Tag: long covid management

Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome

Abstract:

Background: Post Exertional Symptom Exacerbation (PESE) is a characteristic symptom of Post-COVID Syndrome (PCS).

Objectives: This prospective study investigated the effect of a 6-week structured World Health Organisation (WHO) Borg CR-10 5-phase pacing protocol on PESE episodes and quality of life in a cohort of individuals with long-standing PCS (average duration of symptoms was 17 months).

Methods: Participants received weekly telephone calls with a clinician to complete the Leeds PESE Questionnaire (LPQ) and identify the appropriate phase of the pacing protocol. EQ-5D 5L was completed at the intervention’s beginning and end to measure overall health.

Results: Thirty-one participants completed the 6-week protocol, with a statistically and clinically significant reduction in the average number of PESE episodes (from 3.4 episodes in week one to 1.1 in week six), with an average decrease of 16% (95% CI: 9% to 24%; p<0.001) each week, and reduction across all three exertional triggers (physical, cognitive, and emotional). Physical activity levels showed moderate improvements during the intervention period. Mean EQ-5D 5L scores improved from 51.4 points to 60.6 points (paired difference of 9.2 points, 95% CI: 3.2 to 15.2 points; p=0.004).

Conclusions: A structured pacing protocol significantly reduces PESE episodes and improves overall health in PCS.

Source: Parker M, Sawant HB, Flannery T, Tarrant R, Shardha J, Bannister R, Ross D, Halpin S, Greenwood DC, Sivan M. Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome. J Med Virol. 2022 Dec 2. doi: 10.1002/jmv.28373. Epub ahead of print. PMID: 36461167. https://pubmed.ncbi.nlm.nih.gov/36461167/

Mid-term Follow-Up chest CT findings in recovered COVID-19 patients with residual symptoms

Abstract:

Objectives: More than a year has passed since the initial outbreak of SARS-CoV-2, which caused many hospitalizations worldwide due to COVID-19 pneumonia and its complications. However, there is still a lack of information detailing short- and long-term outcomes of previously hospitalized patients. The purpose of this study is to analyze the most frequent lung CT findings in recovered COVID-19 patients at mid-term follow-ups.

Methods: A total of 407 consecutive COVID-19 patients who were admitted to the XXXX and discharged between February 27, 2020, and June 26, 2020 were recruited into this study. Out of these patients, a subset of 108 patients who presented with residual asthenia and dyspnea at discharge, altered spirometric data, positive lung ultrasound and positive chest X-ray was subsequently selected, and was scheduled to undergo a mid-term chest computer tomography study, which was evaluated for specific lung alterations and morphological patterns.

Results: The most frequently observed lung CT alterations, in order of frequency, were ground glass opacities (81%), linear opacities (74%), bronchiolectases (64,81%), and reticular opacities (63,88%). The most common morphological pattern was the nonspecific interstitial pneumonia pattern (63,88%). Features consistent with pulmonary fibrosis were observed in 32 patients (29,62%).

Conclusions: Our work showed that recovered COVID-19 patients that were hospitalized and that exhibited residual symptoms after discharge had a slow radiological recovery with persistent residual lung alterations.

Advances in knowledge: This slow recovery process should be kept in mind when determining the follow-up phases in order to improve the long-term management of patients affected by COVID-19.

Source: Marchetti F, Izzi N, Donatelli A, Valentini A, Muzic SI, Dore R, Di Sabatino A, Perrone T, Falaschi F, Sabatini U, Ballesio A, Meloni F, Lettieri S, Mojoli F, Perlini S, Novati S, Pagani E, Klersy C, Bruno R, Preda L. Mid-term Follow-Up chest CT findings in recovered COVID-19 patients with residual symptoms. Br J Radiol. 2022 Nov 25:20220012. doi: 10.1259/bjr.20220012. Epub ahead of print. PMID: 36427055.  https://pubmed.ncbi.nlm.nih.gov/36427055/

Recommendations for Successful Implementation of the Use of Vocal Biomarkers for Remote Monitoring of COVID-19 and Long COVID in Clinical Practice and Research

Abstract:

The COVID-19 pandemic accelerated the use of remote patient monitoring in clinical practice or research for safety and emergency reasons, justifying the need for innovative digital health solutions to monitor key parameters or symptoms related to COVID-19 or Long COVID. The use of voice-based technologies, and in particular vocal biomarkers, is a promising approach, voice being a rich, easy-to-collect medium with numerous potential applications for health care, from diagnosis to monitoring.

