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Aim: To investigate the impact of Covid-19 on daily activity, maximal physical performance, and clinical frailty of people living with diabetes (any type) 1-year post-hospitalisation for Covid-19 in the UK. Method(s): This study is part of PHOSP-Covid, a multicentre long-term cohort study that recruited adults (>=18 years) who were discharged from one of the 83 NHS hospitals across the four UK nations following a clinical diagnosis of Covid-19 before March 31, 2021. We compared The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, Incremental shuttle walk test (ISWT) distance (m), and clinical frailty (Rockwood frailty level), 5-month and 1-year after discharge in patients with and without diabetes. Result(s): Out of 2545 individuals (538 (21%) with diabetes), the proportion of individuals who classified as either 'mildly frail' or 'moderately or higher frail severity' was higher in individuals with diabetes (month 5: diabetes 9.9%, no diabetes 4.7%;month 12: diabetes 8%, no diabetes 4.9%). ISWT distance in patients with diabetes were significantly lower at both follow-ups but this measure improved from 5-months to 1-year (290 [95% CI: 190-440] vs 370 [250-560] for diabetes and 340 [210-450] vs 420 [270-590] for those without, both p < 0.01). At both time points, people with diabetes reported higher levels of fatigue (36 [24-44] vs 39 [25-46] at 5-month (p = 0.03);37 [26-45] vs 40 [28-47] at 1-year visit (p < 0.01)). Conclusion(s): One year after hospitalisation long Covid is more observed in people with diabetes.
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CD4+CD25+FOXP3+regulatory T cells (Tregs) contribute to the maintenance of immune homeostasis and tolerance in the body. The expression levels and functional stability of FOXP3 control the function and plasticity of Tregs. Tregs critically impact infectious diseases, especially by regulating the threshold of immune responses to pathogenic microorganisms. The functional regulatory mechanism and cell-specific surface markers of Tregs in different tissues and inflammatory microenvironments have been investigated in depth, which can provide novel ideas and strategies for immunotherapies targeting infectious diseases.Copyright © 2021. All rights reserved.
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Objectives: Patients with immune-mediated rheumatic diseases (IMRD) constitute an important subgroup of immunosuppressed patients at risk of developing severe infections. Since coronavirus 19 infection (COVID-19) is an international public health emergency, it is necessary to observe the relationship between this viral infection and the development or intensification of the clinical course of IMRD and the persistence of new associated symptoms. The aim of this study is to trace this population's epidemiological profile and evaluate the frequency of chronic fatigue syndrome in patients with IMRD and COVID-19 compared to uninfected patients. Method(s): This is a descriptive cross-sectional observational study with a comparison group. The sociodemographic, clinical, and FACIT-F Fatigue Scale data were from patients with IMRD of Project Reumacov, organized by the Brazilian Society of Rheumatology, locally inManaus/Amazonas. The statistical analysis was performed through the inferential method to demonstrate the prevalence. Result(s): 268 patients were evaluated, those who had contact with COVID-19 had fatigue according with the fatigue assessment scale compared to unexposed patients. There was a statistically significant correlation between fatigue post-COVID-19 infection in the patients studied. Conclusion(s): Clinically relevant fatigue was a prevalent and commonly reported symptom in the post-COVID-19 period in the evaluated population. These data should direct attention to the reported manifestations as they affect the functioning of individuals' socioeconomic and health well-being throughout the pandemic period and beyond.
