Recovery and symptom trajectories up to two years after SARS-CoV-2 infection: population based, longitudinal cohort study

BMJ, Journal Year: 2023, Volume and Issue: unknown, P. e074425 - e074425

Published: May 31, 2023

To evaluate longer term symptoms and health outcomes associated with post-covid-19 condition within a cohort of individuals SARS-CoV-2 infection.Population based, longitudinal cohort.General population canton Zurich, Switzerland.1106 adults confirmed infection who were not vaccinated before 628 did have an infection.Trajectories self-reported status covid-19 related between months six, 12, 18, 24 after excess risk at six compared had no infection.22.9% (95% confidence interval 20.4% to 25.6%) infected fully recover by months. The proportion reported having recovered decreased 18.5% (16.2% 21.1%) 12 17.2% (14.0% 20.8%) infection. When assessing changes in status, most participants continued recovery (68.4% (63.8% 72.6%)) or overall improvement (13.5% (10.6% 17.2%)) over time. Yet, 5.2% (3.5% 7.7%) worsening 4.4% (2.9% 6.7%) alternating periods impairment. point prevalence severity also time, 18.1% (14.8% 21.9%) reporting 8.9% (6.5% 11.2%) all four follow-up time points, while 12.5% (9.8% 15.9%) alternatingly absent present. Symptom was higher among those (adjusted difference 17.0% (11.5% 22.4%)). Excess difference) for individual ranged from 2% 10%, the highest risks observed altered taste smell (7.7% 11.8%)), post-exertional malaise (9.4% (6.1% 12.7%)), fatigue (5.4% (1.2% 9.5%)), dyspnoea (7.8% (5.2% 10.4%)), reduced concentration (8.3% (6.0% 10.7%)) memory (5.7% 7.9%)).Up 18% up two years infection, evidence symptom controls. Effective interventions are needed reduce burden condition. Use multiple outcome measures consideration expected rates heterogeneity trajectories important design interpretation clinical trials.ISRCTN18181860, .

Language: Английский

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Effectiveness of a personalised self-management intervention for people living with long covid (Listen trial): pragmatic, multicentre, parallel group, randomised controlled trial

BMJ Medicine, Journal Year: 2025, Volume and Issue: 4(1), P. e001068 - e001068

Published: Jan. 1, 2025

To evaluate the effectiveness of Listen, a self-management support intervention, for people living with long covid who were not in hospital. Pragmatic, multicentre, parallel group, randomised controlled trial. Twenty four sites England and Wales. Identified from clinic waiting lists, word mouth, adverts/social media self-referred to trial, 554 adults receive either Listen trial intervention or NHS usual care. The involved up six one-to-one personalised sessions trained healthcare practitioners an accompanying handbook co-designed by lived experience health professionals. Usual care was variable, ranging no access, access mobile applications resources, specialist clinics. primary outcome Oxford participation activities questionnaire (Ox-PAQ) routine scale score at three months assessed intention-to-treat population. Secondary outcomes included Ox-PAQ emotional wellbeing social engagement scores, Short Form-12 (SF-12) survey, fatigue impact scale, generalised self-efficacy months. EuroQol five-dimension five-level (EQ-5D-5L) utility. Serious adverse events recorded. Between 27 May 2022 15 September 2023, (mean age 50 (standard deviation 12.3) years; 394 (72.4%) women) randomly assigned. At months, participants assigned group reported small non-significant improvements capacity daily as (adjusted mean difference -2.68 (95% confidence interval (CI) -5.38 0.02), P=0.052) compared For secondary outcomes, receiving also significant mental (Ox-PAQ -5.29 CI -8.37 -2.20), P=0.001; SF-12 2.36 0.77 3.96), P=0.004), reductions (fatigue -7.93 -11.97 -3.88), P<0.001), increases (generalised 2.63 1.50 3.75), P<0.001). No differences found (-2.07 -5.36 1.22), P=0.218) physical (0.32 -0.93 1.57), P=0.612). related serious reported. resulted short term when Improvements wellbeing, fatigue, quality life, Physical affected intervention. limited understanding how much change is clinically meaningful this population along unblinded design, use self-referral recruitment method variable may have introduced unintended bias thus limits robust conclusions about Further research required fully establish ISRCTN36407216, ISRCTN registry, registered January 2022.

