Long covid—mechanisms, risk factors, and management

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n1648 - n1648

Published: July 26, 2021

Since its emergence in Wuhan, China, covid-19 has spread and had a profound effect on the lives health of people around globe. As 4 July 2021, more than 183 million confirmed cases been recorded worldwide, 3.97 deaths. Recent evidence shown that range persistent symptoms can remain long after acute SARS-CoV-2 infection, this condition is now coined covid by recognized research institutes. Studies have affect whole spectrum with covid-19, from those very mild disease to most severe forms. Like involve multiple organs many systems including, but not limited to, respiratory, cardiovascular, neurological, gastrointestinal, musculoskeletal systems. The include fatigue, dyspnea, cardiac abnormalities, cognitive impairment, sleep disturbances, post-traumatic stress disorder, muscle pain, concentration problems, headache. This review summarizes studies term effects hospitalized non-hospitalized patients describes they endure. Risk factors for possible therapeutic options are also discussed.

Language: Английский

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Exercise program for the management of anxiety and depression in adults and elderly subjects: Is it applicable to patients with post-covid-19 condition? A systematic review and meta-analysis

Journal of Affective Disorders, Journal Year: 2023, Volume and Issue: 325, P. 273 - 281

Published: Jan. 10, 2023

Language: Английский

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Assessment of Anxiety, Stress, and Depression Among COVID-19 Survivors After 40 Months in the Kurdistan Region of Iraq: An Online Cross-Sectional Study

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: July 3, 2024

Background and aims: COVID-19 survivors often experience significant pervasive psychological distress. This study aimed to investigate the prevalence demographic factors affecting anxiety, stress, depression levels among in Kurdistan region of Iraq. Method: online cross-sectional was conducted from August 1, 2023 December 17, 2023, Iraq, including Erbil, Sulaymaniyah, Duhok. Purposive sampling used collect data using an survey. The survey included information Depression, Anxiety, Stress Scale - 21 Items (DASS-21). Statistical analysis performed Stata version 12 (StataCorp LLC, College Station, TX), with frequency percentage for categorical variables mean standard deviation quantitative variables. Ordinal regression analyses were assess associations between mental health outcomes. A p-value less than 0.05 considered statistically significant. Results: total 783 participants enrolled study. score anxiety 11.62 ± 4.71, indicating moderate levels. For depression, 11.54 5.21, mild levels, 14.0 5.78, normal Younger individuals (15-27) showed higher stress (Estimate: 18.96, P=0.001) 2.79, compared older age groups. Males reported significantly lower -1.01, P=0.001), -1.29, -0.72, females. Participants a diploma had 0.65, P=0.004) 0.77, P=0.002) those only elementary education. Conclusions: found survivors, To address these issues, it is recommended that policymakers develop targeted interventions. Healthcare providers should focus on early identification treatment, providing personalized counseling support enhance coping mechanisms overall well-being. By implementing measures, outcomes Iraq can be improved.

Language: Английский

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Multi‐disciplinary collaborative consensus guidance statement on the assessment and treatment of postacute sequelae of SARS‐CoV‐2 infection (PASC) in children and adolescents

