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Avaliar a relação entre gravidade dos sintomas da Covid-19 e qualidade de vida na Covid Longa em adultos e idosos. Trata-se de estudo transversal, prospectivo e multicêntrico, realizado com indivíduos com idade superior á 18 anos com Covid Longa, de ambos os sexos, acompanhados nas Clínicas Escolas da Universidade Paulista UNIP. Foi aplicado uma ficha de avaliação, no qual foram coletadas informações como, dados pessoais, história clínica da Covid-19, e manejos da doença em relação a necessidade de oxigenoterapia, ventilação mecânica não invasiva (VNI) e invasiva (VM) e traqueostomia (TQT), bem como o questionário SF36 versão Brasileira. A pesquisa foi submetida e aprovada pelo CEP da Universidade Paulista UNIP, parecer 4.894.652. Os adultos e idosos que foram internados tiveram pior qualidade de vida nos domínios capacidade funcional, vitalidade e saúde mental. Aqueles que utilizaram oxigenoterapia, VM e TQT, tiveram maior acometimento no domínio saúde mental e os indivíduos que utilizaram a VNI, tiveram pior pontuação no domínio capacidade funcional. Conclui-se que adultos e idosos com Covid Longa apresentaram pior qualidade de vida à longo prazo, sobretudo naqueles com maior gravidade dos sintomas da Covid-19, ou seja, que necessitaram de internação, oxigenoterapia, VNI, VM e traqueostomia.
To evaluate the relationship between the severity of Covid-19 symptoms and quality of life adults and elderly with Long Covid in. This is a cross-sectional, prospective and multicenter study, carried out with individuals aged over 18 years with Long Covid, of both gender, followed at the Clinic School of Universidade Paulista - UNIP. Infor-mations such as personal data, clinical history of Covid-19, and disease management in relation to used of oxygen therapy, non-invasive (NIV) and invasive mechanical ventila-tion and tracheostomy was collected. SF36 questionnaire version Brazilian was aplied to assess quality of life . Adults and elderly people who were hospitalized had a worse quality of life in functional capacity, vitality and mental health domains. Furthermore, those who used oxygen therapy, intubation and tracheostomy, had worse mental health. The individuals who used NIV had worse scores in domain capacity works. It is con-cluded that adults and elderly people with Long Covid had a worse quality of life in the long term, especially in those with more severe symptoms of Covid-19, that is, those who required hospitalization, oxygen therapy, invasive and non-invasive mechanical ventilation and tracheostomy.
Relacionar la gravedad de los síntomas de Covid-19 y la calidad de vida en adultos y ancianos con Largo Covid. Métodos: Se trata de un estudio transversal, prospectivo y multicéntrico, realizado con individuos mayores de 18 años con Largo Covid, de ambos sexos, seguidos en las Clínicas Escolas de la Universidade Paulista - UNIP. Se aplicó un formulario de evaluación, en el cual se recolectó información como datos personales, antecedentes clínicos de Covid-19 y manejo de la enfermedad en relación a la necesidad de oxigenoterapia, ventilación mecánica no invasiva e invasiva y traqueotomía, así como la Cuestionario SF36 versión brasileña. Resultados: Los adultos y ancianos hospitalizados tenían peor calidad de vida en los dominios capacidad funcional, vitalidad y salud mental. De los cuales usaban oxigenoterapia, intubación y traqueotomía, tenían peor salud mental. Los individuos que usaban ventilación mecánica no invasiva tenían peores puntuaciones en el domínio del la capacidad funcional. Conclusión: Se concluye que los adultos y ancianos con Covid Largo tuvieron una peor calidad de vida a largo plazo, especialmente en aquellos con síntomas más severos de Covid-19, es decir, aquellos que requirieron hospitalización, oxigenoterapia, invasiva y no invasiva. ventilación mecánica y traqueotomía.
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Resumen Introducción : La evolución del síndrome post COVID ha sido variable y carecemos de información sobre su impacto en los profesionales de la salud. Métodos : Realizamos una encuesta a través de una red social en profesionales de la salud sobre casos de síndrome post COVID-19 confirmados con PCR. En un cuestionario web, preguntamos sobre 21 síntomas, su gravedad, duración, grado de afectación de la actividad y reincorporación al trabajo. Resultados : Respondieron 4673 profesionales sanita rios de 21 países, edad media de 47 años, 64% mujeres. El curso inicial fue asintomático en el 9%, síntomas leves en el 36%, síntomas moderados sin hospitalización en el 40% o con hospitalización en el 11%, y síntomas graves en el 1%. Los síntomas más prevalentes fueron fatiga (67%), insomnio (44%), ansiedad (42%), mialgia (41%) y anosmia (41%). La prevalencia se redujo a la mitad en los primeros 5 cinco meses, pero en muchos casos se prolongó durante más de un año. En el análisis multi variado los síntomas tendieron a agruparse en clusters (cognitivos, neuropsiquiátricos, cardiorrespiratorios, digestivos, otros). La necesidad de cambiar de área de trabajo fue del 16% y la falta de reincorporación al tra bajo del 7%, relacionadas con la mayor edad, el número de síntomas y la gravedad del curso inicial. Conclusión : En muchos casos la persistencia de los síntomas post COVID-19 puede ser prolongada y te ner un impacto laboral en los profesionales sanitarios, requiriendo la adopción de políticas específicas para reducir el daño.