Language: Английский

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Laboratory Findings and Biomarkers in Long COVID: What Do We Know So Far? Insights into Epidemiology, Pathogenesis, Therapeutic Perspectives and Challenges

International Journal of Molecular Sciences, Journal Year: 2023, Volume and Issue: 24(13), P. 10458 - 10458

Published: June 21, 2023

Long COVID (LC) encompasses a constellation of long-term symptoms experienced by at least 10% people after the initial SARS-CoV-2 infection, and so far it has affected about 65 million people. The etiology LC remains unclear; however, many pathophysiological pathways may be involved, including viral persistence; chronic, low-grade inflammatory response; immune dysregulation defective reactivation latent viruses; autoimmunity; persistent endothelial dysfunction coagulopathy; gut dysbiosis; hormonal metabolic dysregulation; mitochondrial dysfunction; autonomic nervous system dysfunction. There are no specific tests for diagnosis LC, clinical features laboratory findings biomarkers not specifically relate to LC. Therefore, is paramount importance develop validate that can employed prediction, prognosis its therapeutic response, although this effort hampered challenges pertaining non-specific nature majority manifestations in spectrum, small sample sizes relevant studies other methodological issues. Promising candidate found some patients markers systemic inflammation, acute phase proteins, cytokines chemokines; reflecting persistence, herpesviruses endotheliopathy, coagulation fibrinolysis; microbiota alterations; diverse proteins metabolites; biomarkers; cerebrospinal fluid biomarkers. At present, there only two reviews summarizing they do cover entire umbrella current biomarkers, their link etiopathogenetic mechanisms or diagnostic work-up comprehensive manner. Herein, we aim appraise synopsize available evidence on typical classification based pathogenetic main symptomatology frame epidemiological aspects syndrome furthermore assess limitations as well potential implications interventions.

Language: Английский

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Viral persistence in children infected with SARS-CoV-2: current evidence and future research strategies

The Lancet Microbe, Journal Year: 2023, Volume and Issue: 4(9), P. e745 - e756

Published: June 26, 2023

In this Personal View, we discuss current knowledge on SARS-CoV-2 RNA or antigen persistence in children infected with SARS-CoV-2. Based the evidence that virus can persist adults, have done a literature review and analysed studies looked for antigens undergoing autopsy, biopsy, surgery either death from COVID-19 multisystem inflammatory syndrome, assessments long other conditions. Our analysis suggests children, independent disease severity, spread systemically weeks to months. We what is known about biological effects of viral infections highlight new scenarios clinical, pharmacological, basic research exploration. Such an approach will improve understanding management post-viral syndromes.

Language: Английский

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Neutrophil extracellular traps and long COVID

Frontiers in Immunology, Journal Year: 2023, Volume and Issue: 14

Published: Sept. 27, 2023

Post-acute COVID-19 sequelae, commonly known as long COVID, encompasses a range of systemic symptoms experienced by significant number survivors. The underlying pathophysiology COVID has become topic intense research discussion. While chronic inflammation in received considerable attention, the role neutrophils, which are most abundant all immune cells and primary responders to inflammation, been unfortunately overlooked, perhaps due their short lifespan. In this review, we discuss emerging neutrophil extracellular traps (NETs) persistent inflammatory response observed patients. We present early evidence linking persistence NETs pulmonary fibrosis, cardiovascular abnormalities, neurological dysfunction COVID. Several uncertainties require investigation future studies. These include mechanisms SARS-CoV-2 brings about sustained activation phenotypes after infection resolution; whether heterogeneity neutrophils seen acute persists into phase; presence autoantibodies can induce protect them from degradation; exert differential, organ-specific effects; specifically NET components contribute pathologies, such fibrosis; senescent drive formation through pro-inflammatory secretome Answering these questions may pave way for development clinically applicable strategies targeting NETs, providing relief health crisis.

