Antioxidant/anti-inflammatory effect of Mg2+ in coronavirus disease 2019 (COVID-19).

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), characterised by high levels of inflammation and oxidative stress (OS). Oxidative stress induces oxidative damage to lipids, proteins, and DNA, causing tissue damage. Both inflammation and OS contribute to multi-organ failure in severe cases. Magnesium (Mg2+ ) regulates many processes, including antioxidant and anti-inflammatory responses, as well as the proper functioning of other micronutrients such as vitamin D. In addition, Mg2+ participates as a second signalling messenger in the activation of T cells. Therefore, Mg2+ deficiency can cause immunodeficiency, exaggerated acute inflammatory response, decreased antioxidant response, and OS. Supplementation with Mg2+ has an anti-inflammatory response by reducing the levels of nuclear factor kappa B (NF-κB), interleukin (IL) -6, and tumor necrosis factor alpha. Furthermore, Mg2+ supplementation improves mitochondrial function and increases the antioxidant glutathione (GSH) content, reducing OS. Therefore, Mg2+ supplementation is a potential way to reduce inflammation and OS, strengthening the immune system to manage COVID-19. This narrative review will address Mg2+ deficiency associated with a worse disease prognosis, Mg2+ supplementation as a potent antioxidant and anti-inflammatory therapy during and after COVID-19 disease, and suggest that randomised controlled trials are indicated.

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.

Post COVID-19 Syndrome Monitoring in Confirmed COVID-19 Patients with Telemedicine at Cipto Mangunkusumo Hospital.

BACKGROUND: The incidence of post-covid-19 syndrome is quite high and requires further monitoring after the patient is discharged from treatment. So we need a proper monitoring method and description of the Covid-19 syndrome in Indonesia.  Methods: This retrospective cohort study with total sampling method uses data from medical records and telemedicine observations of confirmed COVID-19 patients who received treatment in the Kiara room at Cipto Mangunkusumo. The data were then analyzed using chi-squared and multinomial logistic regression techniques. RESULTS: A total of 133 samples were used, including 44.4% male and 55.6% female, with an average age Standard Deviation (SD) of 40.36 (17.94). The severity levels of Covid-19 were mild (66.9%). The most common post-Covid-19 symptom manifestations was cough expressed at the first follow-up (first week after recovery) and second follow-up (the fourth week after recovery). Furthermore, the significant relationship between severity levels and post-Covid-19 symptomatic syndrome outcomes is the critical headache or vertigo symptoms with an RR of 8.70 (95% CI, 1.10-68.69,). In comparison, the telemedicine quality assessment was declared good, as shown by 98.7% of an examined sample. CONCLUSION: The most manifestation shown in the first and fourth week of follow-up is cough. Other symptoms tend to decrease in the second follow-up. The severity level associated with post-Covid-19 manifestations are severe-critical with headache or vertigo as a risk factor and mild with symptoms of headache or vertigo as a preventative. Meanwhile, the quality of telemedicine services was recognized as good by the majority of the sample.

Para and Post-COVID-19 CNS Acute Demyelinating Disorders in Children: A Case Series on Expanding the Spectrum of Clinical and Radiological Characteristics.

Viral infections can serve as a trigger for variable autoimmune, antibody-mediated demyelinating disorders. There is accumulating evidence that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, causing coronavirus disease 2019 (COVID-19) infection and responsible for the current worldwide pandemic, can lead to a cascade of immune-mediated brain and spinal cord demyelinating injuries. However, such observation in the pediatric age group was only reported in very few patients. Thus, the heterogeneous spectrum of this phenomenon in children is still unfolding. We are reporting a case series of five pediatric patients with a variety of acute central nervous system (CNS) demyelinating disorders in the context of acute or recent COVID-19 infection. A 16-year-old female with anti-myelin oligodendrocyte glycoprotein (MOG) disorder, an eight-year-old male with acute disseminated encephalomyelitis (ADEM), a 13-year-old female with neuromyelitis optica spectrum disorder (NMOSD), and two 14 and 13-year-old females with new-onset multiple sclerosis (MS) are reported, all of whom presented acutely following COVID-19 infection. We propose that para and post-infectious CNS demyelinating disorders can potentially follow acute COVID-19 infection in children. Considering SARS-CoV-2 testing as a part of diagnostic workup is possibly useful. Awareness of the presence of this phenomenon can help in the recognition and management of those patients.