PM&R, Journal Year: 2022, Volume and Issue: 14(10), P. 1241 - 1269

Published: Sept. 28, 2022

Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are generally asymptomatic or have mild symptoms low rates of hospitalization (<2%) and death (<0.03%).1 After initial infection, some children, including those who experienced disease, develop other postacute manifestations COVID, multisystem inflammatory in children (MIS-C, not discussed this statement) sequelae SARS-CoV-2 infection. The latter post-COVID condition may be known as long long-haul COVID-19, long-term effects chronic COVID.2 This guidance statement uses the terminology infection (PASC). Data limited on epidemiology risk factors for PASC adolescents. prevalence varied considerably between studies from 4 to 66%.1, 3-5 There is also large variation reported frequency persistent symptoms. Recent suggested that possible pediatric patients older age, female gender, history allergic disease.6 In general, Hispanic Latino (Hispanic) non-Hispanic Black (Black) had higher cumulative COVID-19-associated hospitalizations (16.4 10.5 per 100,000, respectively) than did White (White) (2.1), although it currently if a factor children.6 Studies investigated pandemic itself care developmental disabilities,7-10 recent study finding that, intellectual disability was strongest independent COVID-19 mortality.11 More area needed. Limited exists regarding assessment treatment Additional challenges diagnosis include overlap psychosocial (eg, social isolation, loss routine school activities, fear illness, family members friends) children.12-14 Although there adult presentations intervention options, management rehabilitation unique considerations, cannot systematically transcribed pediatrics. First, approach child differ; developmentally, young disabilities difficulty describing their Pediatric histories vested parties (parents, caregivers, coaches, teachers) vital subsequently help guide management. Compared adults, fewer preexisting health conditions, conditions increase PASC, such type diabetes, uncommon pediatrics.15 Therefore, require same laboratory radiographic tests adults. Finally, perspective, often previously healthy; thus, can represent stark departure baseline individuals families present increased stress urgency address. With mind, American Academy Physical Medicine Rehabilitation (AAPM&R) Multi-Disciplinary Collaborative (PASC Collaborative) convened workgroup address urgent need interim adolescents PASC. following information meant assist primary physician specialty evaluations created, part, expert recommendations established centers extensive experience managing an iterative modified Delphi achieve consensus series Consensus Guidance Statements focused most prominent symptoms.16-18 As statements, detailed literature review performed before initiation approach, full description our methodology has been published detail previously.19 each systemic section specific were developed refined, emerging current conducted ongoing basis. monitoring occurred until finalization manuscript throughout process ascertain best available evidence used. expansion Workgroup intent recognize standards differ younger populations requiring specialization focus. Achieving followed one adjustment reflect specialized expertise Workgroup. second wave voting, ensure completeness base recommendations, at level opposed level. then referred consensus-based final vote prior finalization. composed approximately 30 specialists representing eight clinics institutions across United States engagement caregivers gain patient perspective process. recognizes due typically cluster cross multiple body systems overlap. discussion presented report intended common presenting organ system seen by pediatricians, medicine practitioners, subspecialists encounter (Table 1). Importantly, provided Statement should preclude clinical judgment must applied context patient, adjustments preferences, comorbidities, factors. any plan, clinicians treating encouraged discuss unknowns treatments prognosis, well benefits risks approach. Fatigue (generalized, exercise intolerance, postexertional malaise) Sleep disturbances Fever Anxiety Depression/low mood Increased somatic unexplained findings School avoidance Regression academic milestones Dizziness/lightheadedness Orthostatic intolerance Headache Nausea Syncope presyncope Tremulousness Paresthesias numbness Dizziness vertigo Difficulty attention/concentration memory Cognitive fatigue "brain fog" Shortness breath dyspnea Chest (thoracic) pain tightness Cough activity/exercise Palpitations tachycardia Weakness Muscle, bone, joint Nausea/vomiting/reflux Abdominal Bowel irregularities (constipation/diarrhea) Weight Lack appetite first point contact provide bulk therapeutic For complex medical needs, multidisciplinary interdisciplinary approaches beneficial.20-27 Multidisciplinary treat population opened spring 2020, continued, focusing needs emerged they accessible all,28 which case clinician will larger role coordinating evaluation(s) care. Previsit symptom checklists screening tools facilitate gathering optimize time providers evaluation.21, 27, 29, Goals visit (1) determine impact function; (2) assess what additional helpful; (3) identify "red flag" warrant further testing and/or referral subspecialists; (4) differentiate new different supported positive polymerase chain reaction (PCR), antigen, antibody SARS-CoV-2; however, negative rule out reasons. Some test because lack testing, waning levels, false-negative testing.31, 32 vaccination increase; decrease unless specifically order antinucleocapsid antibodies. A strong epidemiological link close contact) distinctive features (anosmia/ageusia) without alternative considered evaluation begin thorough systems, comprehensive physical examination warranted. Key areas focus summarized Table 2. considerations options based (Tables 3–11). Description "inciting event" Characterize pertinent symptoms1, 20, 25, 34 Factors limit activity result noted, attention nutrition, sleep, exercise, mental health.2, 27 Refer Tables 3-11 parameters. Assess functional limitations Past medical, surgical, family, Review past history. Specific placed behavioral health,2, 35 surgeries hospitalizations, status SARS-CoV-2. examination: Assessment: Clinicians incorporate history, microbiological exam making Concerning signs ("red flags") addressed targeted therapies strategies related Labs/radiology Follow-up plan referrals – Follow symptom-based outlined sections follow ). Evaluation: •Full neuromuscular provocative musculoskeletal •Consider orthostatic signs/standing experiencing lightheadedness/ dizziness (See Autonomic Dysfunction/POTS 5 more information) formal functioning endurance (examples 6-minute walk (40), sit stand feasible) •Bloodwork: complete blood count, metabolic panel, thyroid-stimulating hormone/free T4, iron ferritin, vitamin D magnesium, B12, erythrocyte sedimentation rate/C-reactive protein, celiac 4-10 concerned comorbid contributing EI. Interventions/considerations: Medications: Lifestyle modifications: activity: insomnia (difficulty falling asleep, sleep deprivation), maintenance, events restless