence of long COVID. Methylprednisolone was administered, resulting in the resolution of symptoms. The patient remained asymptomatic during the follow-up.

Source: Chuangsen Fang, Liangliang Zheng, Ao Li et al. Long COVID with Persistent High Fever as the Main Manifestation: A Case Report, 06 November 2023, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-3506143/v1] https://www.researchsquare.com/article/rs-3506143/v1 (Full text)

Beyond the acute illness: Exploring long COVID and its impact on multiple organ systems

Abstract:

Unprecedented worldwide health catastrophe due to the COVID-19 pandemic has ended up resulting in high morbidity and mortality rates. Even though many people recover from acute infection, there is rising concern regarding post-COVID-19 conditions (PCCs), often referred to as post-acute sequelae of SARS-CoV-2 infection (PASC) or “long COVID.”

The respiratory, cardiovascular, neurological, and endocrine systems are just a few of the many organ systems that can be impacted by this multifarious, complicated illness. The clinical manifestations of long COVID can vary among individuals and may include fatigue, dyspnea, chest pain, cognitive impairment, and new-onset diabetes, among others.

Although the underlying processes of long COVID are not fully understood, they probably involve unregulated immune response, persistent generation of pro-inflammatory cytokines (chronic inflammation), autoimmune-like reactions, persistent viral replication, and micro-clot formation.

To create successful treatments and care plans, it is essential to comprehend the immunological mechanisms causing these difficulties. The pathogenesis of long COVID should be clarified and potential biomarkers to help with diagnosis and treatment should be sought after. To reduce the burden of long COVID on people and healthcare systems around the world, the need for long-term monitoring and management of long COVID problems should be emphasized. It also underscores the significance of a multidisciplinary approach to patient care. The goal of this review is to carefully evaluate the clinical signs and symptoms of long COVID, their underlying causes, and any potential immunological implications.

Source: Bhattacharjee N, Sarkar P, Sarkar T. Beyond the acute illness: Exploring long COVID and its impact on multiple organ systems. Physiol Int. 2023 Nov 9. doi: 10.1556/2060.2023.00256. Epub ahead of print. PMID: 37943302. https://akjournals.com/view/journals/2060/aop/article-10.1556-2060.2023.00256/article-10.1556-2060.2023.00256.xml (Full text)

Remission of severe forms of long COVID following monoclonal antibody (MCA) infusions: A report of signal index cases and call for targeted research

Abstract:

Objective: Long COVID has afflicted tens of millions globally leaving many previously-healthy persons severely and indefinitely debilitated. The objective here was to report cases of complete, rapid remission of severe forms of long COVID following certain monoclonal antibody (MCA) infusions and review the corresponding pathophysiological implications.

Design: Case histories of the first three index events (among others) are presented. Unaware of others with similar remissions, each subject independently completed personal narratives and standardized surveys regarding demographics/occupation, past history, and the presence and respective severity grading of 33 signs/symptoms associated with long COVID, comparing the presence/severity of those symptoms during the pre-COVID, long-COVID, post-vaccination, and post-MCA phases.

Setting: Patient interviews, e-mails and telephone conversations.

Subjects: Three previously healthy, middle-aged, highly-functioning persons, two women and one man (ages 60, 43, and 63 years respectively) who, post-acute COVID-19 infection, developed chronic, unrelenting fatigue and cognitive impairment along with other severe, disabling symptoms. Each then independently reported incidental and unanticipated complete remissions within days of MCA treatment.

Interventions: The casirivimab/imdevimab cocktail.

Measurements and main results: Irrespective of sex, age, medical history, vaccination status, or illness duration (18, 8 and 5 months, respectively), each subject experienced the same complete remission of their persistent disabling disease within a week of MCA infusion. Each rapidly returned to normal health and previous lifestyles/occupations with normalized exercise tolerance, still sustained to date over two years later.