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Respiratory symptoms and functional disorders are registered in patients who suffered from COVID-19 (COronaVIrus Disease 2019). Aim. Clinical and functional evaluation of the respiratory system during 6-month follow-up in patients who had moderate and severe COVID-19. Methods. 80 patients were included in the cohort observational prospective study. Patients were examined in 46 (36 - 60) days from the onset of symptoms of COVID-19 and in 93 (89 - 103) and 180 (135 - 196) days at the 2nd and 3rd stages respectively. At all stages, symptoms, dyspnea level, and quality of life were analyzed using validated questionnaires, and a 6-minute step test was performed. At the 2nd and 3rd stages, we assessed spirometric parameters, total lung capacity, carbon monoxide diffusing capacity (DLCO), and high resolution computed tomography scans of chest organs. Results. At the 1st stage of the study, 62% of patients complained of fatigue, muscle weakness, 61% of patients had dyspnea of variable severity. At the 3rd stage of the study, 43% and 42% of patients had the same complaints respectively. The prevalence of moderate COVID-19 form in patients with 35 (25 - 45)% lung damage and severe COVID-19 form with 75 (62 - 75)% of lung damage was established. At the 2nd stage, a DLCO < 80% level was recorded in 46% of patients with 35 (25 - 45)% lung damage and in 54% of patients with 75 (62 - 75)%. At the 3rd stage, DLCO < 80% was diagnosed in 51.9% and 48.1% of patients with of 35 (25 - 45)% and 75 (62 - 75)% lung damage respectively. The level of DLCO < 60% was found in 38,5% and 35,5% of patients with moderate and severe lung damage at the 2nd and 3rd stages of the study respectively. Conclusion. The symptoms were reported less frequently during the 6-month follow-up after COVID-19. 77% and 87% of patients had DLCO < 80% in 93 (89 - 103) and 180 (135 - 196) days after the disease onset, respectively. 38.5% and 35.5% of those patients, predominantly having suffered COVID-19 in severe form, had DLCO < 60% at 93 (89 - 103) and 180 (135 - 196) days, respectively. This calls for a continuous observation and regular examinations after COVID-19.Copyright © 2022 Leshchenko I.V., Glushkova T.V.
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The purpose is to verify whether patients with Long Covid-19 symptoms can recover Functional Capabilities and Endurance reaching the normotype subjects' level. The study is a before-after trial comparing the affected sample with baseline normotype data. The study was carried out at the private clinic "Move Different" near Aosta Italy. The clinic has an agreement with public health for a project for patients with Long Covid-19 symptoms. About 60 subjects (mean age 62+-3) healed from Covid-19 Virus with more than one day of hospitalization, older than 60 years old were included. They were divided into two clusters: Low Performance Patients (LPP) and Medium Performance Patients (MPP), decided by the Medical Equipe. The program consisted of 10 sessions of 1h, divided into 2/3 treatments per week;based on the use of Virtual Reality and Augmented Reality through a Digital Mirror. Tests were performed before and after the intervention. Increase in meters covered in the 6 Minutes Walking Test (MPP increases 56+- 65 meters, LPP increases 99+-74 meters). Wilcoxon test was performed between pre and post 6MWT for both of populations (pvalue < 0.005, pvalue < 0.005). After the treatment, results are close to normative data of Perera et al, 2006, Geriatrics. The improvement of both groups is statistically significantly difference;data support that especially the medium-functional group achieves the similar level of normotype subjects. A future randomized control trial aimed at testing whether improvement of this method over a traditional one is suggested. The authors declared no potential conflicts of interest with respect to the research authorship and/or publication of this poster.
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MULTIDIMENSIONAL ASSESSMENT OF DYSPNEA IN POSTCOVID PATIENTS REFERRED TO PULMONARY REHABILITATION In patients who suffer sequels after severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV2), dyspnea is the most prevalent respiratory symptom. We aimed to analyze a subgroup of patients under follow-up in the pulmonology rehabilitation units after hospitalization for moderate-severe SARS-CoV2 pneumonia. We prospectively studied 455 patients until November 2021. We analyzed: dyspnea by mMRC scale, grade of fatigue by FACIT-F (0 without fatigue-4 intense fatigue), spirometry and DLCO, 6-minute walk test (Osses'equations), isometric strength of dominant quadriceps (weakness threshold <70%), maximal sniff nasal inspiratory pressure test (weakness thresholds <70 cmH2O for men and <60 cmH2O for women), body composition and physical activity IPAQ-7. We grouped our sample according to the severity of the mMRC dyspnea (>= 2 vs < 2) and results were compared for the global sample and separately for men and women. Table 1 shows the baseline characteristics. 41.5% of women and 19.5% of men showed inspiratory muscle weakness. 52.7% of the patients reported dyspnea mMRC >= 2 and studied variables were significantly worse (Table 2). In the women group, only the 6-minute walk distance, the level of physical activity and the fatigue grade were significantly worse in patients with greater dyspnea (Table 2). Conclusion(s): In our sample, multifactorial moderate-intense dyspnea becomes a good marker of functional capacity, muscle function, grade of fatigue and physical activity in patients who have suffered from moderate-severe Covid-19 pneumonia.
