Efficiency of application of sorbed probiotics in the complex therapy of pneumonia caused by SARS-CoV-2. Quality of life in the short term COVID-19

Aim. To determine the clinical efficacy and safety of the immobilized (sorbed) probiotics Bifidobacterium bifidum 1 (5x108 CFU) and B. bifidum 1 (5x107 CFU) in combination with Lactobacillus plantarum 8P-A3 (5x107 CFU) in the complex therapy of pneumonia caused by SARS-CoV-2 in adult patients without severe risk factors and their impact on health-related quality of life (QoL). Material and methods. An open, randomized prospective study included 100 patients (45 males, 55 females), aged from18 to 60 years without risk factors for severe COVID-19, with pneumonia confirmed by computed tomography and an area of lung lesion no more than 75% (moderate forms). SARS-CoV-2 RNA in nasal and oropharyngeal swabs (RT-PCR) was detected in 72% of the participants, in the rest it was highiy probable in terms of the aggregate parameters. The publication presents the results of self-assessment (94 respondents) of working capacity limitations, shortness of breath, intestinal disorders since the end of the probiotic regimen (PR: hospitalization period - B. bifidum 1, 3 capsules 2 times a day for 10 days, then after hospitalization - B. bifidum 1 in combination with L. plantarum 8P-A3 2 powders 3 times a day for 14 days) and QoL (Short Form Medical Outcomes Study: SF-36) 1 month after hospitalization. Results. At the end of PR, the ability to engage in daily activities was higher by 23.1% [95% confidence interval 5.3-37.3, OR 0.08 (0.08-0.77)]. Difficulty of breathing during exercise was less common by 29.7% [15.1-44.5%], OR 0.09 [0.02-0.40], hard stools and no bowel movements were recorded less often by 21.3% [8.5-34, 1] for 1-3 days. One month after hospitalization, the QoL of the patients receiving standard treatment was significantly reduced relative to population indicators in Russia. It was more significantly due to the psychological component of health [total measurement 38.1 (36.2-40.0)] and less significantly due to the physical component [49.5 (48.3-50.8)]. The main reasons limiting daily activities [Role Emotional (RE): 39.4 (37.4-41.4)] were decreased vitality [VT: 40.2 (38.9-041.5)], emotional depression [Mental Health (MH): 41.2 (39.4-43.0)], deficit of social contacts [Social Functioning (SF): 45.1 (43.7-46.6)]. The patients who received PR had a higher ability to carry out daily activities [RE: 57.7 (55.6-59.7)], the severity of psychological problems associated with fatigue, anxiety and depression was lower [MH: 59.8 (58.7-60.9), p<0,001]. The effect of the PR on negative perceptions of social isolation was comparatively less [SF: 53.9 (52.2-55.4)]. The QoL of the patients who additionally suffered from diarrhea in the acute period of SARS-CoV-2 pneumonia was worse in comparison with the patients without diarrhea (due to pain and inability to endure physical activity). The effects of immobilized (sorbed) probiotics to the QoL of the patients with diarrhea during the acute period of COVID-19 were most significant. Conclusion. PR had a significant positive effect on the QoL within a month after hospitalization, increasing working capacity and improving mental health, reducing the severity of psychological problems and fatigue. Additional researches are needed on the possible relationship of organic and functional gastrointestinal diseases with the progression of diarrhea in patients infected with SARS-CoV-2. No side effects of the sorbed probiotics regimen have been identified.Copyright © Eco-Vector, 2022.

