Updated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID

Infection and Chemotherapy, Год журнала: 2024, Номер 56(1), С. 122 - 122

Опубликована: Янв. 1, 2024

"Long COVID" is a term used to describe condition when the symptoms and signs associated with coronavirus disease 2019 (COVID-19) persist for more than three months among patients infected COVID-19; this has been reported globally poses serious public health issue. Long COVID can manifest in various forms, highlighting need appropriate evaluation management by experts from fields. However, due lack of clear clinical definitions, knowledge pathophysiology, diagnostic methods, treatment protocols, it necessary develop best standard guidelines based on scientific evidence date. We developed guideline diagnosing treating long analyzing latest research data collected start COVID-19 pandemic until June 2023, along consensus expert opinions. This provides recommendations diagnosis that be applied practice, total 32 key questions related COVID. The should comprehensive, including medical history, physical examination, blood tests, imaging studies, functional tests. To reduce risk developing COVID, vaccination antiviral during acute phase are recommended. will revised there reasonable updates availability new

Язык: Английский

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Higher vulnerability to poor circadian light hygiene in individuals with a history of COVID-19

Chronobiology International, Год журнала: 2025, Номер unknown, С. 1 - 14

Опубликована: Янв. 6, 2025

Seven-day actigraphy was performed within 1 month in 122 community-dwelling adults (mean age 24.40 y, 31 (25.4%) men) the same city of Tyumen, Russia. Groups with different COVID-19 status (present, COVID-19(+),

Язык: Английский

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Cognitive functions and underlying parameters of human brain physiology are associated with chronotype

Nature Communications, Год журнала: 2021, Номер 12(1)

Опубликована: Авг. 3, 2021

Circadian rhythms have natural relative variations among humans known as chronotype. Chronotype or being a morning evening person, has specific physiological, behavioural, and also genetic manifestation. Whether how chronotype modulates human brain physiology cognition is, however, not well understood. Here we examine cortical excitability, neuroplasticity, are associated with in early late individuals. We monitor motor stimulation-induced learning cognitive functions at circadian-preferred non-preferred times of day 32 Motor performance (working memory, attention) along their electrophysiological components significantly enhanced the circadian-preferred, compared to time. This outperformance is excitability (prominent facilitation, diminished inhibition), long-term potentiation/depression-like plasticity. Our data show convergent findings can modulate from basic physiological mechanisms behaviour higher-order cognition.

Язык: Английский

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The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events

Journal of Personalized Medicine, Год журнала: 2022, Номер 12(5), С. 681 - 681

Опубликована: Апрель 24, 2022

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out late 2019. Impact Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective persistent event. However, there less agreement on structure IES-R, signifying need for further investigation. This study aimed evaluate psychometric properties Arabic version IES-R among individuals Saudi quarantine settings, psychiatric patients, general public during outbreak. Exploratory factor analysis revealed that items present five factors with eigenvalues > 1. Examination several competing models through confirmatory resulted best fit six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, irritability/dysphoria. Multigroup supported configural, metric, scalar invariance this model across groups gender, age, marital status. significantly correlated Depression Anxiety Stress Scale-8, perceived health status, vulnerability COVID-19, denoting good criterion validity. HTMT ratios subscales were below 0.85, discriminant values coefficient alpha three samples ranged between 0.90 0.93. In path analysis, intrusion hyperarousal had direct positive effects sleep, irritability. Numbing irritability mediated indirect avoidance. result signifies cognitive activation main driving dynamics underlying behavioral, emotional, symptoms trauma. findings support robust validity indicating sound measure can be applied wide range experiences.

Язык: Английский

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Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