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Background: We explored if fatigue influenced the long-term functional capacity of patients post COVID-19. Method(s): People after COVID -19, grouped by treatment setting (home - H, hospital ward - HW or intensive care unit - ICU), were studied 12 months after discharge. Fatigue-Functional Chronic Illness Assessment Questionnaire Fatigue Subscale, FACIT-F and functional capacity-6min walk test, 6MWD and 1min sit-to-stand test, 1minSTS were assessed. Groups were compared with one-way ANOVA or Kruskal-Wallis H test. Spearman's rho and multiple regression analyses were performed between fatigue-functional tests. Result(s): 148 subjects (H, n=44;HW, n=60;ICU, n=44) participated. Fatigue was clinically relevant at 12 months although not significantly different among groups [H: 41(35-49);HW: 42(33-50);ICU;42(32-48) points;p=.979). Functional capacity was significantly higher in those treated at home (6MWD: H,626 114m, HW: 527 146m, ICU: 528 129m, p<.001;1minSTS: H,29 11reps, HW: 23 8reps, ICU: 24 8reps, p<.002). Fatigue was significantly correlated with functional tests within each group (FACIT-F-6MWD,.317<rho<=.550, p<.01;FACIT-F-1minSTS, .364<rho<=.485, p<.01). Each point of FACIT-F could change 6MWD by 5-6m and 1minSTS by. 3-.5reps, explaining between 12-33% of change in 6MWD and 17-22% of change in 1minSTS (Table 1). Conclusion(s): Fatigue seems to influence functional capacity of patients post COVID-19. Early management of this symptom seems important for their long-term management.
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Background: The evolution of SARS-CoV-2 pneumonia is unpredictable and patient-dependent. The aim of our study was to assess the clinical, radiological, and respiratory functional outcomes three months after the diagnosis of hypoxemic pneumonia due to SARS-CoV-2. Method(s): Retrospective study conducted on the records of adult patients hospitalized in COVID-19 medical units in Mongi Slim La Marsa Hospital, for hypoxemic pneumonia due to SARS-Cov2 during the period from October 2020 to August 2021. Three months after le diagnosis of the pneumonia, all patients have had an appointment for examination, control thoracic CT scan and respiratory function assessment. Result(s): A total of 455 patients was hospitalized for hypoxemic pneumonia due to SARS-Cov2 during the period of study but only 57 (gender ratio M/F= 1,19 ;mean age= 62+/-10 years) had respiratory functional and radiological evaluation at three months. At least one symptom persisted in 58% of patients: dyspnoea (33%), asthenia (12%), dry cough (14%), and diffuse chest pain (9%). Chest CT showed persistent abnormalities in 3/4 of patients: ground-glass opacities (68%), consolidations (14%), pulmonary fibrosis (15%) and reticulations (10%). The mean value of the forced vital capacity (FVC) in percentage relative to predicted values was 81,5+/-15% and that of total lung capacity in percentage relative to predicted values was 87+/-19%. Persistent consolidation lesions were associated with lower FVC in percentage (p=0.009) and persistent dyspnea (p=0.013). Conclusion(s): Persistent thoracic CT scan abnormalities in post SARS-CoV-2 hypoxemic pneumonia are frequent with an impact on respiratory function.
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The assessment of functional capacity in severe post-COVID-19 patients, after hospitalization, is essential for estimating functional consequences, disability and exertional desaturation. To date, the 6-minutes walk test (6WMT) and the 1-minute sit-to-stand test (1STST) have been the most commonly used tests. The aim of this study is to investigate the relationship and discuss the utility of the 1STST compared to the 6MWT for follow-up evaluation of the functional status of severe post-COVID-19 patients. A cross-sectional study was performed in a post-COVID-19 public care clinic. A total of 55 patients (mean age: 57.85, SD 12.65) were evaluated. Functional performance was evaluated by 1STST and 6MWT. Both tests were performed 6 months after hospital discharge, on the same day, 1 hour apart. During the tests, the severity of dyspnea (by Modified Borg Scale), heart rate and pulse oxygen saturation (by pulse oximeter) were measured. A significant positive correlation was observed between 1STST and 6MWT (r = 0.30, p =. 026, 95% CI = [0.04, 0.53]). The correlation coefficient between the two tests was 0.30, indicating a moderate effect size. Also, the differences on the severity of dyspnea, heart rate and pulsed oxygen saturation between the two tests were not statistically significant (p =. 061;p =. 169;p =. 965). The 6MWT requires technical execution conditions that are not always easy to meet. Considering the statistically significant relationship between the 1STST and 6MWT, the 1STST may be used for a quick and alternative measurement of the functional assessment in post-COVID-19 patients.
