Long COVID: major findings, mechanisms and recommendations

Nature Reviews Microbiology, Journal Year: 2023, Volume and Issue: 21(3), P. 133 - 146

Published: Jan. 13, 2023

Language: Английский

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Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection

JAMA, Journal Year: 2023, Volume and Issue: 329(22), P. 1934 - 1934

Published: May 25, 2023

Importance SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms other health effects occurring after acute infection, termed postacute sequelae of (PASC), also known as long COVID . Characterizing PASC requires analysis prospectively and uniformly collected data from diverse uninfected infected individuals. Objective To develop a definition using self-reported describe frequencies across cohorts, vaccination status, number infections. Design, Setting, Participants Prospective observational cohort study adults without at 85 enrolling sites (hospitals, centers, community organizations) located in 33 states plus Washington, DC, Puerto Rico. who were enrolled the RECOVER adult before April 10, 2023, completed symptom survey 6 months more onset test date. Selection included population-based, volunteer, convenience sampling. Exposure infection. Main Outcomes Measures 44 participant-reported (with severity thresholds). Results A total 9764 participants (89% infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios 1.5 greater (infected vs participants) for 37 symptoms. Symptoms contributing to score postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes sexual desire capacity, loss change smell taste, thirst, chronic cough, chest pain, abnormal movements. Among 2231 first on December 1, 2021, within 30 days 224 (10% [95% CI, 8.8%-11%]) positive months. Conclusions Relevance was developed based prospective study. As step providing framework investigations, iterative refinement that further incorporates clinical features needed support actionable definitions PASC.

Language: Английский

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The immunology of long COVID

Nature reviews. Immunology, Journal Year: 2023, Volume and Issue: 23(10), P. 618 - 634

Published: July 11, 2023

Language: Английский

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COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review

Cureus, Journal Year: 2023, Volume and Issue: unknown

Published: March 31, 2023

POTS (Postural Orthostatic Tachycardia Syndrome) is a multisystem disorder characterized by the abnormal autonomic response to an upright posture, causing orthostatic intolerance and excessive tachycardia without hypotension. Recent reports suggest that significant percentage of COVID-19 survivors develop within 6 8 months infection. Prominent symptoms include fatigue, intolerance, tachycardia, cognitive impairment. The exact mechanisms post-COVID-19 are unclear. Still, different hypotheses have been given, including autoantibody production against nerve fibers, direct toxic effects SARS-CoV-2, or sympathetic nervous system stimulation secondary Physicians should high suspicion in survival when presented with dysfunction conduct diagnostic tests like Tilt table others confirm it. management COVID-19-related requires comprehensive approach. Most patients respond initial non-pharmacological options, but become more severe they do not approach, pharmacological options considered. We limited understanding knowledge POTS, further research warranted improve our formulate better plan.

Language: Английский

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Nirmatrelvir-Ritonavir and Symptoms in Adults With Postacute Sequelae of SARS-CoV-2 Infection

JAMA Internal Medicine, Journal Year: 2024, Volume and Issue: 184(9), P. 1024 - 1024

Published: June 7, 2024

Importance There is an urgent need to identify treatments for postacute sequelae of SARS-CoV-2 infection (PASC). Objective To assess the efficacy a 15-day course nirmatrelvir-ritonavir in reducing severity select PASC symptoms. Design, Setting, and Participants This was 15-week blinded, placebo-controlled, randomized clinical trial conducted from November 2022 September 2023 at Stanford University (California). The participants were adults with moderate severe symptoms 3 months or longer duration. Interventions 2:1 treatment oral (NMV/r, 300 mg 100 mg) placebo-ritonavir (PBO/r) twice daily 15 days. Main Outcomes Measures Primary outcome pooled 6 (fatigue, brain fog, shortness breath, body aches, gastrointestinal symptoms, cardiovascular symptoms) based on Likert scale score 10 weeks. Secondary outcomes included symptom different time points, burden relief, patient global measures, Patient-Reported Measurement Information System (PROMIS) orthostatic vital signs, sit-to-stand test change baseline. Results Of 155 (median [IQR] age, 43 [34-54] years; 92 [59%] females), 102 NMV/r group 53 PBO/r group. Nearly all (n = 153) had received primary series COVID-19 vaccination. Mean (SD) between index randomization 17.5 (9.1) months. no statistically significant difference model-derived across core weeks groups. No between-group differences found Patient Global Impression Severity Change scores, summative baseline PROMIS fatigue, dyspnea, cognitive function, physical function measures. Adverse event rates similar groups mostly low grade. Conclusions Relevance results this showed that population patients generally safe but did not demonstrate benefit improving vaccinated cohort protracted Further studies are needed determine role antivirals PASC. Trial Registration ClinicalTrials.gov Identifier: NCT05576662

Language: Английский

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Post-COVID dysautonomias: what we know and (mainly) what we don’t know

