Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 52
Filter
1.
Ann Neurol ; 91(3): 367-379, 2022 03.
Article in English | MEDLINE | ID: covidwho-1636023

ABSTRACT

OBJECTIVE: The purpose of this study was to describe cerebrovascular, neuropathic, and autonomic features of post-acute sequelae of coronavirus disease 2019 ((COVID-19) PASC). METHODS: This retrospective study evaluated consecutive patients with chronic fatigue, brain fog, and orthostatic intolerance consistent with PASC. Controls included patients with postural tachycardia syndrome (POTS) and healthy participants. Analyzed data included surveys and autonomic (Valsalva maneuver, deep breathing, sudomotor, and tilt tests), cerebrovascular (cerebral blood flow velocity [CBFv] monitoring in middle cerebral artery), respiratory (capnography monitoring), and neuropathic (skin biopsies for assessment of small fiber neuropathy) testing and inflammatory/autoimmune markers. RESULTS: Nine patients with PASC were evaluated 0.8 ± 0.3 years after a mild COVID-19 infection, and were treated as home observations. Autonomic, pain, brain fog, fatigue, and dyspnea surveys were abnormal in PASC and POTS (n = 10), compared with controls (n = 15). Tilt table test reproduced the majority of PASC symptoms. Orthostatic CBFv declined in PASC (-20.0 ± 13.4%) and POTS (-20.3 ± 15.1%), compared with controls (-3.0 ± 7.5%, p = 0.001) and was independent of end-tidal carbon dioxide in PASC, but caused by hyperventilation in POTS. Reduced orthostatic CBFv in PASC included both subjects without (n = 6) and with (n = 3) orthostatic tachycardia. Dysautonomia was frequent (100% in both PASC and POTS) but was milder in PASC (p = 0.002). PASC and POTS cohorts diverged in frequency of small fiber neuropathy (89% vs 60%) but not in inflammatory markers (67% vs 70%). Supine and orthostatic hypocapnia was observed in PASC. INTERPRETATION: PASC following mild COVID-19 infection is associated with multisystem involvement including: (1) cerebrovascular dysregulation with persistent cerebral arteriolar vasoconstriction; (2) small fiber neuropathy and related dysautonomia; (3) respiratory dysregulation; and (4) chronic inflammation. ANN NEUROL 2022;91:367-379.


Subject(s)
Blood Pressure/physiology , COVID-19/complications , Cerebrovascular Circulation/physiology , Heart Rate/physiology , Inflammation Mediators/blood , Adult , COVID-19/blood , COVID-19/diagnosis , COVID-19/physiopathology , Fatigue/blood , Fatigue/diagnosis , Fatigue/physiopathology , Female , Humans , Male , Middle Aged , Orthostatic Intolerance/blood , Orthostatic Intolerance/diagnosis , Orthostatic Intolerance/physiopathology , Retrospective Studies
3.
Eur J Phys Rehabil Med ; 57(4): 653-662, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1406909