PM&R, Год журнала: 2023, Номер 15(5), С. 640 - 662

Опубликована: Март 29, 2023

COVID-19 has been a transformative novel disease in modern health care. Unlike many other viral illnesses, not only causes multiorgan damage during the acute stage of infection, but also potential to cause long-term sequelae, as part post-acute sequelae SARS-CoV-2 infection (PASC) or long-COVID syndrome. In 2022 study released by Centers for Disease Control and Prevention,1 electronic record (EHR) data were examined from time period March 2020–November 2021 persons United States aged ≥18 years assess incidence 26 conditions often attributable post-COVID-19. Among all patients, 38% individuals experienced an incident condition compared with 16% controls; affected multiple systems included cardiovascular, pulmonary, hematologic, renal, endocrine, gastrointestinal, musculoskeletal, neurologic, psychiatric signs symptoms.1 Neurological symptoms occur approximately 80% hospitalized patients phase infection.2 The most prevalent PASC neurologic that remain after 3–4 weeks initial include "brain fog" (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), myalgias (55%).3 Importantly, studies outcomes across care-setting spectrum (nonhospitalized, hospitalized, admitted intensive care) continue emerge. Addressing this knowledge gap is important helping guide care strategies system capacity planning. U.S. Department Veterans Affairs national databases used build cohort 154,068 COVID-19, 5,638,795 contemporary controls 5,859,621 historical estimate risks burdens disorders at 12 months following COVID-19. elevated even people who did require hospitalization Investigators found increased risk various including ischemic hemorrhagic stroke, cognition memory disorders, peripheral nervous episodic (eg, migraine seizures), extrapyramidal movement mental musculoskeletal sensory Guillain–Barré syndrome (GBS), encephalitis encephalopathy.4 up 10% critically ill have cranial nerve involvement.6 Sleep patterns can be disturbed these neurological turn, exacerbate symptoms.7-10 Interestingly, presence severity do fully correlate symptoms.11 Another claims involving 78,252 demonstrated 75.8% persistent (coded U09.9 post condition) anosmia, headache, altered status, seizure, which significantly activities daily living, asymptomatic mild hospitalization.12 This guidance statement focuses on PASC, headaches, neuropathies neuropathic pain, muscular pain/weakness tremors, conditions. Fatigue, autonomic dysfunction, cognitive function changes are reviewed separate American Academy Physical Medicine Rehabilitation (AAPM&R) statements.8, 10, 13 addition, AAPM&R consensus document focused currently development. Despite prevalence emerging longevity symptoms, limited exists regarding assessment treatment PASC. Multi-Disciplinary Collaborative (PASC Collaborative), consisting experts PM&R, neurology, internal medicine, family practice, pediatric specialties, cardiology, physical therapy, occupational social work among disciplines, was convened address pressing need iterative, modified Delphi process achieve recommendations series statements prominent symptoms. These informed established centers experience managing PASC.8-10, 13, 14 There intentional focus equity disparities address. Beyond patient care, hope broadened understanding current practices will help identify areas future research. A full description methodology published previously.15 We acknowledge definition evolving, there factors contribute diagnosis management. Literature available our suggested defined persistence beyond 4 onset infection.16 Alternative definitions lasting longer than 3 months.17 World Health Organization "post-COVID condition," describing timing "usually COVID-19" "for least 2 months."18 Based feedback process, we agree earlier evaluation, diagnosis, management improve access beneficial interventions. For purposes statement, recommend expanded if improving 1 month symptom onset. At present, scientific evidence effective limited, prevents creation evidence-based clinical guidelines. intended reflect practice assessment, testing, treatments based expert opinion professionals regularly. It resource concise point reference geared toward clinicians different specialties caring patients. should preclude judgment must applied context specific patient, adjustments preferences, comorbidities, factors. structured first outline evaluation components (Table 1: Initial Evaluation Neurologic Sequelae Patients PASC) 2: Treatment Options Sequelae) review both how consider wide differential possible aspects further diagnostic workup. section dedicated "Red Flag" presentations prompt emergent escalation features Subsequent narrative sections common best Clinicians conduct history predisposing prior relevant hospitalizations, course infection(s), treatments, vaccines/boosters, pertinent history, history. present illness address: those identified new worsening focal deficits, urgent/emergent referral emergency department warranted. (The Red Flags corresponding table provides additional information). Determination neuroimaging individual Consider consultation neurologist imaging testing. Evaluate medication supplement use may impact signs, parameters (i.e., medications adverse side effects, such dry mouth, visual changes, dizziness, and/or sleep/sedation). Include duration helped, worsened, had little no Of note, antihistamine, anticholinergic, antidepressant/anxiolytic, muscle relaxant basic lab workup considered without visit: complete blood count differential; chemistries renal hepatic tests, thyroid stimulating hormone, c-reactive protein, erythrocyte sedimentation rate, vitamins B1, B6, B12, D, magnesium, hemoglobin A1c (HbA1c). Other laboratory autoimmune syndromes, exam, concern comorbid outlined tables follow. return their activities, recommending regular activity tolerated, improved sleep patterns. cautioned avoid rapid overuse triggered exertion. approach recommended ensure flare tolerated. As initially primary clinics. undertake task identifying any ominous particularly reports progressive warrant urgent neurologist, neurosurgeon, findings herald severe, systemic disorder 3: Flags). thorough includes gaining patient's sensory, motor, autonomic, particular attention intervention safety patient. Identification red flag due versus another medical via examination essential. Referral: (ED) neurology depending course/urgency. Action: forced vital appropriate. ED neurosurgery course/urgency associated neuroimaging, Bladder incontinence retention bladder scan, urinalysis, urodynamics, voiding diary, timed Referral cardiology consideration EEG/arrhythmia monitoring. Determine circumstances recent events, certain strenuous, med abnormalities cardiac function—time resolution. Basic tests pituitary adrenal function, inflammation, optimize medications, evaluate safety. Positional—increased intracranial pressure (or low CSF pressure) Worst life (thunderclap headache)–subarachnoid hemorrhage Headache structural affecting brain spinal cord Refer statement. Any (especially rapidly progressive) flag; weakness, deficits indicative diffuse infarct, GBS, neuroimmune concerns trigger workup, could potentially magnetic resonance (MRI) brain, work, cerebrospinal fluid (CSF) studies, electrodiagnostic upper motor neuron hyperreflexia, pathologic clonus reflexes, spasticity, impaired bowel continence, evolving urinary impaction/obstruction processes cord. If vascular (e.g., infarct) neuroinflammatory syndromes transverse myelitis, Neuromyelitis Optica Spectrum Disorder, sclerosis, etc.) Prompt avert catastrophic irreversible central damage.19-23 Acute inflammatory demyelinating polyneuropathy/GBS reported subsequent acutely PASC.22, 23 An nerves, detailed examination, stretch postural reflexes performed. Screening orthostatic hypotension accomplished direct questioning pressures. coexistent especially variation refer dysfunction guidance.13 Neuropsychiatric hallucinations, headaches "thunderclap" addressed. Episodes unexplained loss consciousness more looking underlying arrhythmia seizure disorder. Cranial (refer next Table 4). Symptoms stroke well facial droop, aphasia, unilateral weakness assessed. Assess lateral medullary infarction vertigo, nystagmus, ataxia, nausea vomiting, dysphagia, hiccups. Although ptosis, ophthalmoplegia, diplopia result directly lead blurred vision excluded. example, ophthalmoplegia seen Miller Fisher variant GBS. (ICP) described (headache worse supine position, nausea, status papilledema), worrisome cerebral venous thrombosis; venography computed tomography (CT) venography. New difficulties nature addressed urgently rule out intraocular glaucoma. Signs When appropriate, comorbidities as: Approach: • Recommend avoidance tobacco, alcohol, spicy foods, foods extreme temperature Resources: appropriate: worsen symptoms: angiotensin-converting enzyme (ACE) level; serologies VZV, HSV, EBV PCR (polymerase chain reaction); plasma reagin (RPR); human immunodeficiency virus (HIV); thyroglobulin peroxidase antibodies (TPO TG Ab). neuro-ophthalmology: Signs: studies: conditions: coupled involvement, multidisciplinary encountered clinics serving introduce area followed approaches obtaining histories, conducting therapeutic when specialists broader team. Multiple commonly leads linger PASC.7, 24, 25 One largest evaluating Turkish 356 developed abnormalities, highest involvement (30%), olfactory (27%), glossopharyngeal (25%), vestibulocochlear (17%) though presented neuropathies.26 hypoglossal resistant SARS-CoV-2, lingering (3–60 days) neuropathies, hearing, tinnitus, paresthesia, trigeminal neuralgia. significant difference terms age, gender, body mass index, requirement group unaffected patients.26 Similarly, systematic 56 36 nerves (51%), abducens oculomotor