leg syndrome, apnea), hypersomnia (excessive daytime sleepiness) Behavioral interventions: When Whom: Psychology therapist cognitive therapy interventions sufficient concern (anxiety, depression) specialist abnormalities PSG disorder broad differential.20, 25-27, 41 reported, overlaps fatigue.3, 42 inactivity well-documented both overall health43; important mobilize timely fashion minimize lasting decreased poor tolerance. prolonged meet criteria myalgic encephalomyelitis/chronic (ME/CFS), exclusion. ME/CFS characterized profound occurring least 6 months significant impairment day-to-day functioning, performance, extracurricular activities.44 Postexertional malaise unrefreshing hallmarks disorder, commonly cooccurring conditions.45 relationship unclear point, but noted after viral illnesses, prominently Epstein–Barr virus.37, 46 If "crashing" activity, educated "pacing" careful made avoid exacerbation symptoms; benefit medicine. Appendix 1 Centers Disease Control Prevention resources ME/CFS.) Recommendations programs tailored individual take into account access opportunities equipment (ie, gym class, recess, safe neighborhood, bicycle). protocols return play recreational athletes mild-to-moderate COVID43, 47 using graduated approach48; these types cause malaise. gradual slowly increasing through subsymptom threshold program similar recommended postconcussion better tolerated.49 Oversight occupational (in limiting activities daily living) helpful guidance. restrictions translated settings sports extracurriculars (see Accommodations section). critical optimal function development systems. Insufficient associated changes, impaired concentration, immune response. Post-COVID difficulties children.3, 50-52 It whether manifestation having psychological product distress, combination factors.53 Mental concerns 4) influenced biological (direct infection) (disrupted quality life, loved ones routine) factors.54 resulted anxiety, depression, irritability, boredom, inattention, new-onset youth during pandemic.55 Many undergone trauma losing grief, exacerbating Additionally, exacerbated many racial ethnic minority groups gender/sexual individuals.56 One demonstrated girls, ethnicity, public versus private insurance, comorbidity likely exhibit neuropsychiatric symptoms,57 demographic socioeconomic studied further. problems since start particularly screen all particular, suicidal ideation especially attempts, ideation, changes mood. Of note, emergency room visits attempts started early 2020 (ages 12–17 years) sustained adolescent females.58 Patient assessment: Depression Evaluation/scales consider: *Note: PHQ-9 contains suicidality question; prepared score positive. Suicidality adults symptoms54 newly anxiety youth.55 primarily recurrence upon in-person absence (which PASC). monitored closely. Adolescents differential impacts pandemic, minoritized racial/ethnic group screened closely.59 documented lesser extent studies, premorbid depression.60, 61 These occasionally behavior uncharacteristic withdrawal). Clinical suggests somatization SSRDs cases PASC; assume SSRD investigation always recommended. considering neurological refer collaborate subspecialties neurology, rheumatology, medicine, gastroenterology) diagnosis. neurologic made, multi-disciplinary clinic psychology when available.62 25% posttraumatic up 50 days post infection.63 To date, PTSD reported. elevated hospitalization, period intensive care, procedures.64 addition, unfortunate outcomes maltreatment.63, 65 small study, amassing stressors found key implicated parent-perceived stress, whereas depression abuse potential.66 consequently increases odds physicians vigilant potential underlying maltreatment identified evidence-based therapy) warranted consideration medication psychiatry appropriate depending severity available. Treatment anxiety/depression initiated severity, dysfunction, comfort provider. From psychotherapy assistance identifying provider working illness interventions, pain, consider population.67 Families parent training promote learning children. Postural (POTS) autonomic nervous 5), nature. affecting females ages 12–50 years triggered pregnancy, fever, surgery, trauma.70, 71 Symptom burden significant, resulting life ability participate work. pacing69 whom: PLUS addition POTS, forms hypotension (OH), (OT), vasovagal syncope.70 First-line POTS consists lifestyle 5) focuses reducing improving life. Exercise water salt intake shown reduce HR improve POTS.68, 72 Currently, no Food Drug Administration-approved medications volume, HR, vasoconstriction trialed. do still discussed, several reports documenting onset adults,73, 74 very patients.75, 76 Common fatigue, brain fog, nausea, dysfunction POTS.77 similarly services warranted.78 Case show patient- parent-reported difficulties.27 Objective neuropsychological data deficits patients, relatively preserved processing speed executive functions mood/anxiety concerns.27 Accordingly, accommodations Section) impede child's learn engage community. Where available, determining supports inform approaches. needed, seizure stroke). brief, could completed concussion model) patients.80, 81 Delaying severely impair comorbidities prolongs recovery.82-84 (e.g., Health Questionnaire-9, Generalized Disorder Scale-7, checklist). See details. Treat, collaboration specialists, goal support extra taking time, notes advance, assignments, breaks class time/school hours, reduced after-school activities). Significant change emergent inventories [eg, PROMIS] judgment) OR compensatory needed 1–2 implementation Screen flag symptoms" secondary headaches caused condition. Headaches PASC.5, 85, 86 headache line guidelines Neurology Society.87 Abnormal concerning central disease warrants prompt neuroimaging. migraine, tension) yet describe "headache types." 5). mainstay remains counseling education influence frequency.87, 88 potentially multifactorial multifaceted beyond directly targeting alone. Providers wish preventative frequency, headache-related disability. Because constellation symptoms,86 choice guided comorbidity. Daily used might exacerbate example, side effect topiramate includes slowing, worsen patient's fog Medications amitriptyline, use postconcussive headaches, tension neuropathic pain,89, 90 However, gastrointestinal amitriptyline nerve-related Other preventive like propranolol POTS; cyproheptadine disruption, abdominal stimulation; duloxetine useful prominent. starting doses, mindful effects, individualize 7).92, 93 Preexisting asthma PASC.92 Pulmonary pulmonary include, minimum, pulse oximetry, chest x-ray (CXR), spirometry, pulmonologist where indicated lung normal PASC,93 others indicate 50% imaging spirometric abnormalities.26 dyspnea, exercise-induced hypoxemia minute test) beneficial.91 persist abnormal workup. symptoms: limitations: illnesses include: History asthma, yes, current, previous, prescribed Focused exam: document presence wheeze, crackles, sounds, rhonchi, sternal wall tenderness, scoliosis, digital clubbing, hypermobility asthma: controller bronchodilators Presence bronchodilator responsiveness spirometry suggestive history- inhaled corticosteroids Functional disorders c

