Lived experience of patients with Long COVID: a qualitative study in the UK.

BACKGROUND: Long COVID is a rapidly evolving global health crisis requiring interdisciplinary support strategies that incorporate the lived experience of patients. Currently, there is a paucity of research documenting the day-to-day experiences of patients living with Long COVID. OBJECTIVE: To explore the lived experience of Long COVID patients. STUDY DESIGN: Longitudinal, observation study. SETTING: An inductive, data-driven, qualitative approach was used to evaluate hand-written diaries obtained from individuals who had been referred to a Derbyshire Long COVID clinic. PARTICIPANTS: 12 participants (11 females, age 49±10 years, 11 Caucasians) were recruited. Participants were included if they had a previous confirmed or suspected COVID-19 infection with ongoing recovery, >18 years old, understood the study requirements and provided informed consent. METHOD: Participants were directed to complete self-report diaries over 16 weeks. Responses were transcribed verbatim and analysed using thematic analysis. RESULTS: Three key themes were highlighted: (1) understanding who helps patients manage symptoms, (2) daily activities and the impact on quality of life and health status and (3) the effect of turbulent and episodic symptom profiles on personal identity and recovery. CONCLUSIONS: The novel challenges presented by Long COVID are complex with varying inter-related factors that are broadly impacting functional status and quality of life. Support mechanisms must incorporate the lived experiences and foster true collaborations between health professionals, patients and researchers to improve patient outcomes. TRIAL REGISTRATION NUMBER: NCT04649957.

Teaching Sports and Exercises Science: experiences and life skills of a lecturer

The following document reports the experiences and life skills developed under the current didactic situation in Sports and Exercise Science. In particular, the manuscript discusses the pedagogic theories that should be fostered to improve the return to campus. The real-life experiences are presented in light of the Social and Emotional Learning and the Learning by Doing theories. The following document aims to reflect on social constructivism and embodied theories to improve the new (post-covid) learning environment. The introduction focuses on the Quality Assurance Agency for Higher Education benchmark statement and progresses to the most recent Blended approaches. With reflections upon in-class assessments, spaces and pace. In conclusion, the cartesian dualism (body-mind) is discussed and ideas for future research in pedagogy are presented to improve teaching and learning experiences in the post-covid scenario. Insegnare Scienze Motorie: esperienze e abilità di un docente universitario. Il documento ha come scopo quello di riflettere sul costruttivismo sociale e sulle embodied theories per migliorare il nuovo ambiente di apprendimento (post-covid). Il seguente documento riporta le esperienze e le abilità sviluppate nell‘attuale situazione didattica, nello specifico riguardo le scienze motorie. In particolare, nel testo sono discusse le teorie pedagogiche che dovrebbero essere incoraggiate per migliorare il ritorno in aula. Le esperienze didattiche sono presentate alla luce delle teorie dell‘apprendimento sociale ed emotivo e del Learning by Doing. L‘introduzione si concentra sul Quality Assurance Agency for Higher Education benchmark e presenta i più recenti approcci didattici definiti Blended, con l'aggiunta di riflessioni su valutazioni, spazi e ritmo della classe. In conclusione, viene discusso il dualismo cartesiano (corpo-mente) e vengono presentate idee per future ricerche in pedagogia al fine di migliorare le esperienze di insegnamento e di apprendimento nello scenario post-covid.