manifesting hypogeusia/ageusia, palsy, ophthalmoparesis.7 bilateral, GBS (MFS). displayed lesions (52%).7 summarized 4. Notably, develop lumbar puncture cytoalbuminologic dissociation GBS/MFS. high level suspicion GBS/MFS intubated where diagnoses easily missed, issues well. Isolated respond favorably steroids, acyclovir/valacyclovir treat reactivated latent neuronal herpes infection. benefit intravenous immunoglobulin exchange.7 Most isolated favorable outcome supportive partial recovery duration. importance proper ongoing properly treated period. post-COVID-19 previously hospitalization.27 meta-analysis ranged 8% 15% 6 infection.27 Post-COVID-19 varied (estimated about 25%) rest having tension-type thunderclap presentations.28 Viral infections known headache.29 factor previous migraine. cumulative lifetime 7.4% males 21% females.30 Three large population-based inverse relationship between household income/education States.30 Persistent phase.31 worsened disturbances, mood loss, fatigue.31 Headaches unique presentation. standardized determine secondary.32 determined headache's phenotype. cognizant secondary disorders. using SNOOP4 tool: see 5: Warning Signals Raise Suspicion Secondary Causes Using Mnemonic cause.33 distinct clearly remembered pain becoming continuous unremitting within 24 hours, over better accounted International Classification Disorders-3 diagnosis.34 typically refractory treatment. describes considerations options types phenotypes Obtain co-occurring (like tension-type, it (space-occupying lesions, infections, abnormalities). SNOOP433 Complete supplements ascertain they might contributing headaches. nonresponsive over-the-counter medications. comorbidities: Nonpharmacologic therapies (acupuncture, relaxation deep breathing exercises, biofeedback) sensitivity, resistance, inability tolerate medication. Ideas include: Medication occurs 15 days develops consequence months. To ergotamines, triptans, opioids, combination analgesics taken 10 simple (acetaminophen, aspirin, nonsteroidal anti-inflammatory drugs) per months.34 biological mechanism maintaining homeostasis, tissue repair, immune regulation, processing/consolidation, quality life.37 Optimal positive results health.38 research 2022, meeting Associated Professional Societies, investigators Cleveland Clinic 41.3% moderate disturbances indicated severe issues. indicates Black three times likely moderate-to-severe recovering anxiety higher-than-average disturbance.39 31 5153 34% 45% 57% depression anxiety.40 noted misalignment sleep–wake cycle circadian rhythms negatively affect attention, concentration, learning, memory, some PASC.41 Management insomnia requires stepwise approach, beginning attempts eliminate minimize obstructive apnea, interfere optimal sleep. 7 considerations. Successful behavioral pharmacologic devised recognized PASC-associated entered into chronic insomnia. preferred line therapy (CBT-I), multicomponent targeting cognitions behavior poor Behaviorally, encouraged maintain consistent routine establishing stable bed wake time, try lie sleeping, sleeping environment comfort, substances sleep, reduce (sleep restriction), get experiencing anxiety. CBT-I addresses anxious thoughts surrounding sleeplessness, expectations, insomnia, promotes relaxation, mindfulness, meditation. validated face-to-face remote applications (such online teletherapy) shown promising small studies.42 of: sleep: Clinician prescription guided effects cautiously. accessible many, either lack therapists, limitations insurance, time. cases, short acceptable thoroughly evaluated beforehand, regularly treatment, continues positively diary very helpful tool gain insight problems, monitor whether successful. diaries normally completed once twice day. usually consists several questions related times, nap caffeine alcohol use, general functioning. (less month) stressors causes. However, fails substantial distress, short-term warranted immediate interference daytime control escalating Interventions, tailored polypharmacy elderly dosing pregnant lactating women considered. Social determinants (SDOH) instance, someone lives crowded multigenerational home works night shift difficulty quantity 8 examples SDOH 8: Equity Considerations Examples PASC: Sequelae). Racial/Ethnic Minority Groups Example: People (including African-American), American-Indian/Alaska Native, Pacific Islander, Asian-American, Mixed Race, Latino/Hispanic (ethnicity) Individuals racial/ethnic minority groups lower rates rehabilitation classified White/Caucasian.47, 48 All impairment symptomatology tremor, vestibular complaints, paresis specialized neurorehabilitation programs. Referrals timely manner. Treating physicians what type interventions programs considering cost accessibility. Every effort made close gaps groups. Biologic Sex Female adults Biologically female differences diagnoses. hormone levels estrogen)