In this viewpoint, we provide an overview of the potential benefits and limitations of using voice to monitor COVID-19, Long COVID, and related symptoms. We then describe an optimal pipeline to bring a vocal biomarker candidate from research to clinical practice and discuss recommendations to achieve such a clinical implementation successfully.

Source: Fischer A, Elbeji A, Aguayo G, Fagherazzi G. Recommendations for Successful Implementation of the Use of Vocal Biomarkers for Remote Monitoring of COVID-19 and Long COVID in Clinical Practice and Research. Interact J Med Res. 2022 Nov 15;11(2):e40655. doi: 10.2196/40655. PMID: 36378504; PMCID: PMC9668331. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668331/ (Full text)

SARS-CoV-2-on-Chip for Long COVID Management

Abstract:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a “wicked evil” in this century due to its extended progression and huge human mortalities. Although the diagnosis of SARS-CoV-2 viral infection is made simple and practical by employing reverse transcription polymerase chain reaction (RT-PCR) investigation, the process is costly, complex, time-consuming, and requires experts for testing and the constraints of a laboratory. Therefore, these challenges have raised the paradigm of on-site portable biosensors on a single chip, which reduces human resources and enables remote access to minimize the overwhelming burden on the existing global healthcare sector.

This article reviews the recent advancements in biosensors for long coronavirus disease (COVID) management using a multitude of devices, such as point-of-care biosensors and lab-on-chip biosensors. Furthermore, it details the shift in the paradigm of SARS-CoV-2-on-chip biosensors from the laboratory to on-site detection with intelligent and economical operation, representing near-future diagnostic technologies for public health emergency management.

Source: Cherusseri J, Savio CM, Khalid M, Chaudhary V, Numan A, Varma SJ, Menon A, Kaushik A. SARS-CoV-2-on-Chip for Long COVID Management. Biosensors (Basel). 2022 Oct 18;12(10):890. doi: 10.3390/bios12100890. PMID: 36291027; PMCID: PMC9599615. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9599615/ (Full text)

Preliminary Guidelines for the Clinical Evaluation and Management of Long COVID

Abstract:

Long-lasting coronavirus disease 2019 (COVID-19) symptoms beyond 12 weeks, the so-called ‘long COVID’ have been increasingly reported worldwide. Long COVID can be manifested in various forms, and there is an increasing demand for proper assessment and management. However, it is challenging when trying to determine the best-practice standards of care based on the current evidence because there is no internationally agreed clinical definition or clear treatment pathway. Therefore, the present guidelines have been drafted to provide advice on diagnosis and management based on the latest updated available evidence and the consensus of expert opinion. So far, no standard test and drug treatment can be strongly recommended for patients with long COVID because of a lack of evidence. The present guidelines provide advice based on 12 key questions, including appropriate interventions for long COVID that can be used in clinical practice. Continuous careful observation and studies related to long COVID are needed for the long-term impact of COVID-19 and proper management for long COVID to be determined.

Source: Kim Y, Kim SE, Kim T, Yun KW, Lee SH, Lee E, Seo JW, Jung YH, Chong YP. Preliminary Guidelines for the Clinical Evaluation and Management of Long COVID. Infect Chemother. 2022 Sep;54(3):566-597. doi: 10.3947/ic.2022.0141. PMID: 36196612; PMCID: PMC9533168. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533168/ (Full text)

Complementary and Alternative Medicine for Long COVID: Scoping Review and Bibliometric Analysis

Abstract:

Prolonged symptoms after the clearance of acute coronavirus disease 2019 (COVID-19) infection, termed long COVID, are an emerging threat to the post-COVID-19 era. Complementary and alternative medicine (CAM) interventions may play a significant role in the management of long COVID. The present study aimed to identify published studies on the use of CAM interventions for long COVID and provide an overview of the research status using bibliometric analysis.

The present scoping review searched MEDLINE, Embase, and Cochrane Library from inception until November 2021 and identified published studies on CAM interventions for long COVID. A narrative analysis of the study types and effectiveness and safety of the CAM interventions are presented and a bibliometric analysis of citation information and references of the included publications were analyzed using the Bibliometrix package for R. An electronic database search identified 16 publications (2 clinical studies and 14 study protocols of systematic reviews or clinical studies) that were included in the present study. Dyspnea or pulmonary dysfunction, quality of life, olfactory dysfunction, and psychological symptoms after COVID-19 infection were assessed in the included publications.