Developing novel life skills and experiences: a pilot study with Functional Advanced Didactics

The pandemic has produced profound changes in teaching activities, with consequences on the educational processes and social development of students. In this sense, the following contribution explores the potential of Advanced Functional Didactics (DAF), a didactic proposal that aims to deliver traditional didactic contents through motor activity. Carried out in a difficult social context, namely the IC Ristori of Naples, located in the Forcella district, the study involves a second class of primary school and a first class of lower secondary school. The experimental hypothesis of this research is that the introduction of the DAF can bring benefits to the physical, psychological, social and learning abilities of the learners. This pilot study was the first to carry it out, thus proposing to verify the impact of this methodology on students to collect useful responses to improve it.Alternate :La pandemia ha prodotto profondi cambiamenti nelle attività didattiche, con conseguenze sui processi formativi e di sviluppo sociale degli studenti. In tal senso, il seguente contributo esplora le potenzialità della Didattica Avanzata Funzionale (DAF), una proposta didattica che mira ad erogare i contenuti didattici tradizionali attraverso l'attività motoria. Realizzato in un contesto sociale difficile, ossia l'IC Ristori di Napoli, sito nel quartiere di Forcella, lo studio coinvolge una classe seconda della scuola primaria e una classe prima della scuola secondaria di primo grado. L'ipotesi sperimentale di questa ricerca è che l'introduzione della DAF possa apportare benefici alle capacità fisiche, psicologiche, sociali e di apprendimento dei discenti. Questo studio pilota è stato il primo a realizzarla, proponendosi quindi di verificare l'impatto di questa metodologia sugli studenti allo scopo di raccogliere risposte utili a migliorare quest'ultima.

The effects of COVID-19 on respiratory muscle performance: making the case for respiratory muscle testing and training.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltration via angiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory muscle (RM) performance was hypothesised as a contributing factor to the severity of coronavirus disease 2019 (COVID-19) symptoms, such as dyspnoea, and outcomes. This was attributed to similarities between patient populations at elevated risk for severe COVID-19 symptoms and those with a greater likelihood of baseline RM weakness and the effects of prolonged mechanical ventilation. More recent evidence suggests that SARS-CoV-2 infection itself may cause damage to the RM, and many patients who have recovered report persistent dyspnoea despite having mild cases, normal lung function or undamaged lung parenchyma. These more recent findings suggest that the role of RM in the persistent dyspnoea due to COVID-19 may be more substantial than originally hypothesised. Therefore, screening for RM weakness and providing interventions to improve RM performance appears to be important for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions.

Impact of Rehabilitation on Fatigue in Post-COVID-19 Patients: A Systematic Review and Meta-Analysis

The post-COVID-19 syndrome may affect patients after the COVID-19 post-acute phase. In particular, the 69% of patients reported persistent fatigue at the discharge. To date, no clear data are available regarding the most effective rehabilitative approaches for the treatment of this condition. Thus, this systematic review aimed to evaluate the rehabilitation treatment's efficacy on fatigue in post-COVID-19 patients. We systematically searched PubMed, Scopus, and Web of Science databases to find longitudinal study designs presenting: post-COVID-19 patients as participants;a rehabilitative approach aimed to reduce post-COVID-19 syndrome as intervention;and fatigue intensity assessed through an evaluation tool that quantified the perceived exertion (i.e., fatigue severity scale, FSS;Borg Scale (BS);Borg Category Ratio 10, CR10;Checklist Individual Strength (CIS) fatigue scale;FACIT (Functional Assessment of Chronic Illness Therapy) fatigue scale). The present systematic review protocol was registered on PROSPERO (registration number CRD42021284058). Out of 704 articles, 6 studies were included. Nearly all patients showed COVID-19-related fatigue, and after the rehabilitation treatment, only 17% of subjects reported the persistency of symptoms. The overall effect size reported a −1.40 decrease in Borg Category Ratio 10 with a SE of 0.05 and a 95% CI between −1.50 and −1.30 (p < 0.001). The present systematic review and meta-analysis underlines the rehabilitation role in the fatigue reduction in patients affected by post-COVID-19 syndrome.