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Background: Fatigue is a common symptom after a COVID-19 infection. There is evidence to support COVID-19 rehabilitation (CoR) improving symptoms. However, there is concern that exercise therapies may increase postexertional symptom exacerbation (PESE). Aim(s): To determine the effect of 6 weeks of CoR on fatigue and symptoms of PESE. Method(s): 148 patients (55 +/- 13 y;56 [38%] male) completed 6 weeks of CoR including symptom-titrated exercise and education. Fatigue was assessed pre- and post-CoR using the Functional Assessment Chronic Illness TherapyFatigue questionnaire (FACIT). Patients with a FACIT score <30 were defined as having severe fatigue. PESE symptoms were assessed in a sub-group of patients (n=44) using a subscale of the DePaul Symptom Questionnaire (DSQ). A mean composite score was calculated for DSQ symptom questions. Result(s): FACIT score reduced pre- to post-CoR with a mean change of -5 +/- 9;p<0.01. The DSQ composite score improved by 20 +/- 21 (p<0.01, n=44). The magnitude of change in the DSQ composite score pre- to post-CoR was not different in those with (26 +/- 22) and without (19 +/- 21) severe fatigue (p=0.44). Conclusion(s): CoR has demonstrated improvements in fatigue and symptoms associated with PESE. The improvement in PESE symptoms pre- to post-CoR was similar in patients with and without severe fatigue, advocating the use of CoR in both cohorts.
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Background: Supervised exercise programs (SEP) have demonstrated an improvement in quality of life (QoL), cardiovascular health, treatment tolerance and disease outcomes in early breast cancer patients. In metastatic breast cancer (MBC), previous data suggest SEP are safe but no impact on QoL and a low adherence to programs were shown. These studies included a heterogenous population in terms of type of treatments received, numbers of previous lines or comorbidities. From our perspective, MBC profile that could benefit most from SEP needs to be explored. Thus, we conducted a pilot study to assess adherence, safety and impact on QoL of a combined SEP and nutritional program (NP) in a selected population of MBC of patients treated with cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6). Method(s): This is a prospective, single center, single arm pilot study. SEP consisted in a 12-week intervention with twice a week in-person resistance exercise session. Patients also completed weekly aerobic exercise goals in self-managed sessions monitored with activity trackers. SEP was conducted by registered Physical Activity and Sports Science instructors that followed American College of Sports Medicine guidelines. In addition, participants had an initial nutritional assessment and personalized counselling by a qualified nutritionist. Adherence to treatment, biological variables and QoL assessments (FACIT-Fatigue and QLQ-C30 questionnaires) were collected at baseline (B) and week-12 (w12). Primary endpoint was global adherence (>=70% of attended sessions relative to scheduled sessions). Secondary endpoints included safety, changes in biological variables and QoL. Paired samples t-tests (Wilcoxon) were used to assess biological changes and QoL. Result(s): Patients (n=26) were recruited from October 2020 to November 2021. Median age was 47,5 years (45-55);84,6% of patients were ECOG 0. 42,3% of patients were receiving Abemaciclib;34,6% Ribociclib and 23,1% Palbociclib in first (73,1%) or second (26,9%) line treatment. Patients had bone (69,2%);visceral metastasis (57,7%) or both (30,8%). 2 patients did not start the intervention and additional 7 patients discontinued the program prematurely, the majority of them due to COVID-related concerns. Considering all patients who at least attended one session, global adherence was 66% (39-77,5%) and 45,8% of patients achieved an adherence of >= 70%. Patients reported an improvement in QoL [B global QLQ-C30 66,6 (50-75), w12 75 (66,6-83,3);p 0,0121] and fatigue [B FACIT-Fatigue 37 (30-44), w12 42 (38-48);p 0,0017]. Sit-to-stand repetitions in 30-second period also improved [(B 15 (12-17), 19 (15-23);p 0,0002]. Same benefits were seen in patients with adherence >= 70%. No statistically significant changes were seen in body fat or muscular composition and handgrip scores. Importantly, no safety issues related to study intervention were reported. Conclusion(s): Even though the study was conducted during COVID-19 pandemic, global adherence was 66%. For the first time in MBC, SEP and NP combined program demonstrated to be safe and improved QoL in patients with first or second line MBC treated with iCDK4/6. Further research is needed to identify strategies that improve QoL in MBC.