Conclusions: These index cases provide compelling clinical signals that MCA infusions may be capable of treating long COVID in certain cases, including those with severe debilitation. While the complete and sustained remissions observed here may only apply to long COVID resulting from pre-Delta variants and the specific MCA infused, the striking rapid and complete remissions observed in these cases also provide mechanistic implications for treating/managing other post-viral chronic conditions and long COVID from other variants.

Source: Scheppke KA, Pepe PE, Jui J, Crowe RP, Scheppke EK, Klimas NG, Marty AM. Remission of severe forms of long COVID following monoclonal antibody (MCA) infusions: A report of signal index cases and call for targeted research. Am J Emerg Med. 2023 Oct 4;75:122-127. doi: 10.1016/j.ajem.2023.09.051. Epub ahead of print. PMID: 37944296. https://www.sciencedirect.com/science/article/pii/S073567572300534X (Full text)

Association between SARS-CoV-2 variants and post COVID-19 condition: findings from a longitudinal cohort study in the Belgian adult population

Abstract:

Background: While many studies on the determinants of post-COVID-19 conditions (PCC) have been conducted, little is known about the relationship between SARS-CoV-2 variants and PCC. This study aimed to assess the association between different SARS-CoV-2 variants and the probability of having PCC three months after the infection.

Methods: This study was a longitudinal cohort study conducted between April 2021 and September 2022 in Belgium. In total, 8,238 adults with a confirmed SARS-CoV-2 infection were followed up between the time of their infection and three months later. The primary outcomes were the PCC status three months post infection and seven PCC symptoms categories (neurocognitive, autonomic, gastrointestinal, respiratory, musculoskeletal, anosmia and/or dysgeusia, and other manifestations). The main exposure variable was the type of SARS-CoV-2 variants (i.e. Alpha, Delta, and Omicron), extracted from national surveillance data. The association between the different SARS-CoV-2 variants and PCC as well as PCC symptoms categories was assessed using multivariable logistic regression.

Results: The proportion of PCC among participants infected during the Alpha, Delta, and Omicron-dominant periods was significantly different and respectively 50%, 50%, and 37%. Participants infected during the Alpha- and Delta-dominant periods had a significantly higher odds of having PCC than those infected during the Omicron-dominant period (OR = 1.61, 95% confidence interval [CI] = 1.33-1.96 and OR = 1.73, 95%CI = 1.54-1.93, respectively). Participants infected during the Alpha and Delta-dominant periods were more likely to report neurocognitive, respiratory, and anosmia/dysgeusia symptoms of PCC.

Conclusions: People infected during the Alpha- and Delta-dominant periods had a higher probability of having PCC three months after infection than those infected during the Omicron-dominant period. The lower probability of PCC with the Omicron variant must also be interpreted in absolute figures. Indeed, the number of infections with the Omicron variant being higher than with the Alpha and Delta variants, it is possible that the overall prevalence of PCC in the population increases, even if the probability of having a PCC decreases.

Source: Thi Khanh HN, Cornelissen L, Castanares-Zapatero D, De Pauw R, Van Cauteren D, Demarest S, Drieskens S, Devleesschauwer B, De Ridder K, Charafeddine R, Smith P. Association between SARS-CoV-2 variants and post COVID-19 condition: findings from a longitudinal cohort study in the Belgian adult population. BMC Infect Dis. 2023 Nov 8;23(1):774. doi: 10.1186/s12879-023-08787-8. PMID: 37940843; PMCID: PMC10634063. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10634063/ (Full text)

Several De-Regulated Chemokine Pathways Characterize Long COVID Syndrome

Abstract:

Introduction: The diagnosis of the Long COVID multi-organ syndrome is impeded by lack of circulating biomarkers. Hypothesis: We hypothesized, that post-COVID syndrome is associated with circulating protein de-regulation, enabling diagnosis of long COVID syndrome.

Methods: Consecutive patients (70% female, 55±8y) with long COVID syndrome (n=70, 64.3% female, 49±6y) and non-diseased, non-vaccinated healthy controls (n=23, 70% female, 55±8y) of the Vienna POSTCOV Registry (EC 1008/2021) were included, and blood samples were collected. Proteomics was performed by using the Olink proteomics technology (Olink Proteomics, Uppsala, Sweden), by using cardiovascular, Immunologic, inflammation and neurologic protein (3×96 protein) panels. Protein-protein interaction network were built by selecting the significantly dysregulated proteins from the 4 panels, and were classified into functional groups.