Impaired clinical outcome and increased postoperative complications in COVID-19 patients undergoing cardiopulmonary bypass

Objective Previous studies reported unfavorable results in COVID-19 patients who underwent cardiac surgery. Complications most frequently observed were respiratory failure and higher incidence of thromboembolic events. We present our single-center experience in patients with perioperative diagnosis of COVID-19 infection undergoing cardiac surgery with extracorporeal circulation. Methods In this observational matched case-control (propensity match 1:2) study, we collected data of patients undergoing open heart cardiac surgery from January 2020 to May 2021, having positive perioperative diagnosis of COVID-19 infection confirmed by polymerase Chain Reaction-PCR (study group). Patients were compared with 56 corresponding controls (control group) who matched for age, sex, body mass index (BMI) and Euro-Score II. Results In the study period 1060 patients underwent cardiac surgery with cardiopulmonary bypass (CPB). Among them, 28 consecutive patients, aged 70.1±9.3 years, had perioperative diagnosis of COVID-19 infection. Four (14%) patients underwent emergency surgery for type-A aortic dissection, 2 (7%) patients died in the Intensive Care Unit for severe respiratory failure, shock and multiple organ failure. Significant bleeding complications occurred in 14 (50%) patients in the study group (vs 6% in the control group, p=<0.05). In the study group, 11 (39%) patients required early surgical reexploration for bleeding, 5 presented cardiac tamponade, 5 (18%) underwent multiple surgical revisions for recurrent bleeding. Three (11%) patients required late chest drainage of a massive sero-hemorrhagic pleural effusion, 1 (4%) presented late postoperative intracranial hemorrhage. Fourteen (50%) patients had severe thrombocytopenia (vs 9% in the control group, p=<0.05). In the study group blood components transfusion and procoagulant drugs administration increased (79% and 78% vs 18% and 11% in the control group, respectively, p=<0.05). In the study group 6 (21%) patients presented postoperative acute renal failure (2% in the control group, p=<0.05), 7 (25%) acute respiratory failure (p=<0.05) requiring prolonged postoperative orotracheal intubation. Sternal dehiscence was observed in 4 (14%) patients in the study group (vs 4% in the control group, p=< 0.05). Complications significantly influenced hospital stay length (20 ± 3.1 vs 8.1 ± 3.9 days, p=< 0.05). In the multivariable logistic regression model the SARS-CoV-2 infection and renal failure were independent factors associated with severe postoperative complications (p=<0.01). Conclusions Clinical outcome of open heart cardiac surgery patients with perioperative COVID-19 infection appears significantly impaired in terms of mortality and postoperative complications. CPB-related inflammatory reaction could likely exacerbate the deleterious effect of COVID-19 on the respiratory and renal systems, as well as on the coagulation pathways. Early and late hemorrhagic complications were very frequent with significantly increased surgical reexplorations for bleeding, a higher incidence of severe thrombocytopenia, of blood components transfusion and procoagulant drugs administration. The increased surgical risk should suggest a cautious attitude in indicating open heart surgery in patients with perioperative COVID-19 infection and surgery should be limited to not postponable or to urgent cases.

Distance Learning during the COVID-19 Pandemic. A Comparison between European Countries

COVID-19 has shaped and changed our normalities, and, with the discovery of new variants, the long-COVID syndrome, and stress disorders, the end of the pandemic seems distant. The current scenario is impacting all aspects of our lives. In particular, many studies reported that the pandemic resulted in increased psychiatric disorders and grief-related symptoms in adolescents. The project developed between Italy and Slovenia investigated students' experiences during the lockdown and, in particular, reported the perception of distanced learning, producing a transparent qualitative analysis that can inform future research and open to discussions on learning strategies. A survey was conducted with secondary school students in Southern Italy between 1 April and 31 May 2020 and in Central Slovenia between 16 March and 28 February 2021. Qualitative and quantitative data were collected based on students' perception of distanced learning, via an online survey platform. The results focused on three main aspects: learning experience, relationships with peers and teachers, and anxiety levels. The data showed similarities and differences in the two cohorts and suggested strategies to improve education (e.g., with blended approaches) to prepare students, teachers, and tutors for the challenges of returning to classes. In particular, data showed that it is recommended to foster collaboration between EU countries and to work to prevent students' social isolation.

Bleeding Complications in Patients With Perioperative COVID-19 Infection Undergoing Cardiac Surgery: A Single-Center Matched Case-Control Study.

OBJECTIVE: Previous studies reported a poor outcome in patients with coronavirus 2019 (COVID-19) undergoing cardiac surgery. Complications most frequently described were respiratory failure, renal failure, and thromboembolic events. In their recent experience, the authors observed a very high incidence of bleeding complications. The purpose of the study was to investigate a possible significant correlation between perioperative COVID-19 infection and hemorrhagic complications compared to non-COVID-19 patients. DESIGN: Single-center, observational, retrospective, matched case-control (1:2) study involving patients who underwent open-heart cardiac surgery from February 2020 and March 2021 with positive perioperative diagnosis of COVID-19 infection, matched with patients without COVID-19 infection. SETTING: Cardiac surgery unit and intensive care unit of a university tertiary center in a metropolitan area. PARTICIPANTS: In the study period, 773 patients underwent cardiac surgery on cardiopulmonary bypass (CPB). Among them, 23 consecutive patients had perioperative diagnosis of COVID-19 infection (study group). These patients were compared with 46 corresponding controls (control group) that matched for age, sex, body mass index, and Society of Thoracic Surgeons score. INTERVENTIONS: Open-heart cardiac surgery on CPB. MEASUREMENTS AND MAIN RESULTS: In the study group, 2 patients (9%) died in the intensive care unit from severe respiratory failure, shock, and multiple organ failure. In the study group, patients showed a significantly higher incidence of bleeding complications (48% v 2%, p = 0.0001) and cases of surgical reexploration for bleeding (35% v 2%, p = 0.0001), a higher incidence of severe postoperative thrombocytopenia (39% v 6%, p = 0.0007), and a higher need of blood components transfusions (74% v 30%, p = 0.0006). Chest tubes blood loss and surgical hemostasis time were markedly prolonged (p = 0.02 and p = 0.003, respectively). CONCLUSIONS: A worrisome increased risk of early and late bleeding complications in COVID-19 patients was observed, and it should be considered when assessing the operative risk. CPB-related inflammatory reaction could exacerbate the deleterious effect of COVID-19 on the coagulation system and likely deviate it toward a hemorrhagic pattern.

Prognostic value of SARS-CoV-2 on patients undergoing cardiac surgery.

OBJECTIVE: To analyze Italian Cardiac Surgery experience during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) identifying risk factors for overall mortality according to coronavirus disease 2019 (COVID-19) status. METHODS: From February 20 to May 31, 2020, 1354 consecutive adult patients underwent cardiac surgery at 22 Italian Centers; 589 (43.5%), patients came from the red zone. Based on COVID-19 status, 1306 (96.5%) were negative to SARS-CoV-2 (COVID-N), and 48 (3.5%) were positive to SARS-CoV-2 (COVID-P); among the COVID-P 11 (22.9%) and 37 (77.1%) become positive, before and after surgery, respectively. Surgical procedures were as follows: 396 (29.2%) isolated coronary artery bypass grafting (CABG), 714 (52.7%) isolated non-CABG procedures, 207 (15.3%) two associate procedures, and three or more procedures in 37 (2.7%). Heart failure was significantly predominant in group COVID-N (10.4% vs. 2.5%, p = .01). RESULTS: Overall in-hospital mortality was 1.6% (22 cases), being significantly higher in COVID-P group (10 cases, 20.8% vs. 12, 0.9%, p < .001). Multivariable analysis identified COVID-P condition as a predictor of in-hospital mortality together with emergency status. In the COVID-P subgroup, the multivariable analysis identified increasing age and low oxygen saturation at admission as risk factors for in-hospital mortality. CONCLUSION: As expected, SARS-CoV-2 infection, either before or soon after cardiac surgery significantly increases in-hospital mortality. Moreover, among COVID-19-positive patients, older age and poor oxygenation upon admission seem to be associated with worse outcomes.