The two clinical studies suggested that Chinese herbal medications were effective in relieving symptoms of pulmonary dysfunction. Bibliometric analysis revealed the current trend of research publication in this area was driven by study protocols written by Chinese, Korean, and Indian authors. Thus, the present scoping review and bibliometric analysis revealed that there are few studies published about the use of CAM for long COVID and long-term management for COVID-19 survivors. Original studies on CAM interventions, including randomized controlled trials and systematic reviews, are required to actively support evidence for their use in the management of long COVID. PROSPERO registration: this trial is registered with CRD42021281526.

Source: Tae-Hun Kim, Sae-Rom Jeon, Jung Won Kang, Sunoh Kwon, “Complementary and Alternative Medicine for Long COVID: Scoping Review and Bibliometric Analysis“, Evidence-Based Complementary and Alternative Medicine, vol. 2022, Article ID 7303393, 7 pages, 2022. https://doi.org/10.1155/2022/7303393 https://www.hindawi.com/journals/ecam/2022/7303393/ (Full text)

A Review of Respiratory Post-Acute Sequelae of COVID-19 (PASC) and the Potential Benefits of Pulmonary Rehabilitation

Abstract:

With the SARS-CoV-2 pandemic continuing into its third year, the number of patients who survive acute COVID-19 infection but go on to develop long-term symptoms is increasing daily. Those individuals who experience one or more of a variety of persistent symptoms post-COVID-19 are now diagnosed with the syndrome called post-acute sequelae of COVID-19 (PASC), often colloquially called “Long COVID.” This article discusses relevant research and current hypotheses regarding the pathophysiology and management of respiratory symptoms of PASC, in order to provide primary care physicians with context for management of this heterogeneous population. We focus on the growing body of research that supports the use of pulmonary rehabilitation for patients with PASC to improve symptoms and quality of life.

Source: Simon M, Simmons JE. A Review of Respiratory Post-Acute Sequelae of COVID-19 (PASC) and the Potential Benefits of Pulmonary Rehabilitation. R I Med J (2013). 2022 Sep 1;105(7):11-15. PMID: 35930484.  https://pubmed.ncbi.nlm.nih.gov/35930484/ http://rimed.org/rimedicaljournal/2022/09/2022-09-11-covid-simon.pdf (Full text available as PDF file)

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)

Post-Acute Sequelae of SARS-CoV-2 infection (PASC) – Lessons Learned From a Coordinated Health Systems Response

Abstract:

Objective: To outline a consensus designed process for triaging and managing patients with Post COVID syndrome at the Mayo Clinic.

Patients and methods: We convened a central multidisciplinary team including members from General Internal Medicine, Occupational Medicine, Physical Medicine & Rehabilitation, Psychology, Allergy and Immunology, Infectious Disease, Pulmonology, Neurology, Cardiology, Pediatrics and Otorhinolaryngology, with membership from all the Mayo Clinic sites in Arizona, Florida, Iowa, Minnesota, and Wisconsin.

Results: Consensus recommendations were made for best practice guidelines on triaging and managing patients. Several innovations were agreed upon including a PASC specific appointment request form for data collection, a bio-registry, a bio-repository, and a PASC specific treatment program.

Conclusions: Given that each clinical site had individual clinical practices, these recommendations were implemented using different models, which may provide broad applicability to other clinical settings.

Source: Ganesh R, Vanichkachorn GS, Munipalli B, Hanson SN, Abu Dabrh AM, Croghan IT, Dawson NL, Hurt RT. Post-Acute Sequelae of SARS-CoV-2 infection (PASC) – Lessons Learned From a Coordinated Health Systems Response. Mayo Clin Proc Innov Qual Outcomes. 2022 Jun 1. doi: 10.1016/j.mayocpiqo.2022.05.007. Epub ahead of print. PMID: 35669936; PMCID: PMC9156955. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9156955/ (Full text)

Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study

Abstract:

Background: In the absence of research into therapies and care pathways for long COVID, guidance based on ’emerging experience’ is needed.

Aim: To provide a rapid expert guide for GPs and long COVID clinical services.

Design and setting: A Delphi study was conducted with a panel of primary and secondary care doctors.

Method: Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of ‘strongly agree’, ‘agree’, or ‘neither agree nor disagree’ from 90% or more of responders were taken as showing consensus.

Results: Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support.

Conclusion: Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.

Source: Nurek M, Rayner C, Freyer A, Taylor S, Järte L, MacDermott N, Delaney BC; Delphi panellists. Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study. Br J Gen Pract. 2021 Oct 28;71(712):e815-e825. doi: 10.3399/BJGP.2021.0265. PMID: 34607799; PMCID: PMC8510689. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8510689/ (Full text)