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Introduction: After acute COVID infection, individuals experience fatigue and a reduced exercise tolerance, however the relationship between these variables has not been established. Aim(s): This study explored the impact of fatigue severity on exercise tolerance in individuals post-COVID infection. Method(s): This observational cohort analysis of individuals attending COVID-rehabilitation was assessed using the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) questionnaire and Incremental Shuttle Walk Test (ISWT) pre- to post- rehabilitation. Individuals were split into mild and severe fatigue (FACIT-F</>=30) groups. Result(s): 295 individuals were assessed (64% male, mean[SD] age 54[15] years, BMI 30.1[8.7] kg/m ). 193 (65%) individuals were in the severe fatigue group. Baseline ISWT distance was reduced in the severe fatigue group (287[181]m) compared to the mild fatigue group (396[217]m, p<0.05). There was a weak positive correlation between Pre-FACIT-F and baseline ISWT (r=0.28). There was a significant improvement in ISWT following rehabilitation of 90[114]m and 62[77]m for severe and mild fatigue groups respectively but there was no differences between groups (p=0.13)Conclusion: Those with severe fatigue had reduced exercise tolerance compared to those with mild fatigue prior to rehabilitation. Rehabilitation improves exercise tolerance in those with mild and severe fatigue, and there are no differences between groups.
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The proceedings contain 67 papers. The topics discussed include: role of endomyocardial biopsy in differential diagnosis of non- -ischemic cardiomyopathy;metformin treatment is associated with improved quality of life and outcome in patients with diabetes and advanced heart failure (HFREF);translational research in the field of inherited arrhythmias;same day discharge via a dedicated radial lounge - results of 1-year experience during the COVID-19 pandemic;functional assessment of microcirculation in takotsubo cardiomyopathy - a pilot study;an interplay of genetics and inflammation affecting left ventricular reverse remodeling in dilated cardiomyopathy;sildenafil inhibits pulmonary hypertension induced by left heart pressure overload in rats;predicting long-term survival after an ischemic stroke;and longitudinal trends in blood pressure, prevalence, awareness, treatment, and control of hypertension in the Czech population. are there any sex differences?.
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Aim: To assess impairment in health status and psychological burden, subjects with Long Covid enrolled in a multidisciplinary follow-up outpatient programme underwent a multidimensional psychological assessment including Zung's Self-rating Anxiety Scale (SAS), Impact of Event Scale-Revised (IES-R), Beck Depression Inventory-II (BDIII), Functional Assessment of Chronic Illness Therapy, Fatigue subscale (FACIT-F), 12-Item Short-Form Health Survey (SF-12). Result(s): Ninety-nine subjects (36M;age 52.6+/-14.5) participated to a self-administered multidimensional psychological evaluation from january2021 to january 2022 (5.5+/-4.4 months after acute infection). Sixty-one out of 99 (61.6%) subjects (20M, age 48.7+/-14.5y) were treated at home during acute SARS-CoV-2 infection. Thirtyfive patients (35.4%) had symptoms of post-traumatic stress disorder (PTSD), 21 patients (21.2%) had moderate to severe depressive symptoms, 47 (47.4%) exhibited clinically significative anxiety. No significant differences in symptoms and psychological evaluation were found in home treated, compared with the subgroup of 38 (38.3%) hospitalized subjects (16M, age59.0+/-13.0y). Irrespective of hospitalization, persistent asthenia was reported in 34 out of 63 females (54.0%), and in 11 males (30.6%) (p=.005);Clinically significant anxiety was found in 37(58.7%) females and in 7(19.4%) males (p=.001). Gender associated significant differences were found as well in FACIT-F, SAS, SF-12, but not in BDI-II and IES-R scores. Conclusion(s): Among a cohort of long covid subjects, gender differences were observed in symptoms reported and in psychological well-being.