ABSTRACT

BACKGROUND: Although there are some retrospective studies to present musculoskeletal findings of the COVID-19, still the muscle strength and fatigue has not been studied in detail. AIM: To reveal the symptoms of musculoskeletal system in COVID-19 patients, to evaluate myalgia, arthralgia and physical/mental fatigue, to assess handgrip muscle strength, and to examine the relations of these parameters with the severity and laboratory values of the disease. DESIGN: This study was designed as a cross-sectional, single-center case series. SETTING: This study took place from May 15, 2020, to June 30, 2020 at the Istanbul University-Cerrahpasa, Cerrahpasa Pandemia Services. POPULATION: Hospitalized 150 adults with laboratory and radiological confirmation of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) according to WHO interim guidance were included in the study. METHODS: The disease severity 2007 IDSA/ATS guidelines for community acquired pneumonia was used. Myalgia severity was assessed by numerical rating scale (NRS). Visual analog scale and Chalder Fatigue Scale (CFS) were used for fatigue severity determination. Handgrip strength (HGS) was measured by Jamar hand dynamometer. RESULTS: One hundred three patients (68.7%) were non-severe, and 47 patients (31.3%) were severe. The most common musculoskeletal symptom was fatigue (133 [85.3%]), followed by myalgia (102 [68.0%]), arthralgia (65 [43.3%]) and back pain (33 [22.0%]). Arthralgia, which was mostly notable at wrist (25 [16.7%]), ankle (24 [16.0%]) and knee (23 [15.3%]) joints, was significantly higher among the severe group. Severe myalgia was prevalent among myalgia sufferers regardless of COVID-19 severity. The physical fatigue severity score was significantly higher in severe cases, whereas this difference was not significant in mental fatigue score. Female patients with severe infection had "lower" grip strength, whereas grip strength among males did not differ significantly between non-severe and severe COVID-19 cases. Nevertheless, the mean values in both genders and in age decades were below the specified normative values. CRP, ferritin, and LDH levels were significantly higher in women with "lower" grip strength compared to the "normal" group. CONCLUSIONS: Aside from other multisystemic symptoms, musculoskeletal symptoms are quite common in patients with COVID-19. Patients have severe ischemic myalgia regardless of disease activity. Although there is a muscle weakness in all patients, the loss of muscle function is more of a problem among women in connection with disease severity. Muscular involvement in Coronavirus disease is a triangle of myalgia, physical fatigue, and muscle weakness. CLINICAL REHABILITATION IMPACT: Muscle involvement in COVID-19 patients does not mean only myalgia but also a combination of physical fatigue and muscle weakness, and this should be considered in planning the rehabilitation strategies of COVID-19 patients.


Subject(s)
COVID-19/complications , Fatigue/physiopathology , Hand Strength/physiology , Muscle Weakness/physiopathology , Musculoskeletal Pain/physiopathology , Adult , Aged , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
4.
Am Heart J ; 241: 83-86, 2021 11.
Article in English | MEDLINE | ID: covidwho-1384824

ABSTRACT

SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.


Subject(s)
Aftercare , COVID-19/physiopathology , Heart Diseases/diagnosis , Referral and Consultation , Adolescent , Ambulatory Care , Atrioventricular Block/diagnosis , Atrioventricular Block/etiology , Atrioventricular Block/physiopathology , Bradycardia/diagnosis , Bradycardia/etiology , Bradycardia/physiopathology , COVID-19/complications , Cardiology , Chest Pain/physiopathology , Child , Child, Preschool , Dyspnea/physiopathology , Echocardiography , Electrocardiography , Fatigue/physiopathology , Female , Heart Diseases/etiology , Heart Diseases/physiopathology , Humans , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Right Ventricular/diagnosis , Hypertrophy, Right Ventricular/etiology , Hypertrophy, Right Ventricular/physiopathology , Implementation Science , Male , Pediatrics , Practice Guidelines as Topic , SARS-CoV-2 , Severity of Illness Index , Syncope/physiopathology , Ventricular Premature Complexes/diagnosis , Ventricular Premature Complexes/etiology , Ventricular Premature Complexes/physiopathology , Young Adult
5.
PLoS One ; 16(7): e0254999, 2021.
Article in English | MEDLINE | ID: covidwho-1325438

ABSTRACT

Over the past few months, the spread of the current COVID-19 epidemic has caused tremendous damage worldwide, and unstable many countries economically. Detailed scientific analysis of this event is currently underway to come. However, it is very important to have the right facts and figures to take all possible actions that are needed to avoid COVID-19. In the practice and application of big data sciences, it is always of interest to provide the best description of the data under consideration. The recent studies have shown the potential of statistical distributions in modeling data in applied sciences, especially in medical science. In this article, we continue to carry this area of research, and introduce a new statistical model called the arcsine modified Weibull distribution. The proposed model is introduced using the modified Weibull distribution with the arcsine-X approach which is based on the trigonometric strategy. The maximum likelihood estimators of the parameters of the new model are obtained and the performance these estimators are assessed by conducting a Monte Carlo simulation study. Finally, the effectiveness and utility of the arcsine modified Weibull distribution are demonstrated by modeling COVID-19 patients data. The data set represents the survival times of fifty-three patients taken from a hospital in China. The practical application shows that the proposed model out-classed the competitive models and can be chosen as a good candidate distribution for modeling COVID-19, and other related data sets.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Models, Statistical , Pandemics , SARS-CoV-2/pathogenicity , COVID-19/diagnosis , COVID-19/physiopathology , China/epidemiology , Cough/diagnosis , Cough/physiopathology , Fatigue/diagnosis , Fatigue/physiopathology , Fever/diagnosis , Fever/physiopathology , Hospitals , Humans , Monte Carlo Method , Survival Analysis
7.
Ann Am Thorac Soc ; 18(6): 997-1003, 2021 06.
Article in English | MEDLINE | ID: covidwho-1256079