Abstract Background : The evolution of post COVID-19 syn drome has been variable and we lack information on its impact on healthcare professionals. Methods : We conducted a survey through a social network in health professionals on post COVID-19 syn drome cases confirmed with PCR. In a web-based ques tionnaire, we asked about 21 symptoms, their severity, duration, degree of activity impairment and return to work. Results : 4673 health professionals from 21 countries responded, mean age of 47 years, 64% women. The initial course was asymptomatic in 9%, mild symptoms 36%, moderate symptoms without hospitalization 40% or with hospitalization 11%, and severe symptoms 1%. The most prevalent symptoms were fatigue (67%), insomnia (44%), anxiety (42%), myalgia (41%) and anosmia (41%). Prevalence dropped by half in the first 5 five months, but in many cases, it lasted for more than a year. In the mul 670 tivariate analysis, symptoms tended to be grouped into clusters (cognitive, neuropsychiatric, cardiorespiratory, digestive, others). The need to change the work area was 16% and lack of return to work 7%, related to older age, number of symptoms and severity of the initial course. Conclusion : in many cases the persistence of post- COVID symptoms can be prolonged and have an occu pational impact on healthcare professionals, requiring the adoption of specific policies to reduce harm.
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Coronavirus disease 19 (COVID-19), caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), has been implicated in having post-COVID-19 sequelae in both adults and children. There is a lack of good data on the prevalence and risk factors for post-COVID-19 sequelae in children. The authors aimed to review the current literature on post-COVID sequelae. The prevalence of post-COVID sequelae in children is highly variable among studies, with an average of 25%. The sequelae may affect many organ systems, though mood symptoms, fatigue, cough, dyspnea, and sleep problems are common. In many studies, it is difficult to establish a causal association due to the lack of a control group. Furthermore, it is difficult to differentiate whether the neuropsychiatric symptoms in children after COVID-19 are due to infection or a result of lockdowns and social restrictions imposed by the pandemic. Children with COVID-19 should be followed by a multidisciplinary team and screened for symptoms, followed by focused laboratory evaluations as needed. There is no specific treatment for the sequelae. Only symptomatic and supportive treatment is required in most cases. More research is necessary to standardize the definitions of sequelae, establish a causal association, assess various treatment options, and the effects of different virus variants, and finally, see the impact of vaccination on the sequelae.
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Background & objectives: The risk factors for clinically significant diffuse parenchymal lung abnormalities (CS-DPLA) persisting after severe coronavirus disease 2019 (COVID-19) pneumonia remain unclear. The present study was conducted to assess whether COVID-19 severity and other parameters are associated with CS-DPLA. Methods: The study participants included patients who recovered after acute severe COVID-19 and presented with CS-DPLA at two or six month follow up and control group (without CS-DPLA). Adults volunteers without any acute illness, chronic respiratory illness and without a history of severe COVID-19 were included as healthy controls for the biomarker study. The CS-DPLA was identified as a multidimensional entity involving clinical, radiological and physiological pulmonary abnormalities. The primary exposure was the neutrophil-lymphocyte ratio (NLR). Recorded confounders included age, sex, peak lactate dehydrogenase (LDH), advanced respiratory support (ARS), length of hospital stay (LOS) and others; associations were analyzed using logistic regression. The baseline serum levels of surfactant protein D, cancer antigen 15-3 and transforming growth factor-? (TGF-?) were also compared among cases, controls and healthy volunteers. Results: We identified 91/160 (56.9%) and 42/144 (29.2%) participants with CS-DPLA at two and six months, respectively. Univariate analyses revealed associations of NLR, peak LDH, ARS and LOS with CS-DPLA at two months and of NLR and LOS at six months. The NLR was not independently associated with CS-DPLA at either visit. Only LOS independently predicted CS-DPLA at two months [adjusted odds ratios (aOR) (95% confidence interval [CI]), 1.16 (1.07-1.25); P<0.001] and six months [aOR (95% CI) and 1.07 (1.01-1.12); P=0.01]. Participants with CS-DPLA at six months had higher baseline serum TGF-? levels than healthy volunteers. Interpretation and conclusions: Longer hospital stay was observed to be the only independent predictor of CS-DPLA six months after severe COVID-19. Serum TGF-? should be evaluated further as a biomarker.
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Post Covid complication occurs in individuals with a history of con?rmed covid-19 infection, that develop within 3months of onset of COVID-19 illness, last for at least 2months and cannot be explained by alternative diagnosis. We aim to estimate the magnitude of post covid complications and its association with risk factors. A follow up study was conducted among 250 COVID19 positive patients from July 2021 to Jan2022. These patients were interviewed telephonically at 3rd month & 6th month after recovery. Majority of post COVID symptoms identified were fatigue (29.6%), anosmia (26.8%) & ageusia (15.2%). At least one of these symptoms was present in 67.6% and 28% patients at 3rd and 6th month post infection respectively. Other clinical features included insomnia (8%), skin rashes (7.6%) and mood disorders (4%). Systemic involvement was seen in 1.2% as new onset hypertension. No significant gender difference was identified in any of the symptoms (?2=0.24, p=0.6). Risk factors associated in developing long COVID-19 were high BMI[RR=1.2], age >60yrs [RR=1.3], poor vaccination status [RR=1.45]and long duration of illness (>14 days) [RR=1.4]. 4 deaths (1.6%) were reported among 8.8% hospitalized patients having severe comorbidities (e.g. Coronary artery disease). Nearly 2/3rd patients were having one or the other symptoms at the end of the 3rd month and 1/4th at the end of 6th months. Also, death during the post COVID period, strongly suggests continuous follow up visits for high risk patients and spreading public awareness to seek health care facilities for follow up.