Language: Английский

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The pathological mechanism of the COVID-19 convalescence and its treatment with traditional Chinese medicine

Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 13

Published: Jan. 10, 2023

The severe acute respiratory syndrome coronavirus - 2 (SARS CoV 2) was reported to cause the Wuhan outbreak of corona virus disease 2019(COVID-19). To date, COVID-19 has infected more than 600 million people gloabally. As a growing number patients recover from infections and are discharged hospitals, proportion in recovery period is gradually increasing. Many these individuals have been experience multiple symptoms during convalescence, such as fatigue, dyspnea pain which designated "long-COVID", "post-COVID syndrome" or "recovery sequelae. We searched for recent articles published PubMed on convalescence found that pathogenesis not yet well recognized. It may be associated with incomplete immune system, parenchymal organ damage (liver lung), coagulation abnormalities, "second hit" caused by viral infection, Phenomenon Cell Senescence-Associated Secretory Phenotype (SASP). Some drugs psychological factors also play non-negligible role it. effect traditional Chinese medicine (TCM) effective treatment phase, can only relieve corresponding symptoms, but improve indicators pulmonary fibrosis. Bufei Huoxue Capsule, drug explicitly mentioned period, exert strong rehabilitative effects physiological activity recovering COVID-19. In addition, previous studies, confirmed ability resist cytokine storms, myocardial damage, makes it potential therapeutic advantages targeting hyperimmune response, abnormalities existing period. conclusion, clinical convalescing complex, its elucidated. medicine, treatment, specific action mechanism need so better role.