ABSTRACT

Rationale: Much is known about the acute infective process of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus of the coronavirus disease (COVID-19) pandemic. The marked inflammatory response and coagulopathic state in acute SARS-CoV-2 infection may promote pulmonary fibrosis. However, little is known about the incidence and seriousness of post-COVID-19 pulmonary pathology. Objectives: To describe the respiratory recovery and self-reported health after infection at the time of outpatient attendance. Methods: Infection severity was graded into three groups: 1) not requiring admission, 2) requiring hospital admission, and 3) requiring intensive care unit care. Participants underwent chest radiography and a 6-minute walk test (6MWT). Fatigue and subjective return to health were assessed, and concentrations of CRP (C-reactive protein), IL-6 (interleukin-6), sCD25 (soluble CD25), and D-dimer were measured. The associations between initial illness and abnormal chest X-ray findings, 6MWT distance, and perception of maximal exertion were investigated. Results: A total of 487 patients were offered an outpatient appointment, of whom 153 (31%) attended for assessment at a median of 75 days after diagnosis. A total of 74 (48%) had required hospital admission during acute infection. Persistently abnormal chest X-ray findings were seen in 4%. The median 6MWT distance covered was 460 m. A reduced distance covered was associated with frailty and length of inpatient stay. A total of 95 (62%) patients believed that they had not returned to full health, whereas 47% met the case definition for fatigue. Ongoing ill health and fatigue were associated with an increased perception of exertion. None of the measures of persistent respiratory disease were associated with initial disease severity. Conclusions: This study highlights the rates of objective respiratory disease and subjective respiratory symptoms after COVID-19 and the complex multifactorial nature of post-COVID-19 ill health.


Subject(s)
COVID-19/complications , Fatigue/physiopathology , Frailty/physiopathology , Lung/physiopathology , Recovery of Function , Adult , Aged , Ambulatory Care , COVID-19/diagnostic imaging , COVID-19/physiopathology , Dyspnea/physiopathology , Female , Health Status , Hospitalization , Humans , Intensive Care Units , Length of Stay/statistics & numerical data , Lung/diagnostic imaging , Male , Middle Aged , Physical Exertion , Radiography, Thoracic , SARS-CoV-2 , Severity of Illness Index , Walk Test
9.
Clin Neurophysiol ; 132(8): 1974-1981, 2021 08.
Article in English | MEDLINE | ID: covidwho-1237654

ABSTRACT

OBJECTIVE: To investigate the peripheral nerve and muscle function electrophysiologically in patients with persistent neuromuscular symptoms following Coronavirus disease 2019 (COVID-19). METHODS: Twenty consecutive patients from a Long-term COVID-19 Clinic referred to electrophysiological examination with the suspicion of mono- or polyneuropathy were included. Examinations were performed from 77 to 255 (median: 216) days after acute COVID-19. None of the patients had received treatment at the intensive care unit. Of these, 10 patients were not even hospitalized. Conventional nerve conduction studies (NCS) and quantitative electromyography (qEMG) findings from three muscles were compared with 20 age- and sex-matched healthy controls. RESULTS: qEMG showed myopathic changes in one or more muscles in 11 patients (55%). Motor unit potential duration was shorter in patients compared to healthy controls in biceps brachii (10.02 ± 0.28 vs 11.75 ± 0.21), vastus medialis (10.86 ± 0.37 vs 12.52 ± 0.19) and anterior tibial (11.76 ± 0.31 vs 13.26 ± 0.21) muscles. All patients with myopathic qEMG reported about physical fatigue and 8 patients about myalgia while 3 patients without myopathic changes complained about physical fatigue. CONCLUSIONS: Long-term COVID-19 does not cause large fibre neuropathy, but myopathic changes are seen. SIGNIFICANCE: Myopathy may be an important cause of physical fatigue in long-term COVID-19 even in non-hospitalized patients.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Fatigue/etiology , Fatigue/physiopathology , Muscular Diseases/etiology , Muscular Diseases/physiopathology , Adult , Aged , COVID-19/diagnosis , Electromyography/trends , Fatigue/diagnosis , Female , Humans , Male , Middle Aged , Muscular Diseases/diagnosis , Neural Conduction/physiology , Registries , Time Factors
10.
J Clin Psychiatry ; 82(3)2021 04 27.
Article in English | MEDLINE | ID: covidwho-1232621