Long COVID in children

Recently concerns have been raised regarding delayed and persistent clinical manifestations following acute COVID infection. The term "Long COVID” refers to a syndrome with multisystem manifestations, persisting beyond 3months of the onset of acute COVID when other likely causes are excluded. Recently, the World Health Organization proposed a definition for adults that included persistent or fluctuating symptoms, impacting daily life, for at least 2months, following acute COVID, that could not be explained by other diagnoses. The condition is better understood among adults, but similar presentations have also been reported in children less frequently. These include fatigue, muscular weakness, shortness of breath, sleeping difficulty, depression, and anxiety. However, there are insufficient epidemiologic studies on Long COVID in children, and the limited data have various methodological limitations. There is no confirmatory diagnostic test and no specific pharmacological treatment for Long COVID. Therefore, individualized symptomatic treatment and multidisciplinary rehabilitation should be attempted. Severe physical or psychiatric manifestations require an urgent referral and appropriate management. Vaccination for the prevention of COVID, as per the local guidelines, is suggested. © 2023 Elsevier Inc. All rights reserved.

'I'm still here, I'm alive and breathing': The experience of Black Americans with long COVID.

AIMS AND OBJECTIVES: In this study, we aimed to characterize the impact of long COVID on quality of life and approaches to symptom management among Black American adults. BACKGROUND: As a novel condition, qualitative evidence concerning long COVID symptoms and their impact on quality of life can inform the refinement of diagnostic criteria and care plans. However, the underrepresentation of Black Americans in long COVID research is a barrier to achieving equitable care for all long COVID patients. DESIGN: We employed an interpretive description study design. METHODS: We recruited a convenience sample of 15 Black American adults with long COVID. We analysed the anonymized transcripts from race-concordant, semi-structured interviews using an inductive, thematic analysis approach. We followed the SRQR reporting guidelines. RESULTS: We identified four themes: (1) The impact of long COVID symptoms on personal identity and pre-existing conditions; (2) Self-management strategies for long COVID symptoms; (3) Social determinants of health and symptom management; and (4) Effects on interpersonal relationships. CONCLUSION: Findings demonstrate the comprehensive ramifications of long COVID on the lives of Black American adults. Results also articulate how pre-existing conditions, social risk factors, distrust due to systemic racism, and the nature of interpersonal relationships can complicate symptom management. RELEVANCE TO CLINICAL PRACTICE: Care approaches that support access to and implementation of integrative therapies may be best suited to meet the needs of long COVID patients. Clinicians should also prioritize eliminating patient exposure to discrimination, implicit bias, and microaggressions. This is of particular concern for long COVID patients who have symptoms that are difficult to objectively quantify, such as pain and fatigue. NO PATIENT OR PUBLIC CONTRIBUTION: While patient perspectives and experiences were the focus of this study, patients were not involved with the design or conduct of the study, data analysis or interpretation, or writing the manuscript.

Tissue injury and leukocyte changes in post-acute sequelae of SARS-CoV-2: review of 2833 post-acute patient outcomes per immune dysregulation and microbial translocation in long COVID.

A significant number of persons with coronavirus disease 2019 (COVID-19) experience persistent, recurrent, or new symptoms several months after the acute stage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This phenomenon, termed post-acute sequelae of SARS-CoV-2 (PASC) or long COVID, is associated with high viral titers during acute infection, a persistently hyperactivated immune system, tissue injury by NETosis-induced micro-thrombofibrosis (NETinjury), microbial translocation, complement deposition, fibrotic macrophages, the presence of autoantibodies, and lymphopenic immune environments. Here, we review the current literature on the immunological imbalances that occur during PASC. Specifically, we focus on data supporting common immunopathogenesis and tissue injury mechanisms shared across this highly heterogenous disorder, including NETosis, coagulopathy, and fibrosis. Mechanisms include changes in leukocyte subsets/functions, fibroblast activation, cytokine imbalances, lower cortisol, autoantibodies, co-pathogen reactivation, and residual immune activation driven by persistent viral antigens and/or microbial translocation. Taken together, we develop the premise that SARS-CoV-2 infection results in PASC as a consequence of acute and/or persistent single or multiple organ injury mediated by PASC determinants to include the degree of host responses (inflammation, NETinjury), residual viral antigen (persistent antigen), and exogenous factors (microbial translocation). Determinants of PASC may be amplified by comorbidities, age, and sex.

