ABSTRACT
Aim/Introduction: A substantial amount of post-COVID-19 patients suffer from debilitating fatigue and cognitive impairment persisting months after infection, referred to as 'long COVID'. The pathophysiology of long COVID is unknown, but post-mortem studies have demonstrated that after acute SARS-CoV-2 infection profound neuro-inflammation may be present. However, to date no clear in-vivo evidence for this is available in patients who survived COVID-19. The aim of this study was to quantify neuro-inflammation in-vivo with [18F]DPA-714 positron emission tomography (PET) in post COVID patients with and without long term complaints. [18F] DPA-714 binds with high affinity to translocator protein (TSPO) that is brought to expression on, among others, activated microglia, enabling visualization of neuro inflammation in-vivo. Material(s) and Method(s): We will include patients with and without persisting postinfectious fatigue, cognitive complaints and smell loss or distortions and will relate it to cognitive, psychiatric and post infectious fatigue symptoms. We will assess in-vivo peripheral and neuro-inflammation with a 90 minutes [18F]DPA-714 PET scan, alternately capturing brain (dynamic 60 minutes) and body (30 minutes;pelvic to head) with both continuous on-line and manual arterial blood sampling for full quantification. The 30-minutes body scan will be performed to examine whole-body inflammation (secondary parameter). Brain MRI will be performed for functional and anatomical information. Additionally, neuropsychological assessment and questionnaires will be performed. So far, we included five patients with long COVID with persisting post-infectious fatigue and cognitive complaints, who all got infected in 2020. Two patients were female and patients were on average 59 +/- 5 years of age. Indeed, this is an ongoing study and more data (>20 patients) will become available in the near future. Result(s): We will report on the first results of this crosssectional observational case-control study in which we quantify peripheral and neuro-inflammation with fully quantitative [18F] DPA-714 PET scans in post-COVID-19 patients. Preliminary results indicate profound neuro-inflammation in these first patients with long COVID. Conclusion(s): Preliminary results of this study indicate that patients with long COVID have profound neuro-inflammation. Results of this study may provide important insight into the underlying pathophysiology of long COVID symptoms and may potentially provide opportunities for future (treatment-directed) studies.
ABSTRACT
Aims: Following COVID-19 a substantial number of patients report persistent fatigue and insomnia. As these symptoms have overlapping features, insomnia can be easily underdiagnosed in post COVID-19 related fatigue (PCRF). The main object of this study was to determine the prevalence of insomnia in patients with PCRF and investigate their sleep characteristics. Data of PCRF patients were compared with those of patients with chronic fatigue syndrome (CFS/ME), a condition also characterized by persistent fatigue. Method(s): In this cross-sectional study insomnia severity, assessed with the Insomnia Severity Index (ISI), and prevalence of clinical insomnia (ISI score >=10), were determined in patients with PCRF (n = 114) and compared with CFS/ME patients (n = 59) using ANCOVA and logistic regression, respectively. Linear regression analyses were used to evaluate if fatigue severity, concentration problems, pain, depressive symptoms and having PCRF or CFS/ME were associated with insomnia severity. Sleep characteristics assessed with sleep diary and accelerometer were determined in patients with PCRF and compared with CFS/ME patients using ANCOVA. Result(s): In PCRF patients the mean (SD) insomnia severity was 11.46 (5.7) and prevalence of clinical insomnia was 64%. Both did not differ significantly from CFS/ME. Insomnia severity was significantly associated with depressive symptoms (beta = 0.49, p = 0.006) and higher age (beta = -0.08, p = 0.04). In PCRF the mean subjective sleep duration in h was 7.39 (1.00), sleep onset latency 0.97 (0.62) and wake after sleep onset 1.24 (0.72). The PCRF group reported a significantly shorter sleep duration than the CFS/ME group (p = 0.002), with a moderate effect size (d = 0.59). Conclusion(s): Insomnia severity and prevalence of clinical insomnia is high in PCRF. Insomnia should be assessed and if present treated with insomnia focused therapy in patients reporting post COVID-19 related chronic fatigue.
ABSTRACT
INTRODUCTION: Telemedicine has been available for more than 20 years and is playing an increasing role in clinical care. However, few studies have evaluated the value of telemedicine in neurosurgical consultations and in guiding neurosurgical care. METHODS: In this prospective observational study, we examined our experience with emergency video telemedicine consultations for neurosurgical patients at a rural hospital system. Our system uses secure and HIPAA-compliant video conferencing to connect providers and patients to a remote neurosurgery consultant, and operates one out of two days. RESULTS: During a ten-month period, 229 neurosurgical telemedicine consultations were performed. Two-thirds of the patients had intracranial pathology, 28% had spinal pathology and 3% of the consults were for patients who returned after care at our institution or required clearance for another procedure. Five patients required transfer within the hospital system and 12 out of the hospital system for a higher level of care (total 7.4%). Patients that required transfer most frequently had intracranial pathology (70%). The number of patients transferred out was less than in the year before telemedicine was available. CONCLUSION: Telemedicine consultation for neurosurgery is feasible for a variety of neurosurgical pathologies, improves patient access to neurosurgery expertise, and facilitates appropriate transfers to a higher level of care when required. Our findings are especially relevant in light of the COVID-19 pandemic, which has highlighted the importance of delivering quality medical care when physical patient contact is not possible.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) results in debilitating long-term symptoms, often referred to as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), in a substantial subgroup of patients. One of the most prevalent symptoms following COVID-19 is severe fatigue. Prompt delivery of cognitive behavioural therapy (CBT), an evidence-based treatment that has shown benefit in reducing severe fatigue in other conditions, may reduce post-COVID-19 fatigue. Based on an existing CBT protocol, a blended intervention of 17 weeks, Fit after COVID, was developed to treat severe fatigue after the acute phase of infection with SARS-CoV-2. METHOD: The ReCOVer study is a multicentre 2-arm randomised controlled trial (RCT) to test the efficacy of Fit after COVID on severe post-infectious fatigue. Participants are eligible if they report severe fatigue 3 up to and including 12 months following COVID-19. One hundred and fourteen participants will be randomised to either Fit after COVID or care as usual (ratio 1:1). The primary outcome, the fatigue severity subscale of the Checklist Individual Strength (CIS-fatigue), is assessed in both groups before randomisation (T0), directly post CBT or following care as usual (T1), and at follow-up 6 months after the second assessment (T2). In addition, a long-term follow-up (T3), 12 months after the second assessment, is performed in the CBT group only. The primary objective is to investigate whether CBT will lead to a significantly lower mean fatigue severity score measured with the CIS-fatigue across the first two follow-up assessments (T1 and T2) as compared to care as usual. Secondary objectives are to determine the proportion of participants no longer being severely fatigued (operationalised in different ways) at T1 and T2 and to investigate changes in physical and social functioning, in the number and severity of somatic symptoms and in problems concentrating across T1 and T2. DISCUSSION: This is the first trial testing a cognitive behavioural intervention targeting severe fatigue after COVID-19. If Fit after COVID is effective in reducing fatigue severity following COVID-19, this intervention could contribute to alleviating the long-term health consequences of COVID-19 by relieving one of its most prevalent and distressing long-term symptoms. TRIAL REGISTRATION: Netherlands Trial Register NL8947 . Registered on 14 October 2020.