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Resumen Además de provocar problemas respiratorios, la infección con el SARS-CoV-2 puede causar un espectro amplio de complicaciones neurológicas como son cefalea, ageusia, anosmia, encefalopatía, enfermedad cerebrovascular, síndrome de Guillain-Barré y otras polineuropatías, meningoencefalitis, encefalopatía hemorrágica necrotizante aguda y síndromes del sistema nervioso central asociados a inflamación. En esta revisión presentamos 39 casos de mielitis transversa aguda (MTA) asociados a infección por el SARS-CoV-2, confirmado por una prueba de reacción en cadena de la polimerasa (PCR) por hisopado nasofaríngeo y/o de antígeno en plasma. Los análisis bioquímicos de los pacientes confirmaron la ausencia de otros patógenos y de autoanticuerpos involucrados en inflamación del sistema nervioso, excepto por 2 casos, uno con autoanticuerpos contra la glicoproteína de la mielina de los oligodendrocitos (anti-MOG IgG) y otro con anti-MOG IgG y antidescarboxilasa del ácido glutámico (anti-GAD65), indicativos de una enfermedad autoinmune del sistema nervioso central. Los estudios de imagenología de resonancia magnética (RMN) confirmaron el diagnóstico de MTA. Aunque no se puede inferir causalidad, es muy probable que los casos aislados de MTA sean consecuencia de un proceso para o postinfeccioso en la COVID-19. La comprensión de los mecanismos que desencadenan estos trastornos neurológicos durante o al final de la infección viral, ayudarán a optimizar las estrategias terapéuticas para el manejo del paciente.
Abstract In addition to causing respiratory problems, SARS-CoV-2 can cause a wide spectrum of neurological complications such as headaches, ageusia, anosmia, encephalopathy, cerebrovascular disease, Guillain-Barré syndrome and other polyneuropathies, meningoencephalitis, acute necrotizing hemorrhagic encephalopathy, and central nervous system syndromes associated with inflammation. In this review we present 39 cases of acute transverse myelitis (ATM) associated to SARS-CoV-2 infection. All cases had a positive polymerase chain reaction (PCR) nasopharyngeal swab and/or antigen test. Biochemical analyses confirmed the absence of other pathogens and autoantibody-mediated neuroinflammatory disease, except for two cases, one with autoantibodies against the oligodendrocyte myelin glycoprotein (anti-MOG IgG) and another with anti-MOG IgG and anti-glutamic acid decarboxylase (anti-GAD65). Magnetic Resonance Imaging (MRI) studies confirmed the diagnosis of ATM. Although causality cannot be inferred, it is likely that isolated cases of ATM are the consequence of a para or post-infectious process in SARS-CoV-2. In this work, the probable causes of ATM associated with SARS-CoV-2 are discussed. The understanding of the mechanisms behind these neurological disorders triggered by a viral infection will help to optimize the therapeutic strategies for patient management.
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Abstract: Most COVID-19 survivors have reported experiencing persistent symptoms after the infection - these types of cases are known as long COVID. Since Brazil was an epicenter of the COVID-19 pandemic, a high burden of long COVID is expected. This study aimed to identify the prevalence and factors associated with long COVID in adults in Southern Brazil, analyzing data from the PAMPA cohort. Participants filled out a self-reported online questionnaire in June 2022. This study only included subjects who tested positive for COVID-19. Long COVID was defined by any symptoms that persisted for at least three months after the SARS-CoV-2 infection. Poisson's regression models with robust variance were used to identify factors associated with long COVID; and results were reported as prevalence ratios (PR) and respective 95% confidence intervals (95%CI). A total of 1,001 participants (77.4% women, mean age [SD] = 38.3 [11.9] years) were analyzed. The prevalence of long COVID among these patients was 77.4% (95%CI: 74.7; 79.9). The likelihood of long COVID was higher in unvaccinated participants (PR = 1.23, 95%CI: 1.06; 1.42), in those with chronic conditions (PR = 1.13, 95%CI: 1.04; 1.24), and in those who were hospitalized due to the COVID-19 infection (PR = 1.24, 95%CI: 1.16; 1.32). This prevalence was also higher in women (PR = 1.21, 95%CI: 1.09; 1.33) than in men. Physical activity was associated with a reduced likelihood of fatigue, neurological complications, coughing, and headaches as persistent symptoms after a COVID-19 infection. It was found that three out of four adults in Southern Brazil experienced long COVID. Public policies aiming to reduce the burden of long COVID must be prioritized, especially in groups that are at higher risk of developing this harmful condition.
Resumo: A maior parte dos sobreviventes da COVID-19 relatou sintomas persistentes após a infecção, também conhecida como COVID longa. O Brasil foi um epicentro da pandemia de COVID-19, logo, espera-se uma alta carga de COVID longa. Este estudo teve como objetivo identificar a prevalência e os fatores associados à COVID longa em adultos no Sul do Brasil. Foram analisados dados da coorte PAMPA. Os participantes preencheram um questionário online autoaplicável em junho de 2022. Foram incluídos apenas os participantes que testaram positivo para COVID-19. A COVID longa foi definida como qualquer sintoma que persistiu por pelo menos três meses após a infecção do SARS-CoV-2. Os modelos de regressão de Poisson com variância robusta foram usados para identificar fatores associados à COVID longa; os resultados foram relatados como razão de prevalência (RP) e seus respectivos intervalos de 95% de confiança (IC95%). Ao todo, 1.001 participantes (77,4% mulheres, idade média [DP] = 38,3 [11,9] anos) foram analisados. A prevalência da COVID longa foi de 77,4% (IC95%: 74,7; 79,9). A probabilidade da COVID longa foi maior em participantes não vacinados (RP = 1,23, IC95%: 1,06; 1,42), pessoas com condições crônicas (RP = 1,13, IC95%: 1,04; 1,24), e pacientes hospitalizados devido à infecção por COVID-19 (RP = 1,24, IC95%: 1,16; 1,32) em comparação com as contrapartes. A prevalência foi maior em mulheres (RP = 1,21, IC95%: 1,09; 1,33) do que em homens. A atividade física foi associada à probabilidade reduzida de fadiga, complicações neurológicas, tosse e dor de cabeça como sintomas persistentes após a infecção por COVID-19. Três em cada quatro adultos no Sul do Brasil tiveram COVID longa. Políticas públicas que visem reduzir a carga da covid longa devem ser priorizadas, especialmente nos grupos de maior risco desta condição.