Cognitive, behavioral, and psychological manifestations of COVID-19 in post-acute rehabilitation setting: preliminary data of an observational study.

Psychological, emotional, and behavioral domains could be altered in COVID-19 patients and measurement of variables within these domains seems to be mandatory. Neuropsychological assessment could detect possible cognitive impairment caused by COVID-19 and the choice of appropriate tools is an important question. Aim of this exploratory study was to verify the effectiveness of an assessment model for patients with COVID-19. Twelve patients were enrolled and tested with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Anxiety and Depression Short Scale (AD-R), and the Neuropsychiatry Inventory (NPI), at the time of their entrance (T0) and discharge (T1) from a rehabilitative unit. Moreover, a follow-up evaluation after 3 months (T2) has been conducted on eight patients. Results showed that at baseline (T0), 58.3% of the patients reported a score below cut-off at MMSE and 50% at MoCA. Although a significant amelioration was found only in NPI scores, a qualitative improvement has been detected at all tests, except for MoCA scores, in the T0-T1 trend analysis. A one-way repeated measures analysis of variance showed a significant variation in AD-R depression score, considering the three-assessment time (T0, T1, and T2). The evaluation and tracking over time of the impact of COVID-19 on cognitive, psychological, and behavioral domains has relevant implications for rehabilitation and long-term assistance needs planning. The choice of assessment tools should consider patients vulnerability and match the best compromise among briefness, sensitivity, and specificity.

Social Bottom-Up Approaches in Post-COVID-19 Scenario: The AGOGHÈ Project

The AGOGHÈ Project aims to produce innovative and entrepreneurial models following the global socioeconomic changes caused by COVID-19. Its objectives include (i) generating awareness, education and social skills through dedicated ethical workstations and workgroups;(ii) developing a novel figure called “Social Trainer” who represents a professional opportunity for young graduates, able to discuss, explain and guide others through the maze of active citizenship rules. The project was developed in the Quartieri Spagnoli of Naples (Italy). The current manuscript reports preliminary data from the local community collected between November and December 2020. Results provide an insight into the neighbourhood, where the lockdown produced an increment in school dropouts and irreparable economic damage. In conclusion, the approach proposed with the AGOGHÈ Project, fully described here, is predicted to be beneficial in increasing social, cultural and economic aspects in the local area and in facilitating a dialogue between people, stakeholders and governments engaging in novel resolutions for post-COVID-19 crises.

Modulation of endothelial organelle size as an antithrombotic strategy.

BACKGROUND: It is long established that von Willebrand factor (VWF) is central to hemostasis and thrombosis. Endothelial VWF is stored in cell-specific secretory granules, Weibel-Palade bodies (WPBs), organelles generated in a wide range of lengths (0.5-5.0 µm). WPB size responds to physiological cues and pharmacological treatment, and VWF secretion from shortened WPBs dramatically reduces platelet and plasma VWF adhesion to an endothelial surface. OBJECTIVE: We hypothesized that WPB-shortening represented a novel target for antithrombotic therapy. Our objective was to determine whether compounds exhibiting this activity do exist. METHODS: Using a microscopy approach coupled to automated image analysis, we measured the size of WPB bodies in primary human endothelial cells treated with licensed compounds for 24 hours. RESULTS AND CONCLUSIONS: A novel approach to identification of antithrombotic compounds generated a significant number of candidates with the ability to shorten WPBs. In vitro assays of two selected compounds confirm that they inhibit the pro-hemostatic activity of secreted VWF. This set of compounds acting at a very early stage of the hemostatic process could well prove to be a useful adjunct to current antithrombotic therapeutics. Further, in the current SARS-CoV-2 pandemic, with a considerable fraction of critically ill COVID-19 patients affected by hypercoagulability, these WPB size-reducing drugs might also provide welcome therapeutic leads for frontline clinicians and researchers.