Language: Английский

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Effectiveness of oral antiviral agents on long‐term cardiovascular risk in nonhospitalized patients with COVID‐19: A multicenter matched cohort study

Journal of Medical Virology, Journal Year: 2023, Volume and Issue: 95(8)

Published: July 31, 2023

Abstract Although a novel oral antiviral agent can improve short‐term COVID‐19 outcomes, its effects on the long‐term namely risk of major adverse cardiovascular events (MACEs), remains unknown. This retrospective cohort study used TriNetX research network to identify nonhospitalized adult patients with between March 1, 2020, and January 2022. A propensity score matching method was form two matched cohorts without receiving nirmatrelvir–ritonavir (NMV‐r) or molnupiravir. The primary outcome incidence MACEs within 30‐day 1‐year period following diagnosis COVID‐19. Two each 80 888 balanced baseline characteristics were formed using matching. During follow‐up period, 976 in group 1609 control developed MACE. Overall, had significantly lower MACE than (hazard ratio [HR], 0.683; 95% confidence interval: 0.630–0.739). HRs overall consistently observed most subgroup analyses (age: >41–≤64 years: 0.60 [0.52–0.89]; age: ≥65 0.68 [0.62–0.76]; women: 0.63 [0.57–0.71]; men: 0.62 [0.55–0.70]; vaccinated: 0.74 [0.63–0.88]; unvaccinated: 0.66 [0.60–0.73]; NMV‐r; 0.65 [0.59–0.71]; molnupiravir: 0.75 [0.61–0.92]). In conclusion, agents, NMV‐r molnupiravir, effective reducing among COVID‐19, particularly when treated aged ≥40 years. These findings suggest potential role agents as preventive measure reduce further outcomes.

Language: Английский

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S1 guidelines for the management of postviral conditions using the example of post-COVID-19

Wiener klinische Wochenschrift, Journal Year: 2023, Volume and Issue: 135(S4), P. 525 - 598

Published: July 1, 2023

Zusammenfassung Die vorliegende Leitlinie S1 ist die Aktualisierung und Weiterentwicklung der Long COVID: Differenzialdiagnostik Behandlungsstrategien. Sie fasst den Stand Kenntnis zu postviralen Zuständen anhand des Beispiels Long/Post COVID zum Zeitpunkt Redaktionsschlusses zusammen. Aufgrund starken Dynamik Wissensentwicklung versteht sie sich als „living guideline“. Der Schwerpunkt liegt auf praktischen Anwendbarkeit Ebene hausärztlichen Primärversorgung, geeignete Stelle für Erstzutritt primäre Betreuung Behandlung verstanden wird. gibt Empfehlungen Versorgungsgang, häufigsten Symptome, in Folge einer Infektion wie mit SARS-CoV‑2 auftreten können, therapeutischen Optionen, Patient:innenführung -betreuung sowie zur Wiedereingliederung Alltag Rehabilitation. Entsprechend Krankheitsbildes einem interdisziplinären interprofessionellen Prozess entstanden Schnittstellen Kooperationsmöglichkeiten.

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Why does malaise/fatigue occur? Underlying mechanisms and potential relevance to treatments in rheumatoid arthritis

Expert Review of Clinical Immunology, Journal Year: 2024, Volume and Issue: 20(5), P. 485 - 499

Published: Jan. 15, 2024

Introduction Fatigue and malaise are commonly associated with a wide range of medical conditions, including rheumatoid arthritis (RA). Evidence suggests that fatigue can be overwhelming for patients, yet these symptoms remain inadequately-managed, largely due to an incomplete elucidation the underlying causes.

Language: Английский

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Autoimmunity and long COVID in children

Reumatologia/Rheumatology, Journal Year: 2024, Volume and Issue: 61(6), P. 492 - 501

Published: Jan. 18, 2024

Numerous hypotheses regarding the pathogenetic mechanisms of long COVID have been proposed. Immune dysregulation and autoimmunity are among leading hypotheses. In this article, we pre-sent two clinical cases COVID. The first case demonstrates phenotype with pain musculoskeletal symptoms, which is often associated mimics systemic connective tissue diseases. second case, a high titer antinuclear antibodies was observed after SARS-CoV-2 infection, but symptoms were limited to fever headache. Only comprehensive evaluation thorough objective examination can con-firm or exclude autoimmune diseases previous infection. A systematic search in PubMed Medline database carried out for studies focusing on immune dysregulation, auto-immunity, its association question role development management approaches discussed.

Language: Английский

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Chinese herbal medicine for dyspnea and persistent symptoms of long COVID: a systematic review and meta-analysis of randomized controlled trials

Journal of Integrative Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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