Post COVID-19 Syndrome ("Long COVID") and Diabetes: Challenges in Diagnosis and Management.

BACKGROUND AND AIMS: Post Covid-19 syndrome (PCS) is a major cause of morbidity. In this article we intend to review the association and consequences of PCS and diabetes. METHODS: We reviewed all studies on "Long Covid", "Post COVID-19 Syndrome" and diabetes in PubMed and Google Scholar. RESULTS: The symptoms of PCS can be due to organ dysfunction, effects of hospitalisation and drugs, or unrelated to these. Type 2 diabetes mellitus has a bidirectional relationship with COVID-19. Presence of diabetes also influences PCS via various pathophysiological mechanisms. COVID-19 can add to or exacerbate tachycardia, sarcopenia (and muscle fatigue), and microvascular dysfunction (and organ damage) in patients with diabetes. CONCLUSION: PCS in patients with diabetes could be detrimental in multiple ways. Strict control of diabetes and other comorbidities, supervised rehabilitation and physical exercise, and optimal nutrition could help in reducing and managing PCS.

Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study.

OBJECTIVES: To describe the prevalence, nature and risk factors for the main clinical sequelae in coronavirus disease 2019 (COVID-19) survivors who have been discharged from the hospital for more than 3 months. METHODS: This longitudinal study was based on a telephone follow-up survey of COVID-19 patients hospitalized and discharged from Renmin Hospital of Wuhan University, Wuhan, China before 1 March 2020. Demographic and clinical characteristics and self-reported clinical sequelae of the survivors were described and analysed. A cohort of volunteers who were free of COVID-19 and lived in the urban area of Wuhan during the outbreak were also selected as the comparison group. RESULTS: Among 538 survivors (293, 54.5% female), the median (interquartile range) age was 52.0 (41.0-62.0) years, and the time from discharge from hospital to first follow-up was 97.0 (95.0-102.0) days. Clinical sequelae were common, including general symptoms (n = 267, 49.6%), respiratory symptoms (n = 210, 39%), cardiovascular-related symptoms (n = 70, 13%), psychosocial symptoms (n = 122, 22.7%) and alopecia (n = 154, 28.6%). We found that physical decline/fatigue (p < 0.01), postactivity polypnoea (p= 0.04) and alopecia (p < 0.01) were more common in female than in male subjects. Dyspnoea during hospitalization was associated with subsequent physical decline/fatigue, postactivity polypnoea and resting heart rate increases but not specifically with alopecia. A history of asthma during hospitalization was associated with subsequent postactivity polypnoea sequela. A history of pulse ≥90 bpm during hospitalization was associated with resting heart rate increase in convalescence. The duration of virus shedding after COVID-19 onset and hospital length of stay were longer in survivors with physical decline/fatigue or postactivity polypnoea than in those without. CONCLUSIONS: Clinical sequelae during early COVID-19 convalescence were common; some of these sequelae might be related to gender, age and clinical characteristics during hospitalization.

The Impact of the Coronavirus Disease 2019 Outbreak on the Attendance of Patients with Surgical Complaints at a Tertiary Hospital Emergency Department.

Introduction: Emergency departments (EDs) during the novel coronavirus disease 2019 (COVID-19) pandemic are perceived as possible sources of infection. The effects of COVID-19 on patients presenting to the hospital with surgical complaints remain uncertain. Methods: A single tertiary center retrospective study analysis compared the ED attendance rate and severity of patients with surgical complaints between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2019 and 2018. Results: Overall, 6,017 patients were included. The mean daily ED visits of patients with nontrauma surgical complaints in the COVID-19 outbreak period declined by 27%-32% (P value <.01) compared with pre-COVID-19 periods. The log number of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in Israel in March 2020 was negatively correlated with the number of ED visits (Pearson's r = -0.59, P < .01). The proportion of patients requiring hospitalization increased by up to 8% during the outbreak period (P < .01), and there was a higher proportion of tachycardic patients (20% versus 15.5%, P = .01). The percentage of visits to the ED by men declined by 5% (P < .01). The ED diagnosis distribution significantly changed during COVID-19 (P = .013), with an 84% decrease in the number of patients hospitalized for diverticular disease (P < .05). Conclusion: During the COVID-19 outbreak, the overall number of patients presenting at the ED with surgical complaints decreased significantly, and there was a higher admissions ratio. The extent to which the pandemic affects hospital ED attendance can help health care professionals prepare for future such events. ClinicalTrials.gov ID: NCT04338672.