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to an increased risk of psychiatric symptoms among frontline health care workers (FHCWs). In the current study, a novel "symptomics" approach was employed to examine the association between acute transdiagnostic symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) and burnout and work and relationship difficulties in FHCWs at an urban tertiary care hospital in New York City. METHODS: Symptoms of COVID-19-related PTSD (4-item PTSD Checklist-5), MDD (Patient Health Questionnaire-8), GAD (Generalized Anxiety Disorder-7), burnout (Single-Item Mini-Z Burnout Assessment), and functional difficulties (Brief Inventory of Psychosocial Functioning) were assessed. Relative importance analyses were conducted to identify PTSD, MDD, and GAD symptoms associated with burnout and functional difficulties. RESULTS: The total number of eligible participants included 6,026 presumed FHCWs, of which 3,360 (55.8%) completed the survey and 2,579 (76.8%) of whom endorsed directly treating patients with COVID-19 and provided sufficient responses to our outcome variables for analysis. Feeling tired/having little energy, being easily annoyed or irritable, and feeling nervous, anxious, or on edge were most strongly associated with burnout; feeling tired/having little energy accounted for the greatest amount of explained variance (> 15%). Negative expectations of oneself or the world, trouble concentrating, and feeling easily annoyed or irritable were most strongly associated with work difficulties; negative expectations of oneself or the world accounted for the greatest amount of explained variance (> 9%). Feeling easily annoyed or irritable, negative expectations about oneself or the world, and feeling bad about oneself were most strongly associated with relationship difficulties; feeling easily annoyed or irritable accounted for the greatest amount of explained variance (> 10%). CONCLUSIONS: Results of this study underscore the importance of a transdiagnostic, symptom-based approach when examining associations between acute psychopathology and burnout and functional difficulties in FHCWs. Further work is needed to determine if early interventions aimed at ameliorating specific psychiatric symptoms may help mitigate risk for peri- and posttraumatic burnout and functional difficulties in this population.


Subject(s)
Anxiety Disorders/physiopathology , Burnout, Professional/physiopathology , COVID-19/therapy , Depressive Disorder, Major/physiopathology , Fatigue/physiopathology , Irritable Mood/physiology , Personnel, Hospital , Stress Disorders, Post-Traumatic/physiopathology , Adult , Female , Hospitals, Urban , Humans , Male , Middle Aged , New York City , Tertiary Care Centers
11.
Chron Respir Dis ; 18: 14799731211015691, 2021.
Article in English | MEDLINE | ID: covidwho-1219161

ABSTRACT

Individuals with lasting symptoms of COVID-19 should be offered a comprehensive recovery programme. 30 individuals (mean[SD] age 58[16]) that completed a 6 week, twice supervised rehabilitation programme demonstrated statistically significant improvements in exercise capacity, respiratory symptoms, fatigue and cognition. Participants improved by 112 m on the Incremental Shuttle Walking Test and 544 seconds on the Endurance Shuttle Walking Test. There were no serious adverse events recorded, and there were no dropouts related to symptom worsening. COVID-19 rehabilitation appears feasible and significantly improves clinical outcomes.