Nature Reviews Neurology, Journal Year: 2024, Volume and Issue: 20(2), P. 99 - 113

Published: Jan. 11, 2024

Language: Английский

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Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design

PLoS ONE, Journal Year: 2023, Volume and Issue: 18(6), P. e0286297 - e0286297

Published: June 23, 2023

Importance SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms other health effects after the acute phase of infection; termed post-acute sequelae (PASC), long COVID. The characteristics, prevalence, trajectory and mechanisms PASC are ill-defined. objectives Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study Adults (RECOVER-Adult) to: (1) characterize prevalence; (2) symptoms, organ dysfunction, natural history, distinct phenotypes PASC; (3) identify demographic, social clinical risk factors for onset recovery; (4) define biological underlying pathogenesis. Methods RECOVER-Adult is a combined prospective/retrospective cohort currently planned enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria suspected, probable, confirmed have evidence no prior infection. Recruitment occurs at 86 sites 33 U.S. states, Washington, DC Puerto Rico, via facility- community-based outreach. Participants complete quarterly questionnaires about determinants, vaccination status, interim infections. In addition, contribute biospecimens undergo physical laboratory examinations approximately 0, 90 180 days from negative test date, yearly thereafter. Some additional testing based on specific random sampling. Patient representatives provide input all study processes. primary outcome PASC, measured by signs symptoms. A paradigm identifying cases will be defined updated using supervised unsupervised learning approaches with cross-validation. Logistic regression proportional hazards conducted investigate associations between factors, onset, resolution Discussion first national, prospective, longitudinal among US adults. Results this intended inform public health, spur trials, expand treatment options. Registration NCT05172024 .

Language: Английский

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Cardiovascular autonomic dysfunction in “Long COVID”: pathophysiology, heart rate variability, and inflammatory markers

Frontiers in Cardiovascular Medicine, Journal Year: 2023, Volume and Issue: 10

Published: Sept. 1, 2023

Long COVID is characterized by persistent signs and symptoms that continue or develop for more than 4 weeks after acute COVID-19 infection. Patients with experience a cardiovascular autonomic imbalance known as dysautonomia. However, the underlying pathophysiological mechanisms behind this remain unclear. Current hypotheses include neurotropism, cytokine storms, inflammatory persistence. Certain immunological factors indicate autoimmune dysfunction, which can be used to identify patients at higher risk of COVID. Heart rate variability imbalances in individuals suffering from COVID, measurement non-invasive low-cost method assessing modulation. Additionally, biochemical markers are diagnosing monitoring These improve understanding driving response its effects on sympathetic parasympathetic pathways nervous system. Autonomic may result lower heart variability, impaired vagal activity, substantial sympathovagal imbalance. New research subject must encouraged enhance long-term risks cause

Language: Английский

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HEART Rate Variability Biofeedback for LOng COVID Dysautonomia (HEARTLOC): Results of a Feasibility Study

Advances in Rehabilitation Science and Practice, Journal Year: 2024, Volume and Issue: 13

Published: Jan. 1, 2024

Introduction: Post-COVID-19 syndrome, or Long Covid (LC) refers to symptoms persisting 12 weeks after the COVID-19 infection. LC comprises a wide range of dysautonomia symptoms, including fatigue, breathlessness, palpitations, dizziness, pain and brain fog. This study tested feasibility estimated efficacy, Heart Rate Variability Biofeedback (HRV-B) programme via standardised slow diaphragmatic breathing technique in individuals with LC. Methods: patients underwent 4-week HRV-B intervention for 10 minutes twice daily 4 using Polar H10 ECG (Electrocardiogram) chest strap Elite HRV phone application. Outcome measures C19-YRSm (Yorkshire Rehabilitation Scale modified), Composite Autonomic Symptom Score (COMPASS-31), WHO Disability Assessment Schedule (WHODAS), EQ5D-5L (EuroQol 5 Dimensions) Root Mean Square Successive Differences between heartbeats (RMSSD) Fitbit device were recorded before intervention. The was pre-registered at clinicaltrials.gov NCT05228665. Results: A total 13 participants (54% female, 46% male) completed high levels independent use technology, data completeness adherence. There statistically significant improvement C19YRS-m ( P = .001), COMPASS-31 .007), RMSSD .047), WHODAS .02) EQ5D Global Health .009). Qualitative feedback suggested could it independently, satisfied reported beneficial effects from Conclusion: is feasible small sample size limits generalisability. warrants further exploration larger randomised controlled study.

Language: Английский

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How to understand the overlap of long COVID, chronic fatigue syndrome/myalgic encephalomyelitis, fibromyalgia and irritable bowel syndromes

Seminars in Arthritis and Rheumatism, Journal Year: 2024, Volume and Issue: 67, P. 152455 - 152455

Published: May 7, 2024

Language: Английский

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