Results: Multiplex protein panel revealed 34 significantly de-regulated proteins as compared to controls. Gene ontology categorized the 29 upregulated proteins into several pathways with significant (false discovery rate <0.05) functional enrichment in biological processes (eg. death-inducing signaling complex assembly or positive regulation of tumor necrosis factor-mediated signaling pathway), and in molecular function (catalytic activity). Downregulated proteins were in association with chemokine-mediated signaling pathway and chemokine activity (Figure). KEGG pathway analyses revealed upregulated apoptosis, TNF- and NF-κB signaling pathways, but unchanged ACE2 receptors in patients with long COVID syndrome.

Conclusions: Several de-regulated chemokine pathways characterize long COVID syndrome and may serve as a combined biomarker panel for long COVOD diagnosis and target drug prediction.

Source: Mariann Gyongyosi, Emilie Han, Dominika Lukovic, Kevin Hamzaraj, Jutta K Bergler-Klein and Ena Hasimbegovic. Several De-Regulated Chemokine Pathways Characterize Long COVID Syndrome. Originally published 6 Nov 2023,Circulation. 2023;148:A18340 https://www.ahajournals.org/doi/abs/10.1161/circ.148.suppl_1.18340

Decreased Pulmonary Blood Flow and Airway Volumes in Patients With Long COVID Syndrome Assessed by Functional Respiratory Imaging

Abstract:

Introduction: In contrast to normal chest X-ray, lung computed tomography (CT), and physiological lung and cardiac functions, many patients with long COVID syndrome suffer from shortness of breath.

Hypothesis: The aim of this study was to quantify the pulmonary blood and airway volumes of long COVID patients compared with that of healthy controls.

Methods: Patients with long COVID syndromes were included if they had PCR-verified previous (≥3 months) SARS-CoV-2 infection, had normal laboratory (e.g. inflammation, coagulation, cardiac or other organ) parameter, normal pulmonary morphology (chest X-ray and CT) and function (spirometry and body plethysmography). The lung CT images were postprocessed by Functional Respiratory imaging analysis by using 3D reconstruction with automated lung vessel segmentation algorithm. Data of the quantitative images were compared with age, gender, and BMI-matched healthy controls.

Results: Thirty patients (45±13 years, 37% male, 25.9±4.3 kg/m^2) at a median time of 256 (118-574) days after a confirmed COVID infection and 30 healthy controls (55±7y, 37% male, 26.3±2.7 kg/m^2) were included. All long COVID patients complained of dyspnoea and 14 (48.3%) patients reported thoracic pain. The total pulmonary blood volume was significantly lower in the long COVID patients compared to controls (190±24.3 mL/m^2 vs230.6±26.2 ml/m^2, p<0.001). Similarly, the capillary-small vessel blood flow (vessel cross sectional area <5 mm^2) was reduced in the long COVID population (118±19 mL vs 132±23 mL, p=0.011). (Figure). The specific image-based airway volume of the distal lung regions was lower than that of the healthy population (11.1±6.74 mL vs 17.33±7.7 mL, p<0.05).

Conclusions: Both the reduced global and capillary pulmonary blood flow, and distal airway volumes indicate impaired gas exchange and might explain the pulmonary complaints of patient with long COVID syndromes even severe months after Coronavirus infection.

Source: Mariann Gyongyosi, Emilie Han, Dominika Lukovic, Eslam Samaha, Jutta K Bergler-Klein and Ena Hasimbegovic. Decreased Pulmonary Blood Flow and Airway Volumes in Patients With Long COVID Syndrome Assessed by Functional Respiratory Imaging. Originally published6 Nov 2023Circulation. 2023;148:A16513 https://www.ahajournals.org/doi/abs/10.1161/circ.148.suppl_1.16513