Subject(s)
COVID-19/rehabilitation , Dyspnea/rehabilitation , Exercise Therapy/methods , Exercise Tolerance/physiology , Fatigue/rehabilitation , Walking/physiology , COVID-19/complications , COVID-19/epidemiology , Dyspnea/etiology , Dyspnea/physiopathology , Fatigue/etiology , Fatigue/physiopathology , Follow-Up Studies , Humans , Pandemics , Quality of Life , SARS-CoV-2 , Surveys and Questionnaires
12.
Biofactors ; 47(2): 232-241, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1178977

ABSTRACT

COVID-19 leads to severe respiratory problems, but also to long-COVID syndrome associated primarily with cognitive dysfunction and fatigue. Long-COVID syndrome symptoms, especially brain fog, are similar to those experienced by patients undertaking or following chemotherapy for cancer (chemofog or chemobrain), as well in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or mast cell activation syndrome (MCAS). The pathogenesis of brain fog in these illnesses is presently unknown but may involve neuroinflammation via mast cells stimulated by pathogenic and stress stimuli to release mediators that activate microglia and lead to inflammation in the hypothalamus. These processes could be mitigated by phytosomal formulation (in olive pomace oil) of the natural flavonoid luteolin.


Subject(s)
COVID-19/drug therapy , Cognitive Dysfunction/drug therapy , Fatigue/drug therapy , Luteolin/therapeutic use , Brain/drug effects , Brain/physiopathology , Brain/virology , COVID-19/complications , COVID-19/physiopathology , COVID-19/virology , Cognitive Dysfunction/complications , Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/virology , Cytokines/genetics , Fatigue/complications , Fatigue/physiopathology , Fatigue/virology , Humans , Mast Cells/drug effects , Mast Cells/virology , SARS-CoV-2/pathogenicity
13.
BMJ Open Respir Res ; 8(1)2021 03.
Article in English | MEDLINE | ID: covidwho-1140340

ABSTRACT

BACKGROUND: Descriptions of clinical characteristics of patients hospitalised withCOVID-19, their clinical course and short-term inpatient and outpatient outcomes in deprived urban populations in the UK are still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequelae of patients admitted to two large District General Hospitals across a large East London National Health Service Trust during the first wave of the pandemic. METHODS: A retrospective analysis was carried out on a cohort of 1946 patients with a clinical or laboratory diagnosis of COVID-19, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three respiratory units in the trust. RESULTS: Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow-up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 70% of survivors, with 39% of patients unable to return to work due to ongoing symptoms. CONCLUSIONS: Understanding the acute clinical features, course of illness and outcomes of COVID-19 will be crucial in understanding the effect of differences in risk, as well as the effectiveness of new interventions and vaccination between the successive waves of the pandemic.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Age Factors , Aged , Aged, 80 and over , Alopecia/physiopathology , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Cohort Studies , Cough/physiopathology , Dyspnea/physiopathology , Fatigue/physiopathology , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , London/epidemiology , Male , Memory Disorders/physiopathology , Middle Aged , Multivariate Analysis , Noninvasive Ventilation/statistics & numerical data , Proportional Hazards Models , Retrospective Studies , Return to Work , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Sex Factors
14.
Phys Ther ; 101(6)2021 06 01.
Article in English | MEDLINE | ID: covidwho-1140007

ABSTRACT

OBJECTIVE: The aim of this pilot study was to assess physical fitness and its relationship with functional dyspnea in survivors of COVID-19 6 months after their discharge from the hospital. METHODS: Data collected routinely from people referred for cardiopulmonary exercise testing (CPET) following hospitalization for COVID-19 were retrospectively analyzed. Persistent dyspnea was assessed using the modified Medical Research Council dyspnea scale. RESULTS: Twenty-three people with persistent symptoms were referred for CPET. Mean modified Medical Research Council dyspnea score was 1 (SD = 1) and was significantly associated with peak oxygen uptake (VO2peak; %) (rho = -0.49). At 6 months, those hospitalized in the general ward had a relatively preserved VO2peak (87% [SD = 20]), whereas those who had been in the intensive care unit had a moderately reduced VO2peak (77% [SD = 15]). Of note, the results of the CPET revealed that, in all individuals, respiratory equivalents were high, power-to-weight ratios were low, and those who had been in the intensive care unit had a relatively low ventilatory efficiency (mean VE/VCO2 slope = 34 [SD = 5]). Analysis of each individual showed that none had a breathing reserve <15% or 11 L/min, all had a normal exercise electrocardiogram, and 4 had a heart rate >90%. CONCLUSION: At 6 months, persistent dyspnea was associated with reduced physical fitness. This study offers initial insights into the mid-term physical fitness of people who required hospitalization for COVID-19. It also provides novel pathophysiological clues about the underlaying mechanism of the physical limitations associated with persistent dyspnea. Those with persistent dyspnea should be offered a tailored rehabilitation intervention, which should probably include muscle reconditioning, breathing retraining, and perhaps respiratory muscle training. IMPACT: This study is the first, to our knowledge, to show that a persistent breathing disorder (in addition to muscle deconditioning) can explain persistent symptoms 6 months after hospitalization for COVID-19 infection and suggests that a specific rehabilitation intervention is warranted.