The definition of long COVID used in interventional studies.

INTRODUCTION: There has been little consensus for a specific definition of long COVID, though several organizations have created varying ones. We sought to examine the definition of long COVID used in ongoing clinical trials. METHODS: We searched 'long COVID' and related terms on both PubMed and clinicaltrials.gov for randomized studies that either included patients with long COVID or had a persistent or long-term COVID-related outcome and abstracted long COVID definition components. RESULTS: Of the 92 studies, a laboratory-only confirmed diagnosis of COVID-19 was stipulated in 54.3% (n = 50) studies. We found eight different time durations specified for how long symptoms needed to have occurred, ranging from 4 to 52 weeks, with 12 weeks being the most common (34.8%; n = 32). 35.9% (n = 33) did not specify a time duration. There were 57 different symptoms specified in total, with a median of one symptom identified per study (range 0-32). 8.7% of trials adhered to NICE or WHO definitions. CONCLUSION: Standardized definitions of long COVID should be applied in studies assessing this condition to unify and harmonize research on this topic.

Therapeutic trials for long COVID-19: A call to action from the interventions taskforce of the RECOVER initiative.

Although most individuals recover from acute SARS-CoV-2 infection, a significant number continue to suffer from Post-Acute Sequelae of SARS-CoV-2 (PASC), including the unexplained symptoms that are frequently referred to as long COVID, which could last for weeks, months, or even years after the acute phase of illness. The National Institutes of Health is currently funding large multi-center research programs as part of its Researching COVID to Enhance Recover (RECOVER) initiative to understand why some individuals do not recover fully from COVID-19. Several ongoing pathobiology studies have provided clues to potential mechanisms contributing to this condition. These include persistence of SARS-CoV-2 antigen and/or genetic material, immune dysregulation, reactivation of other latent viral infections, microvascular dysfunction, and gut dysbiosis, among others. Although our understanding of the causes of long COVID remains incomplete, these early pathophysiologic studies suggest biological pathways that could be targeted in therapeutic trials that aim to ameliorate symptoms. Repurposed medicines and novel therapeutics deserve formal testing in clinical trial settings prior to adoption. While we endorse clinical trials, especially those that prioritize inclusion of the diverse populations most affected by COVID-19 and long COVID, we discourage off-label experimentation in uncontrolled and/or unsupervised settings. Here, we review ongoing, planned, and potential future therapeutic interventions for long COVID based on the current understanding of the pathobiological processes underlying this condition. We focus on clinical, pharmacological, and feasibility data, with the goal of informing future interventional research studies.

Inequity and disparities mar existing global research evidence on Long COVID.

Since the pandemic began in December 2019, SARS-Cov2 has accentuated the wide gap and disparities in socioeconomic and healthcare access at individual, community, country, and regional levels. More than two years into the current pandemic, up to three-fourths of the patients are reporting continued signs and symptoms beyond the acute phase of COVID-19, and Long COVID portends to be a major challenge in the future ahead. With a comprehensive overview of the literature, we found that most studies concerning long COVID came from high and upper-middle income countries, and people of low-income and lower-and-middle income regions and vulnerable groups with comorbid conditions have been neglected. Apart from the level of income, there is a significant geographical heterogeneity in investigating the Post-Acute Sequelae of COVID-19 (PASC) or what we call now, long COVID. We believe that these recognizing health disparities is crucial from equity perspective and is the first step toward global health promotion.

Neuropsychiatric symptoms in post-COVID-19 long haulers.

BACKGROUND: Long haulers have been recently reported after contracting coronavirus disease (COVID-19). In the present study, we aimed to screen for the neuropsychiatric signs detected <1 to >6 months after infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to determine whether vaccination has an effect on them. METHODS: An online survey was conducted among participants who had been diagnosed with laboratory-confirmed SARS-CoV-2 infection. The clinical signs and durations of neuropsychiatric complaints and their correlations to sex, age, severity of COVID-19 signs, and vaccination status were screened. RESULTS: A total of 2218 individuals, including 1358 females and 860 males, with an age range of 12-70 years, submitted their responses. The respondents experienced cognitive dysfunction, mood alteration, depression, tinnitus, sleep disorders, and loss of taste and smell, with prevalence rates ranging from 18.9% (tinnitus) to 63.9% (loss of taste and smell). Of the respondents, 2.2-7.7% confirmed the persistence of symptoms for >6 months. Tinnitus was the least common complaint, and only 2.2% of the study participants had tinnitus for >6 months. Meanwhile, mood alteration persisted for >6 months in 7.6% of the study participants. More respondents who received two doses of BNT162b2 vaccine showed persistent symptoms than those in the other groups. Disease severity and female sex were identified as potential determinants of the development and persistency of such symptoms. CONCLUSION: Post-COVID neuropsychiatric symptoms were present in considerable percentages of the study participants with SARS-CoV-2 infection, persisting for >6 months in up to 7.6% of the participants.

Pediatric Post-Acute Sequelae of SARS-CoV-2 infection

Aim: Youth who have not recovered from COVID-19 have been referred to as having Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). The goal of this study was to better understand which symptoms persisted since onset of infection and how these symptoms compare to symptoms experienced by those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Method: A sample of 19 parents who had a child with PASC were recruited using social media to fill out a questionnaire detailing symptoms at two time points. The first time point included their child's current symptoms and the second captured symptoms at initial infection. These participants were compared to a sample of 19 youth with ME/CFS. Results: Findings indicated significant decreases among several immune, neuroendocrine, pain, post-exertional malaise (PEM), and COVID-19 Centers for Disease Control and Prevention (CDC) domain symptoms from time of acute infection to time of current reporting. Fatigue remained at a high level as did several symptoms within the sleep and PEM domains. Participants with ME/CFS had overall worse symptomatology when compared to participants with PASC, especially in the neurocognitive domain. Conclusion: Most symptoms of those with PASC decline over time, but several remain at high levels, including fatigue. These findings are helpful in better understanding common symptom presentation profiles for youth with PASC and can be used to more adequately tailor diagnostic criteria and treatment strategies for youth. © 2023 IACFS/ME.

Comparability of Control and Comparison Groups in Studies Assessing Long COVID.

BACKGROUND: Awareness of long coronavirus disease (COVID) began primarily through media and social media sources, which eventually led to the development of various definitions based on methodologies of varying quality. We sought to characterize comparison groups in long COVID studies and evaluate comparability of the different groups. METHODS: We searched Embase, Web of Science, and PubMed for original research articles published in high-impact journals. We included studies on human patients with long COVID outcomes, and we abstracted study-related characteristics, as well as long COVID characteristics. RESULTS: Of the 83 studies, 3 were randomized controlled trials testing interventions for long COVID, and 80 (96.4%) were observational studies. Among the 80 observational studies, 76 (95%) were trying to understand the incidence, prevalence, and risk factors for long COVID, 2 (2.5%) examined prevention strategies, and 2 (2.5%) examined treatment strategies. Among those 80 studies, 45 (56.2%) utilized a control or comparison group and 35 (43.8%) did not. Compared with 95% of observational studies that documented symptoms or assessed risk factors, all randomized studies assessed treatment strategies. We found 48.8% of observational studies did any adjustment for covariates, including demographics or health status. Of those that did adjust for covariates, 15 (38.5%) adjusted for 4 or fewer variables. We found that 26.5% of all studies and 45.8% of studies with a control/comparator group matched participants on at least 1 variable. CONCLUSION: Long COVID studies in high-impact journals primarily examine symptoms and risk factors of long COVID; often lack an adequate comparison group and often do not control for potential confounders. Our results suggest that standardized definitions for long COVID, which are often based on data from uncontrolled and potentially biased studies, should be reviewed to ensure that they are based on objective data.

Efficiency of application of sorbed probiotics in the complex therapy of pneumonia caused by SARS-CoV-2. Quality of life in the short term COVID-19

Aim. To determine the clinical efficacy and safety of the immobilized (sorbed) probiotics Bifidobacterium bifidum 1 (5×108 CFU) and B. bifidum 1 (5×107 CFU) in combination with Lactobacillus plantarum 8P-А3 (5×107 CFU) in the complex therapy of pneumonia caused by SARS-CoV-2 in adult patients without severe risk factors and their impact on health-related quality of life (QoL). Material and methods. An open, randomized prospective study included 100 patients (45 males, 55 females), aged from18 to 60 years without risk factors for severe COVID-19, with pneumonia confirmed by computed tomography and an area of lung lesion no more than 75% (moderate forms). SARS-CoV-2 RNA in nasal and oropharyngeal swabs (RT-PCR) was detected in 72% of the participants, in the rest it was highiy probable in terms of the aggregate parameters. The publication presents the results of self-assessment (94 respondents) of working capacity limitations, shortness of breath, intestinal disorders since the end of the probiotic regimen (PR: hospitalization period – B. bifidum 1, 3 capsules 2 times a day for 10 days, then after hospitalization – B. bifidum 1 in combination with L. plantarum 8P-А3 2 powders 3 times a day for 14 days) and QoL (Short Form Medical Outcomes Study: SF-36) 1 month after hospitalization. Results. At the end of PR, the ability to engage in daily activities was higher by 23.1% [95% confidence interval 5.3–37.3, OR 0.08 (0.08–0.77)]. Difficulty of breathing during exercise was less common by 29.7% [15.1–44.5%], OR 0.09 [0.02–0.40], hard stools and no bowel movements were recorded less often by 21.3% [8.5–34, 1] for 1–3 days. One month after hospitalization, the QoL of the patients receiving standard treatment was significantly reduced relative to population indicators in Russia. It was more significantly due to the psychological component of health [total measurement 38.1 (36.2–40.0)] and less significantly due to the physical component [49.5 (48.3–50.8)]. The main reasons limiting daily activities [Role Emotional (RE): 39.4 (37.4–41.4)] were decreased vitality [VT: 40.2 (38.9–041.5)], emotional depression [Mental Health (MH): 41.2 (39.4–43.0)], deficit of social contacts [Social Functioning (SF): 45.1 (43.7–46.6)]. The patients who received PR had a higher ability to carry out daily activities [RE: 57.7 (55.6–59.7)], the severity of psychological problems associated with fatigue, anxiety and depression was lower [MH: 59.8 (58.7–60.9), р<0,001]. The effect of the PR on negative perceptions of social isolation was comparatively less [SF: 53.9 (52.2–55.4)]. The QoL of the patients who additionally suffered from diarrhea in the acute period of SARS-CoV-2 pneumonia was worse in comparison with the patients without diarrhea (due to pain and inability to endure physical activity). The effects of immobilized (sorbed) probiotics to the QoL of the patients with diarrhea during the acute period of COVID-19 were most significant. Conclusion. PR had a significant positive effect on the QoL within a month after hospitalization, increasing working capacity and improving mental health, reducing the severity of psychological problems and fatigue. Additional researches are needed on the possible relationship of organic and functional gastrointestinal diseases with the progression of diarrhea in patients infected with SARS-CoV-2. No side effects of the sorbed probiotics regimen have been identified. © Eco-Vector, 2022.

Cortical Grey matter volume depletion links to neurological sequelae in post COVID-19 "long haulers".

OBJECTIVE: COVID-19 (SARS-CoV-2) has been associated with neurological sequelae even in those patients with mild respiratory symptoms. Patients experiencing cognitive symptoms such as "brain fog" and other neurologic sequelae for 8 or more weeks define "long haulers". There is limited information regarding damage to grey matter (GM) structures occurring in COVID-19 "long haulers". Advanced imaging techniques can quantify brain volume depletions related to COVID-19 infection which is important as conventional Brain MRI often fails to identify disease correlates. 3-dimensional voxel-based morphometry (3D VBM) analyzes, segments and quantifies key brain volumes allowing comparisons between COVID-19 "long haulers" and normative data drawn from healthy controls, with values based on percentages of intracranial volume. METHODS: This is a retrospective single center study which analyzed 24 consecutive COVID-19 infected patients with long term neurologic symptoms. Each patient underwent Brain MRI with 3D VBM at median time of 85 days following laboratory confirmation. All patients had relatively mild respiratory symptoms not requiring oxygen supplementation, hospitalization, or assisted ventilation. 3D VBM was obtained for whole brain and forebrain parenchyma, cortical grey matter (CGM), hippocampus, and thalamus. RESULTS: The results demonstrate a statistically significant depletion of CGM volume in 24 COVID-19 infected patients. Reduced CGM volume likely influences their long term neurological sequelae and may impair post COVID-19 patient's quality of life and productivity. CONCLUSION: This study contributes to understanding effects of COVID-19 infection on patient's neurocognitive and neurological function, with potential for producing serious long term personal and economic consequences, and ongoing challenges to public health systems.

Hyperbaric oxygen therapy to treat lingering COVID-19 symptoms.

Background: SARs-Cov-2 infections can produce prolonged illness and significant disability. Patients recovering from COVID-19 can have persistent symptoms leading to long-term morbidity. Methods: Six patients with long-lasting (> 30 days) COVID-19 symptoms were treated with hyperbaric oxygen (HBO2) therapy. All patients were assessed for symptoms using the ImPACT questionnaire, a muscle and joint pain scale, and a modified Borg dyspnea scale. Patients were assessed before, during and after HBO2 treatments. Results: All patients saw improvements in the measured symptoms to levels that were the same as pre-infection levels (five of six patients) or had significant improvement in symptoms (one patient). Conclusion: The results suggest that HBO2 helped to improve symptom scores, reduce the length of time of symptoms, and improved the quality of life. More detailed and randomized studies are needed to confirm the results in this report.

Resilience resources and coping strategies of COVID-19 female long haulers: A qualitative study.

Background: Female long haulers deal with persistent post-acute COVID-19 symptoms that have serious health implications. This study aimed to identify resilience resources at multiple socio-ecological levels for female long haulers and describe how resilience resources affect their responses to long COVID. Methods: Purposive sampling was adopted to recruit participants through social media from April to June 2021 followed by 15 semi-structured interviews. An inductive analytical approach was adopted to categorize themes by open and axial coding that were verified by peer review. Results: Female long haulers relied on resources at various socio-ecological levels to foster their resilience in response to long COVID. At the individual level, they utilized cognitive and emotional resources to increase knowledge, learn new skills, set goals, and manage emotions; behavioral resources (e.g., internal motivation and executive functioning) to perform physical, creative, and recreational activities, and adopt healthier eating habits; and spiritual resources to perform spiritual rituals and connect with God. At the social level, the support from existing relationships and/or online social support groups enhanced their social identity and provided material and informational resources. At the health systems level, the guidance from counselors and physicians and availability of clinics, medicines, and health equipment assisted them in symptom management and medication adherence. Conclusion: The resilience of female long haulers can be enhanced through (1) offering financial and health-related resources, (2) developing online social-support groups, (3) counseling and care service training for healthcare professionals, and (4) implementing more psychosocial interventions by labor organizations.

Long-term Consequences of COVID-19 and the Pandemic: Protocol for a Web-Based, Longitudinal Observational Study (DEFEAT).

BACKGROUND: With population-wide vaccination availability, the global COVID-19 pandemic entered a new phase. Despite vaccination status, some people who were infected with SARS-CoV-2 experience long-term symptoms. OBJECTIVE: In this study, we aim to characterize the long-term effects of SARS-CoV-2 infection and the pandemic. We also aim to build symptom clusters and determine risk factors for developing long COVID symptoms. Furthermore, we assess social participation and health-related quality of life in patients with long COVID and in the general population during a global pandemic. METHODS: With a mixed-methods, web-based approach, we aim to recruit 2000 people in Germany who are older than 18 years and can provide informed consent. In the quantitative arm of the study, we identify symptoms of and predictive factors for long COVID manifestations with cluster analysis and assess social participation during the pandemic with standardized questionnaires. The qualitative arm of the study uses individual interviews and focus group discussions to better understand the illness experience of persons who experience long COVID. RESULTS: Recruitment started in September 2021. Up until July 2022, we recruited approximately 4500 participants via our web-based database. CONCLUSIONS: This study aims to build an innovative, patient-centered, web-based research platform appropriate for the pandemic by minimizing physical contact between study personnel and participants. All study activities are designed to better understand the long COVID syndrome, social participation during the pandemic, and the illness experiences of persons affected by long COVID. TRIAL REGISTRATION: German Clinical Trial Registry DRKS00026007; https://tinyurl.com/yh282fkt. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38718.

Rehabilitation in long COVID-19: A mini-review.

We have been experiencing multiple waves of the coronavirus disease 2019 (COVID-19) pandemic. With these unprecedented waves, we have entered into an era of 'new normal'. This pandemic has enforced us to rethink the very basics of childhood learning: Habits, health etiquette, and hygiene. Rehabilitation has immense importance during this pandemic considering a few aspects. Multidisciplinary COVID-19 rehabilitation clinics are essential to address the demand. The equitable distribution of COVID-19 rehabilitation services for differently-abled individuals during the pandemic is an important aspect. Rehabilitation needs identification and further studies on various rehabilitation interventions are among the key unmet future research needs.

A New Look on Long-COVID Effects: The Functional Brain Fog Syndrome.

Epidemiological data and etiopathogenesis of brain fog are very heterogeneous in the literature, preventing adequate diagnosis and treatment. Our study aimed to explore the relationship between brain fog, neuropsychiatric and cognitive symptoms in the general population. A sample of 441 subjects underwent a web-based survey, including the PANAS, the DASS-21, the IES-R, the Beck Cognitive Insight Scale, and a questionnaire investigating demographic information, brain fog, subjective cognitive impairments (Scc) and sleep disorders. ANOVA, ANCOVA, correlation and multiple stepwise regression analyses were performed. In our sample, 33% of participants were defined as Healthy Subjects (HS; no brain fog, no Scc), 27% as Probable Brain Fog (PBF; brain fog or Scc), and 40% as Functional Brain Fog (FBF; brain fog plus Scc). PBF and FBF showed higher levels of neuropsychiatric symptoms than HS, and FBF showed the worst psychological outcome. Moreover, worse cognitive symptoms were related to the female gender, greater neuropsychiatric symptoms, sleep disorders, and rumination/indecision. Being a woman and more severe neuropsychiatric symptoms were predictors of FBF severity. Our data pointed out a high prevalence and various levels of severity and impairments of brain fog, suggesting a classificatory proposal and a multifaceted etiopathogenic model, thus facilitating adequate diagnostic and therapeutic approaches.

Plasma biomarkers for systemic inflammation in COVID-19 survivors.

BACKGROUND: While the majority of COVID-19 patients fully recover from the infection and become asymptomatic, a significant proportion of COVID-19 survivors experience a broad spectrum of symptoms lasting weeks to months post-infection, a phenomenon termed "post-acute sequelae of COVID-19 (PASC)." The aim of this study is to determine whether inflammatory proteins are dysregulated and can serve as potential biomarkers for systemic inflammation in COVID-19 survivors. METHODS: We determined the levels of inflammatory proteins in plasma from 22 coronavirus disease 2019 (COVID-19) long haulers (COV-LH), 22 COVID-19 asymptomatic survivors (COV-AS), and 22 healthy subjects (HS) using an Olink proteomics assay and assessed the results by a beads-based multiplex immunoassay. RESULTS: Compared to HS, we found that COVID-19 survivors still exhibited systemic inflammation, as evidenced by significant changes in the levels of multiple inflammatory proteins in plasma from both COV-LH and COV-AS. CXCL10 was the only protein that significantly upregulated in COV-LH compared with COV-AS and HS. CONCLUSIONS: Our results indicate that several inflammatory proteins remain aberrantly dysregulated in COVID-19 survivors and CXCL10 might serve as a potential biomarker to typify COV-LH. Further characterization of these signature inflammatory molecules might improve the understanding of the long-term impacts of COVID-19 and provide new targets for the diagnosis and treatment of COVID-19 survivors with PASC.

A Preliminary Survey of the Postacute Symptoms of COVID-19 among Hospital-Discharged Patients and a Proposed Quantitative Framework for Assessment

Background Following a massive outbreak of the coronavirus disease 2019 (COVID-19) pandemic, a significant number of survivors are still suffering from residual symptoms and complications. We designed a preliminary study to evaluate such symptom spectra in COVID-19 patients who had been discharged from the hospital. Methods A telephone interview was conducted with 100-randomly chosen hospital-discharged COVID-19 survivors from the electronic patient record. The interview structure and method were developed by a panel of experts. A specially trained group conducted the interviews and data collection. The statistical analysis was performed in accordance with the data type (continuous and categorical). Group comparisons were also done between intensive care unit (ICU) versus general ward admission, and patients discharged between 3 and 12 weeks versus more than 12 weeks. Additionally, world clouds were used for better visualization of various prevalent symptoms. Results Eighty-two participants were finally included for interview after preliminary screening. Fifty-three patients (64.6%) were male participants;74.4% had at least one symptom. In general, fatigue, cough, insomnia, and shortness of breath were the most common persistent symptoms. Symptoms were more prevalent among the patients discharged from ICU compared with those discharged from the general ward. Cough, loss of appetite, depression, and incoherence were more common in patients after 12 weeks of hospital discharge. Conclusion There is a wide range of persistent symptoms in the COVID-19 survivors who have been discharged from the hospital. Some symptoms arise or persisted even after 12 weeks. Based on the study results, available literature, and expert consensus, an assessment form has been developed that could be used for further research and clinical assessment of similar problems. Large-scale epidemiological study (longitudinal and cross-sectional) is needed to understand the nature and prevalence of the postacute phase of COVID-19 at the country level. The results of this study could inform the stakeholders and policymakers for taking necessary steps toward a further decision.

Social Life of Females with Persistent COVID-19 Symptoms: A Qualitative Study.

Persistent COVID-19 symptoms (long COVID) may bring challenges to long haulers' social lives. Females may endure more profound impacts given their special social roles and existing structural inequality. This study explores the effects of long COVID on the social life of female long haulers. We conducted semi-structured interviews via Zoom between April and June 2021 with 15 female long haulers in the United States, purposely recruited from Facebook and Slack groups and organization websites related to long COVID. Interviews were audio-recorded and transcribed verbatim with consent. The interview data were managed using MAXQDA and examined by thematic analysis. Long COVID negatively affected female long haulers' social lives by causing physical limitations, economic issues, altered social relationships, social roles' conflicts, and social stigma. Long COVID prevented female long haulers' recovery process. Physical limitations altered their perceptions on body, and family-work conflicts caused tremendous stress. They also experienced internalized stigma and job insecurities. This study provides insights into challenges that COVID-19 female long haulers could face in their return to normal social life, underscoring the vulnerability of females affected by long COVID due to significant alterations in their social lives. Shifting to new methods of communication, especially social media, diminished the adverse effects of long COVID (e.g., social isolation).