Clinical and Laboratory Profile of Patients Visiting the Post-COVID-19 Clinic at a Tertiary Care Hospital: A Cross-Sectional Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) survivors may continue experiencing diverse symptoms. This study portrays the clinical and laboratory profile of patients with post-acute sequelae of COVID-19'(PASC) at a tertiary care hospital in India.  Methodology: This cross-sectional study enrolled patients visiting the post-COVID-19 clinic three weeks after their acute COVID-19 illness. Their clinical, serological, and radiological characteristics were collected and analyzed. RESULTS: Of the 259 participants (age: 48.02±15.27 years; 62.25% men), 168 had PASC manifestations. The most frequently reported symptoms were fatigue (n=71(42.26%)), breathlessness (n=38(22.61%)), and cough (n=35(20.83%)). Patients with PASC had higher body mass index (28.24±5.02 vs. 26.26±3.65; p=0.002), history of hypertension (52 (30.95%) vs. 17 (18.6%); p=0.039), uncontrolled systolic blood pressure (37 (22.03) vs. 14 (15.38); p=0.042), and persistent chest x-ray abnormalities (34 (20.23) vs. 10 (10.98); p=0.048). CONCLUSION: Fatigue, breathlessness, and cough are common PASC symptoms. Hypertension, obesity, and abnormal chest x-ray findings at follow-up are potential risk factors for developing PASC.

Post-COVID-19 Arthritis and Sacroiliitis: Natural History with Longitudinal Magnetic Resonance Imaging Study in Two Cases and Review of the Literature.

Severe acute respiratory coronavirus-2 syndrome (SARS-CoV-2) is a well-known pandemic infectious disease caused by an RNA virus belonging to the coronaviridae family. The most important involvement during the acute phase of infection concerns the respiratory tract and may be fatal. However, COVID-19 may become a systemic disease with a wide spectrum of manifestations. Herein, we report the natural history of sacroiliac inflammatory involvement in two females who developed COVID-19 infection with mild flu-like symptoms. After the infection they reported inflammatory back pain, with magnetic resonance imaging (MRI) studies showing typical aspects of sacroiliitis. Symptoms improved with NSAIDs therapy over the following months while MRI remained positive. A literature review was performed on this emerging topic. To our knowledge, this is the first MRI longitudinal study of post-COVID-19 sacroiliitis with almost one year of follow-up. Predisposing factors for the development of articular involvement are unclear but a long-lasting persistence of the virus, demonstrated by nasopharyngeal swab, may enhance the probability of altering the immune system in a favourable background.

Assessment and characterisation of post-COVID-19 manifestations.

BACKGROUND: Post-COVID-19 symptoms and diseases appeared on many survivors from COVID-19 which are similar to that of the post-severe acute respiratory syndrome (SARS) fatigue. Hence, the study aims to investigate and characterise the manifestations which appear after eradication of the coronavirus infection and its relation to disease severity. METHOD: About 287 survivors from COVID-19 were included in the study, each received a questionnaire divided into three main parts starting from subjects' demographic data, data about the COVID-19 status and other comorbidities of the subject, and finally data about post-COVID-19 manifestations. Response surface plots were produced to visualise the link between several factors. RESULTS: Only 10.8% of all subjects have no manifestation after recovery from the disease while a large percentage of subjects suffered from several symptoms and diseases. The most common symptom reported was fatigue (72.8%), more critical manifestations like stroke, renal failure, myocarditis and pulmonary fibrosis were reported by a few percent of the subjects. There was a relationship between the presence of other comorbidities and severity of the disease. Also, the severity of COVID-19 was related to the severity of post-COVID-19 manifestations. CONCLUSION: The post-COVID-19 manifestation is largely similar to the post-SARS syndrome. All subjects recovered from COVID-19 should undergo long-term monitoring for evaluation and treatment of symptoms and conditions that might be precipitated with the new coronavirus infection.