Subject(s)
COVID-19/complications , Dyspnea/physiopathology , Fatigue/physiopathology , Oxygen Consumption/physiology , Physical Fitness/physiology , Dyspnea/virology , Exercise Test , Fatigue/virology , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics , Pilot Projects , Recovery of Function , Retrospective Studies , SARS-CoV-2
15.
Chron Respir Dis ; 18: 14799731211002240, 2021.
Article in English | MEDLINE | ID: covidwho-1138509

ABSTRACT

Knowledge on the sequelae of Coronavirus Disease 2019 (COVID-19) remains limited due to the relatively recent onset of this pathology. However, the literature on other types of coronavirus infections prior to COVID-19 reports that patients may experience persistent symptoms after discharge. To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID-19 infection. A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID-19 patients after discharge. Two independent researchers reviewed and analysed the available literature, and then extracted and assessed the quality of those articles. Of the 1,154 reports returned by the initial search nine articles were found, in which 1,816 patients were included in the data synthesis. In the pooled analysis, we found a prevalence of 0.52 (CI 0.38-0.66, p < 0.01, I 2 = 97%), 0.37 (CI 0.28-0.48, p < 0.01, I 2 = 93%), 0.16 (CI 0.10-0.23, p < 0.01, I 2 = 90%) and 0.14 (CI 0.06-0.24, p < 0.01, I 2 = 96%) for fatigue, dyspnoea, chest pain, and cough, respectively. Fatigue, dyspnoea, chest pain, and cough were the most prevalent respiratory symptoms found in 52%, 37%, 16% and 14% of patients between 3 weeks and 3 months, after discharge in survivors of hospital admission by COVID-19, respectively.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Chest Pain/epidemiology , Cough/epidemiology , Dyspnea/epidemiology , Fatigue/epidemiology , COVID-19/epidemiology , Chest Pain/physiopathology , Cough/physiopathology , Dyspnea/physiopathology , Fatigue/physiopathology , Humans , Prevalence , SARS-CoV-2 , Survivors
16.
Clin Neurophysiol ; 132(5): 1138-1143, 2021 05.
Article in English | MEDLINE | ID: covidwho-1128943

ABSTRACT

OBJECTIVE: A high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations. METHODS: Twelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABAA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABAB receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level. RESULTS: Post-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished. CONCLUSIONS: The present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome. SIGNIFICANCE: TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.


Subject(s)
COVID-19/physiopathology , Cognitive Dysfunction/physiopathology , Fatigue/physiopathology , GABAergic Neurons/physiology , Motor Cortex/physiopathology , Transcranial Magnetic Stimulation/methods , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Cognitive Dysfunction/etiology , Cognitive Dysfunction/therapy , Fatigue/etiology , Fatigue/therapy , Female , Humans , Male , Middle Aged
17.
Respir Physiol Neurobiol ; 288: 103644, 2021 06.
Article in English | MEDLINE | ID: covidwho-1121917

ABSTRACT

The purpose of this study was to examine the physiological mechanisms of persistent dyspnoea in COVID-19 survivors. Non-critical patients (n = 186) with varying degrees of COVID-19 severity reported persistent symptoms using a standardized questionnaire and underwent pulmonary function and 6-minute walk testing between 30 and 90 days following the onset of acute COVID-19 symptoms. Patients were divided into those with (n = 70) and without (n = 116) persistent dyspnoea. Patients with persistent dyspnoea had significantly lower FVC (p = 0.03), FEV1 (p = 0.04), DLCO (p = 0.01), 6-minute walk distance (% predicted, p = 0.03), and end-exercise oxygen saturation (p < 0.001), and higher Borg 0-10 ratings of dyspnoea and fatigue (both p < 0.001) compared to patients without persistent dyspnoea. We have shown that dyspnoea is a common persistent symptom across varying degrees of initial COVID-19 severity. Patients with persistent dyspnoea had greater restriction on spirometry, lower DLCO, reduced functional capacity, and increased exertional desaturation and symptoms. This suggests that there is a true physiological mechanism that may explain persistent dyspnoea after COVID-19.