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Background: Chemotherapy (CTX) for breast cancer (BC) can have a detrimental effect on cardiorespiratory fitness (CRF), as measured by VO2max. This decline may be attenuated by physical activity, which can also reduce mortality risk and improve quality of life (QoL) for patients (pts) with BC. During the COVID-19 pandemic, many have pivoted to home-based exercise routines, which have been shown to be safe and feasible for pts with BC receiving CTX. We conducted the STRENGTH Trial to evaluate the effect of a 12-week virtual supervised exercise program in BC pts receiving CTX on CRF. Method(s): This is a single-center, prospective, single-arm study designed to evaluate the effect of a 12-week virtual supervised exercise training program on CRF in BC pts receiving CTX. Participants aged >=18 years with stage I-IV BC who were planned to receive at least 12 weeks of CTX of investigator's choice were eligible for inclusion. Participants were asked to complete a total of 150 minutes (min) of moderate intensity physical activity/week, as a combination of a 45 min weekly virtual personal training session and workout classes streamed from the Peloton Digital platform (i.e. walking, running, cardio, yoga, strength training, and cycling). The primary endpoint was the distance walked on a Six-Minute Walk Test (6MWT), an accepted surrogate marker for VO2max, at the start and completion of the program. Secondary endpoints included assessment of QoL using the Functional Assessment of Cancer Therapy - General (FACT-G) and symptom assessment using the MD Anderson Symptom Inventory (MDASI) questionnaires at the beginning, middle and end of the study. Exploratory endpoints included treatment adherence, toxicities, completion and response. Result(s): 33 participants signed consent for the clinical trial and 2 withdrew voluntarily prior to beginning the program. 5 participants discontinued prematurely due to a diagnosis of COVID-19 (N=3) and pulmonary embolism (N=2) and were not included in the primary endpoint. One participant remains on study at this time. Median age 49 yrs;range 33-68. Mean BMI 29.55;range 18.1-46.5. 13 HR+/HER2-, 7 HR-/HER2-, 11 HER2+. 14 (45%) pts had Stage I, 11 (35%) pts had Stage 2, 5 (16%) pts had Stage 3, 1 (3%) pt had Stage 4. 23 pts (70%) received either an anthracycline or HER2-based therapy. 19 pts (61%) received neoadjuvant CTX on study, 11 pts (35%) received adjuvant CTX and 1 pt (3%) received treatment in metastatic setting. The average number of exercise min per week per participant was 123.2 min (95% CI, 104.1-142.2), with a relative dose intensity of 82%. In the pts that completed the study thus far (N=25), there was no statistically significant difference between the distance walked during the 6MWT at the start and end of the study (median difference= -10m, range: -129-150m, p= 0.67). There was no statistically significant difference in the FACT-G score at the start and end of the study (median difference= -1.0, range -17.83- 30.0, p=0.54). Pts scored higher on the MDASI (median difference= 0.33, range -1.55-4.62, p=0.04) at the end of the exercise program compared to the beginning. There were no new or unexpected treatment toxicities observed. Conclusion(s): Pts who participated in a 12-week virtual supervised exercise program during CTX for BC did not experience a statistically significant difference in the distance walked during the 6MWT between the beginning and end of the exercise program. Exercise may attenuate the decline in cardiorespiratory function that has historically been observed with CTX for BC. Some pts were not able to adhere to the recommended 150 min of exercise/week suggesting a potential need for modified exercise targets for pts with BC undergoing CTX. This study is limited by a small sample size and larger, randomized clinical trials are needed to further evaluate optimal exercise recommendations for patients with BC undergoing CTX in order to maintain and potentially, even improve, cardiorespiratory function.
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Background: Financial toxicity (FT) is a multi-faceted construct, encompassing material hardship, psychological responses, and coping behaviors. FT adversely impacts patient-reported outcomes by decreasing mental health, affecting health-related quality of life (HRQOL), and deteriorating healthcare adherence. Few studies have assessed the relationship between financial toxicity, distress, coping, self-efficacy, and HRQOL within the context of cancer care disruptions resulting from the pandemic. Method(s): In the COVID-19 Breast Cancer Care Survey, 46 women with primary breast cancer were cross-sectionally evaluated for financial hardship (FACIT-COST), distress (Perceived Stress Scale), coping behaviors (Brief COPE), self-efficacy (Cancer Behavior Inventory-Brief) and HRQOL using the Functional Assessment of Cancer Therapy General (FACT-G) measure. Cancer care disruptions were measured with a series of questions investigating the impact of COVID-19 guidelines on access to healthcare services, treatment, and transition to telemedicine. Given the role of informal caregivers for patients' outcomes, social isolation was additionally included (PROMIS Social Isolation Scale). Descriptive statistics were computed, and bivariate correlations examined. Then, a subsequent regression model investigated predictors of FT in the present sample. Statistical analyses were performed using SAS 9.4 and significance level was set at p< 0.05. Result(s): Overall, participants were adult (Mage= 46.3+/-10.9) women diagnosed with early-stage breast cancer (75.61% Stage I/II). Approximately half of the participants were in active treatment (51.2%) and received multiple types of treatment (85.4% surgery;61% chemotherapy, and 36.5% radiation). Although all participants were insured at time of the study, the mean score of FT was 22.75 (SD=4.10, range: 0-44). Correlation analyses indicated that cancer care disruptions (r= -0.57, p<.001), health-related quality of life (r=-0.51, p=0.0007), coping behaviors (r=-0.33, p=0.037), well-being (r=0.56, p=0.0001), social isolation (r=-0.40, p=0.0096), and psychological distress (r=-0.42, p=0.0064) were significantly correlated with FT. That is, women who reported greater disrupted cancer care delivery, greater difficulties managing the illness, reduced physical and mental health, and those experiencing more social isolation reported worse financial toxicity. Results of the final regression model showed that women who experienced greater COVID19-related cancer care disruptions (beta=-2.82, p=0.0013) and isolation (beta=-0.44, p=0.0196) from supportive networks were more likely to indicate elevated FT scores. Conclusion(s): A multidisciplinary and patient-centered FT management approach can be implemented to extend current financial navigation models to address psychosocial and behavioral factors exacerbated by altered care delivery protocols.
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Background: COVID-19-Convalescent Plasma (CCP) showed beneficial effects when given early in the treatment course or when it contains high-titre of neutralizing antibodies. Here we present a long-term follow up of patients of the multicentric national randomized CAPSID trial that investigated the effect of CCP in hospitalized COVID-19 patients. CCP donors were also included in the follow up and severed as a control group of patients with mild to moderate disease. Method(s): Patients and donors were invited to participate in the long-term follow up. Data on long-term overall survival (OS) were available for n=52 patients (control group: n=22, high titre CCP: n=16, low-titre CCP: n=14) and n=113 donors. Structured interview and a quality of life (QoL) assessment by questionnaires (FACIT fatigue, FACIT dyspnea and EQ-ED- 5DL) were performed. Visits took place online or on site. Laboratory tests included neutralizing antibody testing by PRNT and inflammation markers. Data are given as median with IQR. Medical events were assessed and graded according to CTCAE. For donors the median follow up time was 517 (483-553) days after the first plasmapheresis and for patients 395 (371-417) days after randomization. Result(s): Medical events during follow up were reported in 27% of donors and 16% of patients (p=0.164) with grade 3 or higher in 9% of donors and 22% of patients. More patients than donors reported a decrease in their socioeconomic status and reported more frequently about GI, pulmonal, pain symptoms or alopecia (p<0.02), but no difference in neurologic symptoms including anosmia was observed. Post COVID-Scale was worse in patients with a trend for better outcome in the CCP group (p=0.089). The trend for better OS in the CCP group became more pronounced during the long-term follow up (p=0.08) and OS remained significantly better in the high dose CCP group (p=0.01). All QoL scores showed a consistent trend towards better outcomes of the CCP group. Conclusion(s): To our knowledge, this is the first long-term follow up from a randomized trial of CCP. CCP-donors with mild to moderate COVID- 19 had a significant smaller long-term disease burden than patients with severe disease. The addition of CCP added to standard treatment in severe COVID-19 showed a trend to better OS and QoL. We had previously reported significant better outcomes in the high-titre CCP subgroup (until day 60). This was even more pronounced during the long-term follow up (> 1 year).
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Background. People with post-COVID conditions can have a wide range of symptoms lasting months and it can affect as many as one in five infected people. Interferon beta (IFN-beta) is key in host defence against viruses but can be suppressed by virus or host factors locally at the site of infection. Inhalation of SNG001 (IFN-beta-1a nebuliser solution) aims to restore lung IFN-beta levels. SPRINTER (NCT04732949) was a RCT of inhaled interferon beta in hospitalised COVID-19. There was no effect of SNG001 on the primary endpoints of time to discharge or recovery most likely due to improvements in the standard of care. However, there was an encouraging signal for the key secondary endpoint of prevention of progression to severe disease or death (ITT 26% relative risk reduction [RRR];Odds Ratio [95% CI]: 0.71 [0.44, 1.15];Per Protocol 36% RRR;OR 0.63 [0.35, 1.13]). Post hoc analyses showed enhanced effects favouring SNG001 in subgroups at higher risk of progression. We report on the impact of SNG001 on long COVID symptoms in SPRINTER. Methods. Patients requiring low-flow oxygen were randomized to receive SNG001 (314) or placebo (309) once daily for 14 days, plus standard-of-care. Long COVID symptoms were assessed as a secondary endpoint at follow-up visits via telephone/ video call on Day 60 and Day 90. The following patient reported outcome (PRO) measures were also assessed: General Anxiety Disorder 7 Questionnaire (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Functional Assessment of Chronic Illness Therapy (FACIT) - Fatigue Scale and Brief Pain Inventory (Short Form). Results. When compared to placebo, SNG001 reduced the relative risk of common symptoms of long COVID (fatigue/malaise [RRR=35.4%];dyspnoea [RRR=28.3%];loss of smell and/or taste [RRR=61.4%]). Analysis of the PROs is ongoing. Conclusion. Long COVID can leave patients with lingering cognitive, respiratory, and functional symptoms months after a SARS-CoV-2 infection. Given the shift from pandemic to endemic status for COVID-19 and the need for new treatments then these findings, suggesting SNG001 may be impacting common long COVID symptoms, provide additional support for the further investigation of SNG001. (Figure Presented).