Resumen: La mayoría de los supervivientes de la COVID-19 relató síntomas persistentes tras la infección, también conocida como COVID largo. Brasil fue un epicentro de la pandemia de COVID-19, así, se espera una alta carga de COVID largo. El objetivo de este estudio fue identificar la prevalencia y los factores asociados con la COVID largo en adultos en el Sur de Brasil. Se analizaron datos de la cohorte PAMPA. Los participantes rellenaron un cuestionario en línea autoadministrado en junio de 2022. Solo se incluyeron los participantes que dieron positivo para COVID-19. La COVID largo fue definida como cualquier síntoma que persistió durante al menos tres meses tras la infección del SARS-CoV-2. Se utilizaron los modelos de regresión de Poisson con varianza robusta para identificar factores asociados con el COVID largo; se relataron los resultados como razón de prevalencia (RP) y sus respectivos intervalos de 95% confianza de 95% (IC95%). En total, se analizaron 1.001 participantes (el 77,4% mujeres, edad media [DP] = 38,3 [11,9] años). La prevalencia del COVID largo fue del 77,4% (IC95%: 74,7; 79,9). La probabilidad del COVID largo fue más alta en participantes no vacunados (RP = 1,23, IC95%: 1,06; 1,42), personas con condiciones crónicas (RP = 1,13, IC95%: 1,04; 1,24) y pacientes hospitalizados debido a la infección por COVID-19 (RP = 1,24, IC95%: 1,16; 1,32) en comparación con sus contrapartes. La prevalencia fue más alta en mujeres (RP = 1,21, IC95%: 1,09; 1,33) que en hombres. La actividad física se asoció con la probabilidad reducida de fatiga, complicaciones neurológicas, tos y dolor de cabeza como síntomas persistentes tras la infección por COVID-19. Tres de cada cuatro adultos en el Sur de Brasil han tenido COVID largo. Se deben priorizar las políticas públicas destinadas a reducir la carga del COVID largo, sobre todo en los grupos de mayor riesgo para esta condición.
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Abstract Background Data on post-acute COVID-19 in autoimmune rheumatic diseases (ARD) are scarce, focusing on a single disease, with variable definitions of this condition and time of vaccination. The aim of this study was to evaluate the frequency and pattern of post-acute COVID-19 in vaccinated patients with ARD using established diagnosis criteria. Methods Retrospective evaluation of a prospective cohort of 108 ARD patients and 32 non-ARD controls, diagnosed with SARS-CoV-2 infection (RT-PCR/antigen test) after the third dose of the CoronaVac vaccine. Post-acute COVID-19 (≥ 4 weeks and > 12 weeks of SARS-CoV-2 symptoms) were registered according to the established international criteria. Results ARD patients and non-ARD controls, balanced for age and sex, had high and comparable frequencies of ≥ 4 weeks post-acute COVID-19 (58.3% vs. 53.1%, p = 0.6854) and > 12 weeks post-acute COVID-19 (39.8% vs. 46.9%, p = 0.5419). Regarding ≥ 4 weeks post-acute COVID-19, frequencies of ≥ 3 symptoms were similar in ARD and non-ARD controls (54% vs. 41.2%, p = 0.7886), and this was also similar in > 12 weeks post-acute COVID-19 (68.3% vs. 88.2%, p = 0.1322). Further analysis of the risk factors for ≥ 4 weeks post-acute COVID-19 in ARD patients revealed that age, sex, clinical severity of COVID-19, reinfection, and autoimmune diseases were not associated with this condition (p > 0.05). The clinical manifestations of post-acute COVID-19 were similar in both groups (p > 0.05), with fatigue and memory loss being the most frequent manifestations. Conclusion We provide novel data demonstrating that immune/inflammatory ARD disturbances after third dose vaccination do not seem to be a major determinant of post-acute COVID-19 since its pattern is very similar to that of the general population. Clinical Trials platform (NCT04754698).
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Long COVID is an emerging public health threat, following swiftly behind the surges of acute infection over the course of the COVID-19 pandemic. It is estimated that there are already approximately 100 million people suffering from Long COVID globally, 0.5 million of whom are South African, and for whom our incomplete understanding of the condition has forestalled appropriate diagnosis and clinical care. There are several leading postulates for the complex, multi-mechanistic pathogenesis of Long COVID. Patients with Long COVID may present with a diversity of clinical phenotypes, often with significant overlap, which may exhibit temporal heterogeneity and evolution. Post-acute care follow-up, targeted screening, diagnosis, a broad initial assessment and more directed subsequent assessments are necessary at the primary care level. Symptomatic treatment, self-management and rehabilitation are the mainstays of clinical care for Long COVID. However, evidence-based pharmacological interventions for the prevention and treatment of Long COVID are beginning to emerge. This article presents a rational approach for assessing and managing patients with Long COVID in the primary care setting.