Subject(s)
COVID-19/complications , Dyspnea/physiopathology , Exercise Tolerance , Fatigue/physiopathology , Pulmonary Gas Exchange , Spirometry , Adult , Aged , COVID-19/physiopathology , Chronic Disease , Dyspnea/blood , Female , Forced Expiratory Volume , Functional Status , Humans , Male , Middle Aged , Oxygen/blood , Respiratory Function Tests , SARS-CoV-2 , Severity of Illness Index , Survivors , Vital Capacity , Walk Test
18.
PLoS One ; 16(2): e0247280, 2021.
Article in English | MEDLINE | ID: covidwho-1102383

ABSTRACT

BACKGROUND: The long-term clinical and physiological consequences of COVID-19 infection remain unclear. While fatigue has emerged as a common symptom following infection, little is known about its links with autonomic dysfunction. SARS-CoV-2 is known to infect endothelial cells in acute infection, resulting in autonomic dysfunction. Here we set out to test the hypothesis that this results in persistent autonomic dysfunction and is associated with post-COVID fatigue in convalescent patients. METHODS: We recruited 20 fatigued and 20 non-fatigued post-COVID patients (median age 44.5 years, 36/40 (90%) female, median time to follow up 166.5 days). Fatigue was assessed using the Chalder Fatigue Scale. These underwent the Ewing's autonomic function test battery, including deep breathing, active standing, Valsalva manoeuvre and cold-pressor testing, with continuous electrocardiogram and blood pressure monitoring, as well as near-infrared spectroscopy-based cerebral oxygenation. 24-hour ambulatory blood pressure monitoring was also conducted, and patients completed the generalised anxiety disorder-7 questionnaire. We assessed between-group differences in autonomic function test results and used unadjusted and adjusted linear regression to investigate the relationship between fatigue, anxiety, and autonomic test results. RESULTS: We found no pathological differences between fatigued and non-fatigued patients on autonomic testing or on 24-hour blood pressure monitoring. Symptoms of orthostatic intolerance were reported by 70% of the fatigued cohort at the time of active standing, with no associated physiological abnormality detected. Fatigue was strongly associated with increased anxiety (p <0.001), with no patients having a pre-existing diagnosis of anxiety. CONCLUSIONS: These results demonstrate the significant burden of fatigue, symptoms of autonomic dysfunction and anxiety in the aftermath of COVID-19 infection, but reassuringly do not demonstrate pathological findings on autonomic testing.


Subject(s)
COVID-19/pathology , Anxiety/physiopathology , Autonomic Nervous System/pathology , Blood Pressure , COVID-19/physiopathology , COVID-19/psychology , Electrocardiography , Fatigue/physiopathology , Heart Rate , Humans , Middle Aged
19.
Can Respir J ; 2021: 6692409, 2021.
Article in English | MEDLINE | ID: covidwho-1093889