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Introduction: Accumulating evidence supports that 6 months after COVID-19 almost 80% of the patients present residual neurological manifestations. Some of these symptoms may be associated with autonomic nervous system (ANS) damage. Several possible mechanisms have been proposed, including the detrimental effect of the virus-induced cytokine storm, direct viral spread into the nervous system, and an immune-mediated autoimmune mechanism. The extent of ANS involvement and exact pathological locations are unknown. Method(s): The aim of our study was to characterize the peripheral autonomic nervous system involvement in post-COVID patients. We compared the outcomes of neurological and neurophysiological examinations with the results of asymptomatic control subjects. In our study, we studied 33 patients (20 women, mean age: 39 +/- 8 years) with post-COVID, transient or persistent neurocognitive and/or autonomic nervous system symptoms and 8 (4 women, 29 +/- 5 years) control subjects. After detailed neurological examination, the ANS functional assessment was performed with Quantitative Sudomotor Axon Reflex Test (QSART) and Sudomotor Sympathetic Skin Response (SSR) using Vitalscan SudoCheck + machine. Heart rate variability (HRV) was determined using a WIWE instrument. Result(s): Focal neurological signs were not found in any of the patients. Regarding the autonomic nervous system studies, SSR measurement was the most sensitive in our population: we found abnormal SSR values in 8/33 of our post-COVID patient group (24%), while we did not find any abnormal SSR values in the control group. These 8 post-COVID patients showed moderate to severe (bioelectrical skin conductivity: 24.3-59.4 microS) ANS dysfunction. During the one-minute HRV measurement, we assessed the standard deviation of heart rate variability (SDNN) and the root mean square of the RR intervals (RMSSD). Abnormally low values were measured in 14/33 patients (42%) (SDNN mean: 18-23 ms, RMSSD mean: 13-14 ms). Conclusion(s): In our study, different neurophysiological examination modalities confirmed ANS involvement in post-COVID patients. The extent of cardiovascular autonomic involvement (42%) was higher than sudomotor dysfunction (24%). These ratios significantly exceed the results of similar measurements in the age-matched control group. We suggest that the dysautonomia profile might explain the persistent symptoms after COVID-19. Copyright © 2022
ABSTRACT
The objective of this systematic review was to explore the effect of vitamin D supplementation on functional outcomes among individuals post stroke(PROSPERO CRD42022296462). MEDLINE, PsycInfo, EMBASE, and CINAHL were searched for articles published in any language from database inception to January 5, 2022. Only interventional studies assessing vitamin D supplementation compared to placebo or usual care in adult stroke patients were selected. After duplicate removal, 2,825 studies were screened by two independent reviewers. A total of 41 studies underwent full text review;8 studies met inclusion criteria (6 randomized controlled trials [RCTs] and 2 observational studies). Data were extracted by two independent reviewers using Covidence software. Motor function (Brunnstrom Recovery Stage, Berg Balance Score), mobility (Functional Ambulation Category), activities of daily living (Barthel Index, Functional Independence Measure) and stroke impairment (Modified Rankin Scale, National Institutes for Health Stroke Severity, Scandinavian Stroke Severity) were the outcome measures of interest included in the studies. In total, 562 patients were studied for which 9 of 13 outcome measures showed improvement with vitamin D supplementation. The majority of studies showed an improvement in motor function, mobility, and stroke impairment with vitamin D supplementation;however, the evidence did not support an improvement in activities of daily living with treatment. Strong, methodologically sound RCTs are required to verify these findings. None.