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Masculino , Feminino , Atenção Primária à Saúde , Sinais e Sintomas Respiratórios , Gerenciamento Clínico , Teste Sorológico para COVID-19 , COVID-19 , Doenças Cardiovasculares , SARS-CoV-2RESUMO
Introduction: The COVID-19 pandemic has brought short, medium, and long-term consequences on the quality of life of those affected. Among the complications are those related to the involvement of the nervous system and the structures involved in body movement, with sequelae that may be transitory and/or definitive, and require rehabilitation. Objective: Identify the neuromuscular alterations that affect body movement, associated with COVID-19. Material and methods: A search was made for observational works published in the SCOPUS, PubMed, EBSCO, and Nature databases between January 2020 and June 2022 under the PRISMA methodology, to answer the PICO question: what are the neuromuscular alterations that can potentially affect movement, associated with COVID-19? The established filters were type of study, language, age, availability, publication dates. The MeSH terms were SARS-Cov-2, COVID-19, Long Covid, Motor Activity Neuromuscular Diseases, Neurological Disorders, Guillain-Barré Syndrome, Myelitis Transverse, Stroke, Patient, Peripheral Nervous System Diseases. The methodological quality was evaluated according to STROBE and the level of evidence was established according to CEBM. Results: In the first search, 645 articles were identified. 637 were discarded by filters, titles, duplicate abstracts, methodological quality, and level of evidence. There were 8 articles selected for the present review in which neuromuscular alterations of central and peripheral origin were identified, such as myalgias, fatigue, polyneuroradiculopathies, CNS inflammation, among others, with clinical manifestations that affect movement. Conclusion: COVID-19 is a multisystemic disease that can affect the nervous system with symptoms of neuromuscular alterations that compromise body movement.
Introducción: La pandemia por la COVID-19 ha traído consecuencias a corto, mediano y largo plazo sobre la calidad de vida de los afectados. Entre las complicaciones se encuentran aquellas relacionadas con la afectación del sistema nervioso y las estructuras involucradas en el movimiento corporal, con secuelas que pueden ser transitorias y/o definitivas, y requieren rehabilitación Objetivo: Identificar las alteraciones neuromusculares que afectan el movimiento corporal, asociadas a la COVID-19. Material y métodos: Se hizo una búsqueda de trabajos observacionales publicados en las bases de datos SCOPUS, PubMed, EBSCO y Nature entre enero de 2020 y junio de 2022 bajo metodología PRISMA, para dar respuesta a la pregunta PICO: ¿cuáles son las alteraciones neuromusculares que potencialmente pueden afectar el movimiento, asociadas a la COVID-19? Los filtros establecidos fueron tipo de estudio, idioma, edad, disponibilidad y fechas de publicación. Los términos MesH fueron SARS-Cov-2, COVID-19, Long Covid, Motor Activity Neuromuscular Diseases, Neurological Disorders, Guillain-Barré Syndrome, Myelitis Transverse, Stroke, Patient, Peripheral Nervous System Diseases. La calidad metodológica se evaluó según STROBE y el nivel de evidencia se estableció según CEBM. Resultados: En la primera búsqueda se identificaron 645 artículos. Posteriormente se descartaron 637 por filtros, títulos, resúmenes duplicados, calidad metodológica y nivel de evidencia. Así, quedaron seleccionados 8 para la presente revisión, en los cuales se identificaron alteraciones neuromusculares de origen central y periférico, como mialgias, fatiga, polineuroradiculopatías, inflamación del SNC, entre otras, con manifestaciones clínicas que afectan el movimiento. Conclusión: La COVID-19 es una enfermedad multisistémica que puede afectar el sistema nervioso con síntomas de alteraciones neuromusculares que comprometen el movimiento corporal.
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Resumen Este trabajo aborda el origen y el desarrollo del síndrome pos-COVID-19, el cual consiste en la persistencia a través del tiempo de diferentes síntomas como consecuencia de la infección por SARS-CoV-2. A partir de una revisión narrativa de la literatura científica, se realiza un breve recorrido sobre el nuevo término y se precisa la definición conceptual, los síntomas característicos, las diversas implicaciones en la salud de las personas y las respuestas de atención específica que se han implementado. Se concluye con una llamada de atención a los gobiernos de América Latina y el Caribe para dar tratamiento y seguimiento a este problema de salud pública.
Abstract This work addresses the origin and development of post-COVID-19 syndrome, which consists of the persistence of different symptoms over time as a consequence of SARS-CoV-2 infection. Based on a narrative review of the scientific literature, a brief analysis of the new term is made, specifying the conceptual definition, characteristic symptoms, the various implications for people's health, and the responses to specific care measures that have been implemented. It concludes with a wake-up call to the governments of Latin America and the Caribbean in order for care and surveillance to be provided to this public health problem.
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Abstract Background The chronic aspect that begins to characterize long COVID appeals to the need for interventions proposed by institutions such as the World Health Organization (WHO) and the National Institute for Health and Care Excellence (NICE) to manage the disease, emphasizing behavioral change and self-care. Objective To perform a narrative review of the psychological literature that offers intervention strategies in alignment with the recommendations of the long COVID management guidelines proposed by WHO and NICE. Method MEDLINE, EBSCO, Google Scholar, SciELO, PsycINFO, PubMed, Cochrane, and CONRICYT databases were consulted, using Boolean operators and keywords for an exhaustive search. Results The contributions of the studies were categorized into five intervention strategies based on WHO and NICE recommendation guidelines: Psychoeducation, Self-care, Support networks, Relaxation, and Goal setting. These are given a brief introduction and their relevance to the management of long COVID symptomatology is described. Discussion and conclusion The persistent condition of COVID-19 symptoms makes it necessary to recognize that lifestyle changes must be made, primarily focused on health care and prevention of worsening disease sequelae. These lifestyle changes can be achieved through behavior modification, focusing on protective factors such as education, self-care, support networks, relaxation techniques and, setting appropriate goals.
Resumen Antecedentes El aspecto crónico que empieza a caracterizar al COVID persistente hace un llamado a la propuesta de intervenciones desde instituciones como la Organización Mundial de la Salud (OMS) y el National Institute for Health and Care Excellence (NICE) para lograr un manejo de la enfermedad, el cambio conductual y el autocuidado. Objetivo Elaborar una revisión narrativa sobre la literatura psicológica que ofrece estrategias de intervención acordes a las recomendaciones de las guías de manejo del COVID persistente propuestas por la OMS y el NICE. Método Se consultaron las bases de datos MEDLINE, EBSCO, Google Scholar, SciELO, PsycINFO, PubMed, Cochrane y CONRICYT. Se utilizaron operadores booleanos y palabras claves para una búsqueda exhaustiva. Resultados Las aportaciones de los estudios fueron categorizadas en cinco estrategias de intervención basadas en las guías de recomendación de la OMS y el NICE: Psicoeducación, Autocuidado, Redes de apoyo, Relajación y Establecimiento de metas. En ellas se realiza una breve introducción y se expone su relevancia para el manejo de la sintomatología del COVID persistente. Discusión y conclusión El padecimiento persistente de los síntomas del COVID-19 hace necesario reconocer que deben realizarse cambios en el estilo de vida, principalmente enfocados en el cuidado de la salud y la prevención del empeoramiento de las secuelas de la enfermedad. Estos cambios en el estilo de vida podrán lograrse mediante la modificación de la conducta, orientándola a factores protectores como la educación, el autocuidado, las redes de apoyo, las técnicas de relajación y el establecimiento de metas adecuadas.
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The clinical entity termed as long COVID has gained importance in the recent past. As this phenomenon is still evolving, it is important to document the magnitude of the syndrome during different time periods. This scoping review attempts to synthesize evidence generated from longitudinal studies which have follow‑up periods beyond 3 months, up to 12 months. The review also documents the reported prevalence of long COVID for the different regions of the World Health Organization. Longitudinal studies published till March 2022 were systematically searched on PubMed, Google Scholar, and medRxiv. Among the identified 594 studies, 48 were included in this review. Data from selected studies were synthesized. The overall pooled prevalence of long COVID was 49% (40%–58%). The pooled estimates after 3 months, 4–6 months, 7–9 months, and 10–12 months were 44% (32%–57%), 50% (43%–57%), 49% (37%–62%), and 54% (46%–62%), respectively. Eastern Mediterranean Region (EMR) had the highest pooled prevalence of 63% (34%–92%] and the South East Asian Region (SEAR) had the least pooled estimate of 15% (10%–21%). The study brings out the high prevalence of long COVID even after 12 months of follow‑up. It also shows the regional differences in the reported prevalence of the syndrome. This review highlights the need for well‑planned follow‑up studies, especially in developing nations to understand the magnitude and the pattern of long COVID‑related symptoms as they emerge.
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Coronavirus disease (COVID-19) is an ongoing worldwide pandemic affecting a large population regardless of gender, age, and ethnicity. The persistence of the COVID-19 symptoms has become a significant health issue and is collectively called “Long COVID.” It can be described as the presence of symptoms of COVID even after the recovery from the viral infection. The prolonged symptoms in the patients could be due to various reasons and factors. Prolonged fatigue is a common symptom of Long COVID in patients even after they have recovered from the viral infection. Currently, only rehabilitation has shown promising results in managing the symptoms of Long COVID. Although pharmaceutical drugs have shown potential in treating the symptoms of Long COVID, more clinical evidence is required to confirm its treatment with less to no side effects; since it’s a new disease, the in-depth knowledge of the same is still evolving. Another healthier approach to treating the symptoms of Long COVID could be dietary supplements or “Nutraceuticals,” identified as an alternative to pharmaceuticals, including nutritional supplements, derived nutrients, and dietary and herbal products that display physiological advantages. Nutritional strategies can also play a role in treating hospitalized patients as maintaining the immune system is critical to combat viral infection.Nutraceuticals may be a practical and healthier approach to managing the symptoms of Long COVID or COVID-19. Although ample clinical evidence is present for the treatment of symptoms of COVID-19, further studies in treating Long COVID or its symptoms are required
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RESUMEN Varios países occidentales han iniciado la vuelta a la vida prepandemia al disminuir el número de infectados severos y muertes a pesar de la gran infectividad de la variante ómicron B2. Esto ocurre en medio de reclamos de la población cansada de las restricciones por el COVID-19, los problemas económicos y laborales consecuentes y con un sector antivacuna con importante presencia. El SARS-CoV-2 no desaparecerá, se presentarán nuevas variantes y se deberá estar alerta a sus amenazas y diseñar nuevas vacunas. Sin embargo, el ser humano está aprendiendo las medidas para no infectarse, la importancia de la autoprotección y de la familia, y la vigilancia del virus. Se ha logrado vacunas aún imperfectas que requieren refuerzos en intervalos relativamente cortos. Pero, muchos países no están aún preparados para enfrentar la pandemia -ahora endemia-, por demasiada confianza a una eventual desaparición del virus, la falta de recursos humanos y económicos para una mejor atención en salud, corrupción. La mujer es más sensible a la infección viral y se está haciendo vacunar para evitar la infección grave y muerte. La evidencia encuentra que la gestante con COVID-19 sufre más abortos, partos pretérmino y muerte intrauterina y perinatal. La placenta es la unidad más comprometida en su defensa al feto. La placentitis resultante causa insuficiencia placentaria y lesión hipóxico-isquémica fetal. Los recién nacidos tienen protección dada por el pasaje de anticuerpos maternos, con mayor duración los originados por las vacunas. Aún queda mucho por conocer sobre el futuro de la infección por SARS-CoV-2. Pero ya es realidad un problema complejo e impactante producto de la infección la prolongación de los daños multiorgánicos ocurridos, aún con enfermedad leve, principalmente en los sistemas cardiovascular, pulmonar y cerebral, así como la alteración de la salud mental y el acortamiento de la vida.
ABSTRACT Several western countries have initiated the return to pre-pandemic life with the reduction in the number of severe infections and deaths despite of the high infectivity of the Omicron B2 variant. This is occurring amid complaints from the population tired of the restrictions due to COVID-19, the consequent economic and labor problems and with an antivaccine sector with an important presence. SARSCoV-2 will not disappear, new variants will emerge, and it will be necessary to be alert to its threats and design new vaccines. However, human beings are learning the measures to prevent infection, the importance of self-protection and of the family, and the surveillance of the virus. Imperfect vaccines have been developed that require boosters at relatively short intervals. However, many countries are not yet prepared to face the pandemic now endemic due to overconfidence in the eventual disappearance of the virus, lack of human and economic resources for better health care, and corruption. Women are more sensitive to viral infection and is getting vaccinated to avoid serious infection and death. Evidence finds that pregnant women with COVID-19 suffer more miscarriages, preterm deliveries, and intrauterine and perinatal death. The placenta is the unit most compromised in its defense of the fetus. The resulting placentitis causes placental insufficiency and fetal hypoxic-ischemic injury. Newborns are protected by the passage of maternal antibodies, with a longer duration of those originated by vaccines. Much remains to be known about the future of SARS-CoV-2 infection. But a complex and shocking problem resulting from the infection is already a reality - the prolongation of multiorgan damage, even with mild disease, mainly in the cardiovascular, pulmonary, and cerebral systems, as well as the alteration of mental health and shortening of life.
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Objetivo: Identificar na literatura disponível as sequelas de saúde desenvolvidas pela população adoecida pela COVID-19. Métodos: Revisão integrativa com publicações recuperadas a partir do acesso ao Medline via PubMed e ao Portal Regional da Biblioteca Virtual em Saúde (BVS) em abril de 2021 que responderam à questão norteadora: Quais as principais sequelas de saúde desenvolvidas pela população adoecida pela COVID-19?. A estratégia de busca incluiu os descritores: Coronavirus Infections, COVID-19, SARS-COV-2, Complications, Disease, Adult, Long COVID. Identificaram-se 348 publicações, 196 da BVS e 152 no PubMed. Após análise dos critérios de inclusão/exclusão, permaneceram 66 publicações para leitura na íntegra, restando 27 artigos que compuseram a amostra. Resultados: As evidências selecionadas dos 27 artigos permitiram identificação das principais sequelas: neurológicas, saúde mental, cardíacas, no olfato e paladar, vasculares, cutâneas, respiratórias e gastrointestinais. A maior prevalência de sequelas neurológicas ocorreu em mulheres, bem como as cardíacas nos homens; não havendo distinção da prevalência de sintomas de saúde mental entre homens e mulheres. Conclusão: Com base nesses achados, evidenciou-se a importância do acompanhamento em longo prazo das pessoas que tiveram COVID-19, uma vez que os sintomas desenvolvidos como sequelas não são exclusivos dessa doença e podem impactar na qualidade de vida.
Objective: To identify, in the literature available, the health sequelae developed by the population affected by COVID-19. Methods: This is an integrative review of publications retrieved from Medline via PubMed and the Regional Portal of the Virtual Health Library (Biblioteca Virtual em Saúde BVS) in April 2021 that answered the research question: What are the main health sequelae developed by the population affected by COVID-19? The search strategy included the descriptors: Coronavirus Infections, COVID-19, SARS-COV-2, Complications, Disease, Adult, Long COVID. 348 publications were identified: 196 on BVS and 152 on PubMed. After analyzing the inclusion/exclusion criteria, 66 publications remained for full reading, with a final 27 articles included in the sample. Results: The selected evidence from the 27 articles allowed the identification of the main sequelae: neurological, mental health, cardiac, smell and taste, vascular, cutaneous, respiratory and gastrointestinal sequelae. The highest prevalence of neurological sequelae was found in women, whereas cardiac sequelae were found mostly in men; there was no difference in the prevalence of mental health symptoms between men and women. Conclusion: Based on these findings, the importance of long-term follow-up of people who had COVID-19 was highlighted since the symptoms developed as sequelae are not exclusive to this disease and can impact quality of life.
Objetivo: Identificar en la literatura disponible las secuelas de salud desarrolladas por la población enfermada por COVID-19. Métodos: Revisión integradora con publicaciones recuperadas a partir del acceso al Medline por PubMed y al Portal Regional dela Biblioteca Virtual en Salud (BVS) en abril de 2021 que contestaron a la cuestión norteadora: ¿Cuáles las principales secuelas de salud desarrolladas por la población enfermada por COVID-19?. La estrategia de búsqueda incluyó los descriptores: Coronavirus Infections, COVID-19, SAR-COV-2, Complications, Desease, Adult, Long COVID. Fueron identificadas 348 publicaciones, 196 de la BVS Y 152 en PubMed. Después del análisis de los criterios de inclusión/exclusión, permanecieron 66 publicaciones para lectura completa, restando 27 artículos que compusieron la muestra. Resultados: Las evidencias seleccionadas de los 27 artículos permitieron la identificación de las principales secuelas: neurológicas, salud mental, cardíacas, en el olfato y paladar, vasculares, cutáneas, respiratorias y gastrointestinales. La mayor prevalencia de secuelas neurológicas ocurrió en mujeres, y las cardíacas en los hombres; no habiendo distinción de la prevalencia de síntomas de salud mental entre hombres y mujeres. Conclusión: Con base en estos hallazgos, se evidenció la importancia del acompañamiento a largo plazo de las personas que tuvieron COVID-19, ya que los síntomas desarrollados como secuelas no son exclusivos de esta enfermedad y pueden impactar en la calidad de vida.
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Objective: To determine the change in the quality of life (QoL) of patients who applied to a tertiary outpatient clinic according to their COVID-19 status. Methods: This cross-sectional study comprised 1 370 participants. Short form-12 (SF-12), which includes Physical Component Summary (PCS) and Mental Component Summary (MCS) domains, was used to evaluate the QoL. Different linear regression models created using PCS-12 and MCS-12 were dependent variables. Results: A total of 19.2% of participants had acute COVID-19, and 8.4% had long COVID-19. The most common sypmtoms were fatigue (72.6%), headache (42.5%), and joint pain (39.8%) in patients with long COVID-19. The model including all participants showed that long COVID-19 reduced the QoL in multivariate analysis for both MCS and PCS, while acute COVID-19 had no significant effect on the QoL comparing with those without COVID-19. Model that included participants with COVID-19 showed that long COVID-19 negatively affected the QoL in the multivariate model for PCS-12 and MCS-12. Variables that were significant in the multivariate model for those who had long COVID-19 were having a chronic disease and presence of ongoing symptoms. Females were disadvantaged for PCS-12 and MCS-12 in the multivariate models including all participants, and models including participants who have had COVID-19. Low educational group were disadvantaged for PCS-12 in the multivariate model including all participants. This group were also disadvantaged for PCS-12 and MCS-12 in the multivariate models including participants who had COVID-19. Conclusions: In studies, acute COVID-19 and long COVID-19 should be treated as separate categories. The effects of long COVID-19 should be considered when providing and planning health services. The effect of gender, and education, on QoL shows that health inequalities continue to be effective during the pandemic period.
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Objective: To evaluate long-term effects of COVID-19, and to determine the risk factors in long-COVID in a cohort of the Turkish Thoracic Society (TTS)-TURCOVID multicenter registry. Methods: Thirteen centers participated with 831 patients; 504 patients were enrolled after exclusions. The study was designed in three-steps: (1) Phone questionnaire; (2) retrospective evaluation of the medical records; (3) face-to-face visit. Results: In the first step, 93.5% of the patients were hospitalized; 61.7% had a history of pneumonia at the time of diagnosis. A total of 27.1% reported clinical symptoms at the end of the first year. Dyspnea (17.00%), fatigue (6.30%), and weakness (5.00%) were the most prevalent long-term symptoms. The incidence of long-term symptoms was increased by 2.91 fold (95% CI 1.04-8.13, P=0.041) in the presence of chronic obstructive pulmonary disease and by 1.84 fold (95% CI 1.10-3.10, P=0.021) in the presence of pneumonia at initial diagnosis, 3.92 fold (95% Cl 2.29-6.72, P=0.001) of dyspnea and 1.69 fold (95% Cl 1.02-2.80, P=0.040) fatigue persists in the early-post-treatment period and 2.88 fold (95% Cl 1.52-5.46, P=0.001) in the presence of emergency service admission in the post COVID period. In step 2, retrospective analysis of 231 patients revealed that 1.4% of the chest X-rays had not significantly improved at the end of the first year, while computed tomography (CT) scan detected fibrosis in 3.4%. In step 3, 138 (27.4%) patients admitted to face-to-face visit at the end of first year; at least one symptom persisted in 49.27% patients. The most common symptoms were dyspnea (27.60%), psychiatric symptoms (18.10%), and fatigue (17.40%). Thorax CT revealed fibrosis in 2.4% patients. Conclusions: COVID-19 symptoms can last for extended lengths of time, and severity of the disease as well as the presence of comorbidities might contribute to increased risk. Long-term clinical issues should be regularly evaluated after COVID-19.
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Two cases of hair loss due to coronavirus disease 2019 (COVID-19) sequelae as known as Long COVID were successfully treated with ninjin’yoeito. Case 1 was a 45-year-old woman who complained of hair loss about 2 months after COVID-19 (moderate II in Japanese criteria). Case 2 was a 50-year-old woman who complained of hair loss about 2 months after COVID-19 (mild). In all cases, hair loss stopped next month after treatment with ninjin’yoeito. And their hair began to grow 2 months later administration, the depression caused by hair loss improved as the symptoms improved. Hair loss is one of the symptoms with blood [TM1] deficiency, and patients suffering from Long COVID are also with qi deficiency. We gave ninjinʼyoeito for pattern of both qi and blood [TM1] deficiency with reference to traditional key of treatment, and it contributed to the improvement of symptoms.