ABSTRACT

We aimed to investigate changes in pulmonary function and computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) during the recovery period. COVID-19 patients underwent symptom assessment, pulmonary function tests, and high-resolution chest CT 6 months after discharge from the hospital. Of the 54 patients enrolled, 31 and 23 were in the moderate and severe group, respectively. The main symptoms 6 months after discharge were fatigue and exertional dyspnea, experienced by 24.1% and 18.5% of patients, respectively, followed by smell and taste dysfunction (9.3%) and cough (5.6%). One patient dropped out of the pulmonary function tests. Of the remaining 54 patients, 41.5% had pulmonary dysfunction. Specifically, 7.5% presented with restrictive ventilatory dysfunction (forced vital capacity <80% of the predicted value), 18.9% presented with small airway dysfunction, and 32.1% presented with pulmonary diffusion impairment (diffusing capacity for carbon monoxide <80% of the predicted value). Of the 54 patients enrolled, six patients dropped out of the chest CT tests. Eleven of the remaining 48 patients presented with abnormal lung CT findings 6 months after discharge. Patients with residual lung lesions were more common in the severe group (52.6%) than in the moderate group (3.4%); a higher proportion of patients had involvement of both lungs (42.1% vs. 3.4%) in the severe group. The residual lung lesions were mainly ground-glass opacities (20.8%) and linear opacities (14.6%). Semiquantitative visual scoring of the CT findings revealed significantly higher scores in the left, right, and both lungs in the severe group than in the moderate group. COVID-19 patients 6 months after discharge mostly presented with fatigue and exertional dyspnea, and their pulmonary dysfunction was mostly characterized by pulmonary diffusion impairment. As revealed by chest CT, the severe group had a higher prevalence of residual lesions than the moderate group, and the residual lesions mostly manifested as ground-glass opacities and linear opacities.


Subject(s)
COVID-19/physiopathology , Dyspnea/physiopathology , Fatigue/physiopathology , Lung/physiopathology , Adult , Aged , COVID-19/diagnostic imaging , Cough/physiopathology , Female , Follow-Up Studies , Forced Expiratory Volume , Humans , Lung/diagnostic imaging , Male , Middle Aged , Olfaction Disorders/physiopathology , Peak Expiratory Flow Rate , Pulmonary Diffusing Capacity , Recovery of Function , Respiratory Function Tests , SARS-CoV-2 , Severity of Illness Index , Taste Disorders/physiopathology , Tomography, X-Ray Computed , Vital Capacity
20.
Rev Neurosci ; 32(3): 351-361, 2021 04 27.
Article in English | MEDLINE | ID: covidwho-1067453

ABSTRACT

The ongoing pandemic of Coronavirus disease 2019 (COVID-19) has infected more than 27 million confirmed cases and 8,90,000 deaths all around the world. Verity of viral infections can infect the nervous system; these viral infections can present a wide range of manifestation. The aim of the current study was to systematically review the COVID-19 associated central nervous system manifestations, mental and neurological symptoms. For that we conducted a comprehensive systematic literature review of four online databases, including Web of Science, PubMed, Scopus and Embase. All relevant articles that reported psychiatric/psychological symptoms or disorders in COVID-19 without considering time and language restrictions were assessed. All the study procedures were performed based on the PRISMA criteria. Due to the screening, 14 studies were included. The current study result indicated that, the pooled prevalence of CNS or mental associated disorders with 95% CI was 50.68% (6.68-93.88). The most prevalence symptoms were hyposmia/anosmia/olfactory dysfunction (number of study: 10) with 36.20% (14.99-60.51). Only one study reported numbness/paresthesia and dysphonia. Pooled prevalence of numbness/paresthesia and dysphonia was 5.83% (2.17-12.25) and 2.39% (10.75-14.22). The pooled prevalence of depression and anxiety was 3.52% (2.62-4.54) and 13.92% (9.44-19.08). Our findings demonstrate that COVID-19 has a certain relation with neurological symptoms. The hypsomia, anosmia or olfactory dysfunction was most frequent symptom. Other symptoms were headache or dizziness, dysgeusia or ageusia, dysphonia and fatigue. Depression, anxiety, and confusion were less frequent symptoms.


Subject(s)
Anosmia/epidemiology , Anxiety/epidemiology , COVID-19/physiopathology , Depression/epidemiology , Anosmia/physiopathology , Anxiety/psychology , COVID-19/psychology , Depression/psychology , Dysgeusia/epidemiology , Dysgeusia/physiopathology , Dysphonia/epidemiology , Dysphonia/physiopathology , Fatigue/epidemiology , Fatigue/physiopathology , Headache/epidemiology , Headache/physiopathology , Humans , Hypesthesia/epidemiology , Hypesthesia/physiopathology , Nervous System Diseases/epidemiology , Nervous System Diseases/physiopathology , Paresthesia/epidemiology , Paresthesia/physiopathology , Prevalence , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL