Health-related quality of life in long COVID-19 in context of symptom type

Aim: Coronavirus disease 2019 (COVID-19) is complex multisystem disease. After 4 weeks of persistent symptoms, it is termed as Long COVID-19. Long COVID-19 causes a decrease in health-related quality of life (HRQoL). In this study, it was aimed to determine which symptoms were associated with lower HRQoL in Long COVID-19 in this study. Material(s) and Method(s): This cross-sectional study was conducted in a tertiary research hospital. Patients who have positive RT-PCR results at least 28 days and at most 180 days ago were selected for the study. Online survey was applied to 266 patients who had positive PCR test results for COVID-19. The EuroQoL 5D-3L scale was used to measure the HRQoL as a dependent variable. Socio-demographic features and symptoms were assessed by the survey as independent variables. Due to heteroscedasticity, a robust standard error regression analysis was conducted to make inferences on the effects of persistent symptoms on HRQoL. Result(s): Of the total 266 participants, 163 were females (63.3%). The mean age was 41.2 +/- 11.8 years. One hundred forty-two patients (53.3%) did not report any ongoing symptom. Female gender and lower education level as socio-demographic variables, visual problems and myalgia as persistent symptoms were identified as risk factors for reduced HRQoL in Long COVID-19 patients. Discussion(s): Long COVID-19 patients experience lower levels of HRQoL, especially those with visual problems and/or myalgia. Interventions to raise the HRQoL of Long COVID-19 patients should first target visual problems and myalgia.Copyright © 2023, Derman Medical Publishing. All rights reserved.

A feasibility trial of a computerised Spatial Inattention Grasping Home-based Therapy (c-SIGHT) for spatial neglect post-stroke: Trial update

Introduction: Spatial neglect (SN) is a debilitating neuropsychological syndrome defined as a failure to respond to stimuli in the side of space opposite to the side of the brain injury. Despite the impact, there are currently no clinically effective rehabilitation methods. Computerised rehabilitation can increase enjoyment and feelings of independence (Morse et al.,2020), thus we developed computerised Spatial Inattention Grasping Home-based Therapy (c-SIGHT) which can remotely record adherence and facilitate self-administration. SIGHT, or visuomotor feedback training, or (grasping-to-lift and balance rods) has been shown to be effective in reducing SN (Rossit et al., 2019). Method(s): This research aims to investigate the feasibility of a randomized controlled trial using c-SIGHT vs. an attentional control, while also exploring experiences of self-administering the therapy at home. This is a two-arm, double-blinded feasibility study intends to recruit 46 stroke survivors with SN and allocate them using minimisation to self-administer c-SIGHT or an attentional control for 30 minutes, twice a day for 10 days at home. Participants complete a set of neuropsychological tests and questionnaires at three time points (baseline, post-training, one-month follow-up) and one semi-structured interview after using c-SIGHT. Primary outcomes are feasibility parameters (recruitment, blinding success, adherence, follow-up rates). Secondary outcomes are changes in neglect, cognition and activities of daily living. Result(s): Since May 2021, the study has opened up at five NHS sites in the East of England. Despite COVID-19 delays, 20 stroke survivors have been recruited, 11 completed baseline assessments, and four have completed the study. Conclusion(s): Other preliminary results (e.g., usability) will be presented.

Clinical experience with the alpha2A-adrenoceptor agonist, guanfacine, and N-acetylcysteine for the treatment of cognitive deficits in "Long-COVID19"

Background: Prolonged cognitive deficits ("brain fog") following COVID19 infection (long-COVID) are common and debilitating, yet there are currently no approved treatments. Cognitive impairment particularly targets the working memory and executive functions of the prefrontal cortex (PFC). The PFC has unusual neurotransmission and neuromodulation that render it vulnerable to stressors, and basic research has identified mechanisms that protect PFC connections. Based on the basic neuroscience data, we tried a combined open label treatment to bolster prefrontal function: the alpha2A-adrenoceptor agonist, guanfacine, which strengthens prefrontal connectivity, and the anti-oxidant, N- acetylcysteine (NAC), which protects mitochondria and reduces kynurenic acid blockade of NMDA receptors. Case report: Twelve patients with "brain fog" including difficulties in executive functions were treated with guanfacine (1mg, PO bedtime for the first month, increased to 2mg after 1 month, if well-tolerated) and 600 mg NAC daily. Guanfacine+NAC improved cognitive abilities in eight of the twelve patients;four patients discontinued therapy, two for unspecified reasons and two due to hypotension and/or dizziness, common side effects of guanfacine. Those who stayed on guanfacine+NAC reported improved working memory, concentration, and executive functions, including a resumption of normal workloads. One patient briefly stopped taking guanfacine due to a hypotensive episode and reported a return of cognitive deficits that abated with resumed guanfacine treatment. Conclusion(s): Although placebo-controlled trials will be needed to more rigorously demonstrate efficacy, as these agents have established safety, they may be immediately helpful in treating the large number of patients suffering from prolonged cognitive deficits following COVID19 infection.Copyright © 2022 The Author(s)

Perception of Fourth year MBBS students regarding online learning during Covid-19 pandemic

Aim: To assess the perception of fourth year MBBS students regarding online learning during Covid 19 pandemic. Study Design: Cross sectional survey. Setting(s): Department of Community Medicine, Lahore Medical and Dental College, Lahore. Duration of study: Four months, from April to July, 2022. Study population: All students registered in fourth year MBBS. Methodology: A structured questionnaire was used to collect data from 154 study participants. It consisting of two sections. The first part consisted of background information of study participants. The second portion assessed the perception of students regarding online education during Covid 19.The data was recorded and analyzed using SPSS version 21. Data were described in the form of frequencies and percentages and presented as tables. Result(s): Study participants included 51% females, 57%-day scholars and 83% who had done FSc. Around 62% did not find online learning effective, 73% had communication difficulties, 75% liked self-directed approach of online learning but 74% thought that it was difficult to collaborate with each other, 71% found time management easy, though it was difficult to ask questions and receiving answers (59%). Around 78% of students perceived lack of satisfaction compared with class room learning, 66% preferred face to face learning and 73% found online education less comprehensible than class room activities. Among students, 53% recognised online learning as enjoyable and 34% wanted it to be done regularly, as 32%students never experienced any difficulty during online sessions. The main issues faced in online activities were absence of internet connection (85%), poor computer skills (73%), electricity breakdown (85%) and lack of concentration (80%). Practical implication: The present study highlighted that majority of fourth year MBBS students preferred classroom learning in comparison with online sessions. In light of pandemic, online education has proven valuable in managing sudden crisis, which is why it was important to understand the student perception regarding online education during covid-19 at Lahore Medical and Dental College, Lahore. Conclusion(s): Compared with males, higher number of females complained of lack of internet access and having poor computer skills. Seminars and regular training must be undertaken by medical colleges for their staff and students to inculcate interest and highlight the importance of online education as one of the tools for learning. Online education must be made more interactive and student cantered to create interest and improve student concentration.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Pre-Existing and New-Onset Cognitive Impairment in Patients with COVID-19

Recently, many reports have been available related to neuropsychiatric complications in the course of COVID-19 infection, and its long-term consequences. Many of them are related to psychological factors, such as: isolation, change of existing habits, fear of getting sick and dying, fear of losing a job and fears related to the financial situation, which resulted in an increase in the occurrence of diseases and mental disorders such as adaptation and anxiety disorders, depression. t has been also reported that treatment in conditions of intensive care unit lead to high prevalence of psychiatric disorders like PTSD in discharged patients. In our own studies we observed that patients with new appearing psychiatric symptoms were mostly those, who were professionally active, but did not work remotely. The time the patients spent at home had a negative impact on their well-being, they generally felt worse, their family life suffered more frequently. The most common cognitive symptoms, which are reported embrace: problems with short- and longterm memory, lack of mental clarity, feeling eclipsed, lightheaded, poor concentration, mental fatigue. We also present here a series of post-acute COVID cases from the examined population and provide a concise comparison of observed symptomatology with previous reports.

Microvascular dysfunction and magnesium - impact in COVID times and further on

For decades, the macrovascular system was in the focus of diagnostic and therapeutic medicine. The relevance of microvascular pathology was widely underestimated but is revealed in a new break-through cardiological study. Increasing knowledge reveals the microvascular system as the essential target structure of chronic magnesium-depletion, mediating smoldering chronic disease processes. Microvascular dysfunction could be the common basis for the association of chronic magnesium deficiency and polytopic diseases of high-energy dependent organs: diabetic retinopathy, renal failure - diabetic and other -, microvascular = non-Alzheimer dementia, diastolic cardiac dysfunction (HFpEF - heart failure with preserved ejection fraction) - analog arterial hypertension - microvascular angina, atrial fibrillation but also diabetic foot and diabetic neuropathy. In early studies the actual COVID-19 pandemic is related to microvascular pathomechanisms. Following earlier results reporting better survival of intensive care patients with highly normal magnesium as well as epidemiological associations we recommended for all patients from the beginning of the COVID 19 epidemic high-dose magnesium supplementation 15 - 25 mmol (and zinc 20 mg, vitamin D 2,000 IE each/day). In the context of COVID-19, we can assume four constellations of possibly positive effects of this magnesium strategy: 1. Due to our own limited cohorts the most evident: Tolerance of immunization with Biontech/Pfizer COVID-19 vaccine was distinctly better in our cohort of over 412 vaccinations compared with published data. 2. Rare, but a few patients with more intense adverse reactions had low magnesium and/or abnormal microvascular results in pulse wave analysis. 3. COVID patients (also elderly) with documented high serum magnesium - and pre-supplemented - recovered well from the disease. 4. Two post-Corona, long-COVID patients with symptoms of fatigue, reduced mental concentration, and dizziness reacted well after repeated parenteral magnesium infusion. Whether SARS-Cov-2-antibody formation correlates with magnesium or zinc values is topic of running investigations. Systematic prospective investigations are warranted. But due to the circumstances - considering that there are no evidence-based alternatives - for healthy individuals, for persons at risk, for patients at risk of magnesium depletion as well as for COVID-19 vaccination candidates, optimizing of magnesium is justified (Global Mg COVID-19 project) - and in terms of other health concerns, the prevention of chronic microvascular disease entities also justifies supplementation. Personalized magnesium dosage in medical office should be oriented by practical serum Mg/Ca (mmol/mmol) target 0.4 - including calcium. This approach seems to us to be expedient and more successful didactically. (outpatient medicine: Mg/Ca in serum;intensive care: ionized magnesium).