Язык: Английский

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Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Scientific Reports, Год журнала: 2024, Номер 14(1)

Опубликована: Фев. 26, 2024

Abstract Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East North Africa (MENA) countries; however, extent of medically defined disorders (SDs) remains unclear. This meta-analysis determines SD prevalence identifies associated factors MENA. PubMed, Web Science, Google Scholar, reference lists included studies were searched (latest search: June 2022). Meta-analyses 22 performed using random-effect models. Included used self-reported screening tools for assessing SDs then estimated proportion participants at high risk developing a SD. Central hypersomnolence most prevalent [prevalence pooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia 30.4% 59.1% (Morocco)], circadian rhythm sleep–wake 13.5% 22.4% sleep-related breathing 12.2% 22.5% (Pakistan)], movement 5.9% (Egypt) 30.6% parasomnias 5.6% 17.4% Arabia)]. Female sex, studying latter academic years, having anxiety, excessive internet use, performance significantly with SDs. MENA students. Implementing student-centered interventions targeting groups schools should be considered improve students’ health wellbeing.

Язык: Английский

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Changes in well-being among socially isolated older people during the COVID-19 pandemic: An outcome-wide analysis

Proceedings of the National Academy of Sciences, Год журнала: 2024, Номер 121(18)

Опубликована: Апрель 22, 2024

Older adults experienced major changes during the COVID-19 pandemic and ensuing restrictions, it might be expected that those who were already socially isolated before particularly vulnerable. We apply an outcome-wide longitudinal design on 4,636 participants (mean age 66.8 y) from English Longitudinal Study of Ageing, observed in 2018/19 early (June/July 2020) later (November/December pandemic. Social isolation is defined using index including marital status, social contact, participation 2018/19. Using mixed models, we compare well-being, health, health behaviors, financial Internet use, between nonisolated participants. From to pandemic, (29%) smaller declines life satisfaction quality a increase loneliness. They showed greater smoking physical activity more likely remain worried about their future situation. also did not change likelihood regular contrasting with increased this regard. The groups followed similar trend for general sleep (no change), depression anxiety (increase), expectations difficulties (decrease). Although older generally show poorer outcomes than connected counterparts, they somewhat protected some fronts. Our findings highlight need continually care but attentive times unexpected crises experiencing extreme related necessary policy responses.

Язык: Английский

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Light exposure predicts COVID-19 negative status in young adults

Biological Rhythm Research, Год журнала: 2024, Номер 55(11-12), С. 535 - 546

Опубликована: Ноя. 10, 2024

A weekly actigraphy was conducted within a single month in 122 young adults, who were categorized into two groups: COVID(-): individuals without SARS-CoV-2 infection, n = 43; COVID(+), 79: with confirmed infection. Physical activity, wrist temperature, sleep parameters, and light exposure compared. Higher daytime ambient (LE), blue (BLE) ultraviolet B (UVBE) COVID(-) group. In multivariate model, incorporating BLE amplitude, M10 of physical age, sex, amplitude remained the only significant predictor COVID-19 status (observed power 0.701, p 0.013). ANOVA revealed interactions LE, BLE, UVBE between time day (LE: F 2.040, 0.0025; BLE: 2.426, 0.0002; UVBE: 3.096, < 0.0001), higher values observed during office hours differing groups around 3 pm.

Язык: Английский

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The Relationship Between Insufficient Sleep and Depressive Symptoms in Chinese Adolescents: A National Survey of Contributing Factors

Nature and Science of Sleep, Год журнала: 2025, Номер Volume 17, С. 55 - 67

Опубликована: Янв. 1, 2025

Purpose: There is a lack of national studies examining the relationship between insufficient sleep and depression among Chinese adolescents, previous research has not comprehensively considered related factors. This study aimed to investigate prevalence depressive symptoms in adolescents with explore role associated factors using nationally representative sample China. Patients Methods: A pen-and-paper survey was conducted 24147 from November 2019 January 2020. Data on symptoms, maltreatment experiences, psychological resilience, demographic information, parent–child relationships, parental marital status, duration were collected. Results: total 22231 valid questionnaires analyzed. Among respondents, 67.7% reported sleep, while 32.3% had sufficient sleep. The 25.3% compared 8.2% those Insufficient identified as an independent risk factor for (OR = 3.058, 95% CI: 2.753– 3.396, P < 0.001). In being female, emotional abuse, physical sexual neglect significant ( 0.05), higher resilience scores good protective 0.05). additional included body mass index (BMI), older age, divorce, living single parent Conclusion: significantly adolescents. particularly who are older, have BMI, or come divorced single-parent households, require increased attention. Keywords: duration, adolescent mental health,

Язык: Английский

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Characteristics and Associated Factors of Insomnia Among the General Population in the Post-Pandemic Era of COVID-19 in Zhejiang, China: A Cross-Sectional Study

International Journal of General Medicine, Год журнала: 2025, Номер Volume 18, С. 191 - 206

Опубликована: Янв. 1, 2025

Objective: This study aimed to analyze the changes in insomnia characteristics among general population and explore associated factors during COVID-19 pandemic post-pandemic periods.Methods: A cross-sectional was conducted using an anonymous online survey.Questionnaires were administered at two-time points (T1: March 1-31, 2022; T2: 2023), which included Insomnia Severity Index (ISI) questions related sleep risk factors, including pandemic, familial influences, work conditions, social activities, physical health, use of electronic devices before sleep, environment, food intake exercise etc. compared two points, with logistic regression testing associations sociodemographic covariates factors.Six machine learning models employed develop a predictive model for insomnia, namely regression, random forest, neural network, support vector machine, CatBoost, gradient boosting decision tree. Results:The obtained 2769 1161 valid responses T1 T2, respectively.The prevalence increased from 23.4% 34.83% T2.Univariate analyses indicated activity, intake, significantly differed (p<0.05) between non-insomnia groups.In significant differences observed groups, family structure, health status.The forest had highest prediction accuracy (90.92% correct 86.59% respectively), while most critical variable both time points. Conclusion:The severity have worsened period, highlighting urgent need effective interventions.Notably, status identified as insomnia.

Язык: Английский

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