Language: Английский

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Screening visual environment impact factors and the restorative effect of four visual environment components in large-space alternative care facilities

Building and Environment, Journal Year: 2023, Volume and Issue: 235, P. 110221 - 110221

Published: March 21, 2023

Language: Английский

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Cardiovascular, Pulmonary, and Neuropsychiatric Short- and Long-Term Complications of COVID-19

Cells, Journal Year: 2022, Volume and Issue: 11(23), P. 3882 - 3882

Published: Dec. 1, 2022

Beginning with the various strategies of SARS-CoV-2 virus to invade our bodies and manifest infection, ending recent long COVID, we are witnessing evolving course disease in addition pandemic. Given partially controlled COVID-19 pandemic, greatest challenge currently lies managing short- long-term complications COVID-19. We have assembled current knowledge broad spectrum cardiovascular, pulmonary, neuropsychiatric sequelae following infection understand how these clinical manifestations collectively lead a severe form disease. The ultimate goal would be better find ways prevent deterioration.

Language: Английский

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Hand Washing: When Ritual Behavior Protects! Obsessive–Compulsive Symptoms in Young People during the COVID-19 Pandemic: A Narrative Review

Journal of Clinical Medicine, Journal Year: 2022, Volume and Issue: 11(11), P. 3191 - 3191

Published: June 2, 2022

The Coronavirus Disease 2019 (COVID-19) pandemic had a profound impact on the lifestyles and mental health of young people. It has been hypothesized that focus hygiene fear contamination/infection during may have exacerbated obsessive-compulsive (OC) symptoms in this population. OC are widespread general population, with varying degrees intensity. At their most extreme, they manifest disorder (OCD), which is characterized by obsessive thoughts compulsive behaviors. present narrative review aimed at evaluating relationship between COVID-19 OCD people, especially children adolescents without OCD, focusing vulnerability risk factors lockdown measures. Of six studies identified, four examined clinical samples diagnosed two looked community-based adolescent samples. Five found increased pandemic. Additionally, to anxiety constitute condition measures personal stressful life events can potential triggers symptoms, while ongoing treatment for protective effect. results suggest that, pandemic, behavior (e.g., hand washing) people greatest should be monitored, intervention services maintained. More research needed area.

Language: Английский

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Investigation of liquid biopsy analytes in peripheral blood of individuals after SARS-CoV-2 infection

EBioMedicine, Journal Year: 2023, Volume and Issue: 90, P. 104519 - 104519

Published: March 13, 2023

Post-acute COVID-19 syndrome (PACS) is linked to severe organ damage. The identification and stratification of at-risk SARS-CoV-2 infected individuals vital providing appropriate care. This exploratory study looks for a potential liquid biopsy signal PACS using both manual machine learning approaches.Using high definition single cell assay (HDSCA) workflow biopsy, we analysed 100 Post-COVID patients 19 pre-pandemic normal donor (ND) controls. Within our patient cohort, 73 had received at least 1 dose vaccination prior infection. We stratified the COVID into 25 asymptomatic, 22 symptomatic but not suspected 53 suspected. All investigated in this were diagnosed between April 2020 January 2022 with median 243 days (range 16-669) from diagnosis their blood draw. did histopathological examination rare events peripheral used model evaluate predictors PACS.The classification found cellular acellular consistent features endothelial cells platelet structures PACS-suspected cohort. three categories encompassing hypothesised observed significantly higher incidence cohort compared ND (p-value < 0.05). classifier performed well when separating NDs an accuracy 90.1%, poorly 58.7%.Both differences NDs, suggesting existence after active More research needed stratify its subsyndromes.This work was funded whole or part by Fulgent Genetics, Kathy Richard Leventhal Vassiliadis Research Fund. also supported National Cancer InstituteU54CA260591.

Language: Английский

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Neurological and Psychiatric Manifestations of Long COVID-19 and Their [18F]FDG PET Findings: A Review

Diagnostics, Journal Year: 2023, Volume and Issue: 13(14), P. 2353 - 2353

Published: July 12, 2023

For more than two years, lingering sequalae of COVID-19 have been extensively investigated. Approximately 10% individuals infected by found to experience long-term symptoms termed “long COVID-19”. The neurological and psychiatric manifestations long are particular concern. While pathogenesis remains unclear, emerging imaging studies begun better elucidate certain pathological manifestation. Of specific interest is with [18F]FDG PET which directly reflects cellular glycolysis often linked metabolic inflammatory processes. Seeking understand the molecular basis features COVID-19, this review encompasses most recent literature in area.

Language: Английский

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