Enhancing EQ-5D-5L sensitivity in capturing the most common symptoms in post COVID-19 patients: an exploratory cross-sectional study with focus on fatigue, memory/concentration problems and dyspnea dimensions (preprint)

This study aimed to determine whether the EQ-5D-5L tool captures the most common persistent symptoms, such as fatigue, memory/concentration problems and dyspnea in patients with post COVID-19 conditions, and if adding these symptoms improves the explained variance of the health-related quality of life (HRQoL). In this exploratory cross-sectional study, two cohorts of Swedish patients (n=177) with a history of COVID-19 infection answeared a questionnaire covering sociodemographic characteristics, clinical factors and HRQoL assessed using EQ-5D-5L with the Visual Analogue Scale (EQ-VAS). Spearman rank correlation and multiple regression analyses were employed to investigate the extent to which the most common persistent symptoms such as fatigue, memory/concentration problems and dyspnea were explained by the EQ-5D-5L. The explanatory power of EQ-5D-5L for EQ-VAS was also analysed, both with and without inclusion of symptom(s). We found that the EQ-5D-5L dimensions partly captured fatigue and memory/concentration problems but performed poorly in capturing dyspnea. Specifically, the EQ-5D-5L explained 55% of the variance in memory/concentration problems, 47% in fatigue and only 14% in dyspnea. Adding fatigue to the EQ-5D-5L increased the explained variance of the EQ-VAS by 5.7%, while the addition of memory/concentration problems and dyspnea had a comparatively smaller impact on the explained variance. Our study highlights the EQ-5D-5L’s strength in capturing fatigue and memory/concentration problems in post COVID-19 patients. However, it also underscores the challenges in assessing dyspnea in this group. Fatigue emerged as a notably influential symptom, significantly enhancing the EQ-5D-5L's predictive ability to for the EQ-VAS score in these patients.

Effects of wearing a KF94 face mask on performance, perceptual, and physiological responses during a resistance exercise (preprint)

Wearing a face mask in indoor public places including fitness centers is an effective strategy to prevent the airborne transmission of COVID-19. However, only a few studies have been performed on wearing a mask during resistance exercise (RE) which is primarily performed in indoor fitness centers. This study aimed to investigate the effects of wearing a KF94 mask on exercise volume, perceptual parameters, and physiological responses during RE. Twenty young men participated in this randomized crossover trial. Participants performed moderate-intensity (1RM 60%) RE sessions in two different conditions (KF94 mask vs. no mask). Cardiorespiratory parameters, exercise volume, rating of perceived exertion (RPE), and dyspnea were measured during RE. Blood lactate concentration, blood pressure, arterial stiffness, and perceptual parameters were measured at pre-exercise and post-exercise. Exercise volume, ventilation volume, and ventilation efficiency parameters were lower with the KF94 mask than without the mask. However, RPE and dyspnea were higher with the KF94 mask than without the mask. Central arterial stiffness at post-exercise was higher with the KF94 mask than without the mask. Therefore, wearing a KF94 mask during RE affects exercise volume, perceptual parameters, and physiological responses, suggesting coaches need to modify RE manipulation variables while wearing a KF94 mask.

Interventions for the management of post COVID-19 condition (long COVID): Protocol for a living systematic review & network meta-analysis (preprint)

Background: Up to 15% of survivors of COVID-19 infection experience long-term health effects, including fatigue, myalgia, and impaired cognitive function, termed post COVID-19 condition or long COVID. Several trials that study the benefits and harms of various interventions to manage long COVID have been published and hundreds more are planned or are ongoing. Trustworthy systematic reviews that clarify the benefits and harms of interventions are critical to promote evidence-based practice. Objective To create and maintain a living systematic review and network meta-analysis addressing the benefits and harms of pharmacologic and non-pharmacologic interventions for the treatment and management of long COVID. Methods Eligible trials will randomize adults with long COVID, to pharmacologic or non-pharmacologic interventions, placebo, sham, or usual care. We will identify eligible studies by searches of MEDLINE, EMBASE, CINAHL, PsycInfo, AMED, and CENTRAL, from inception, without language restrictions. Reviewers will work independently and in duplicate to screen search records, collect data from eligible trials, including trial and patient characteristics and outcomes of interest, and assess risk of bias. Our outcomes of interest will include fatigue, pain, post-exertional malaise, changes in education or employment status, cognitive function, mental health, dyspnea, quality of life, patient-reported physical function, recovery, and serious adverse events. For each outcome, when possible, we will perform a frequentist random-effects network meta-analysis. When there are compelling reasons to suspect that certain interventions are only applicable or effective for a subtype of long COVID, we will perform separate network meta-analyses. The GRADE approach will guide our assessment of the certainty of evidence. We will update our living review biannually, upon the publication of a seminal trial, or when new evidence emerges that may change clinical practice. Conclusion This living systematic review and network meta-analysis will provide comprehensive, trustworthy, and up-to-date summaries of the evidence addressing the benefits and harms of interventions for the treatment and management of long COVID. We will make our findings available publicly and work with guideline producing organizations to inform their recommendations.

Changes in lung function and dyspnea perception in Colombian Covid-19 patients after a 12-week pulmonary rehabilitation program. (preprint)

BACKGROUND: Although moderate and severe COVID-19 patients have shown obstructive and restrictive disorders in pulmonary function after recovery from the disease, studies evaluating the effectiveness of rehabilitation programs that seek to improve lung function are scarce. AIM: Herein, we evaluate changes in lung function and perceived dyspnea in Covid-19 patients after undergoing 12 weeks of a PR program. DESIGN: Retrospective observational study SETTING: Cesar, Colombia Neumocesar Pneumological Center. POPULATION: 100 outpatients with a history of Covid-19 METHODS: We evaluated respiratory function using spirometry parameters, as well as the mMRC dyspnea scale for perceived dyspnea in 100 patients with a history of Covid-19. We used univariate and multivariate statistical approaches to assess changes in lung function and perceived dyspnea before and after a PR program to determine whether gender, age, height, weight, comorbidities, and oxygen delivery system affect the recovery of lung function and perceived dyspnea. RESULTS: We found that PR treatment has positive effects on respiratory pathologies caused by SARS-CoV-2 infection regardless of patient gender, indicating that rehabilitation provided benefits regardless of the physical characteristics of the patients. Both univariate and multivariate statistical analyses indicated that FVC, FEV1, FEF 25-75, and mMRC are robust diagnostic indicators of lung function recovery and perceived dyspnea. Both invasive and non-invasive positive pressure ventilatory support had deleterious effects on lung function prolongating patient recovery. CONCLUSIONS: Rehabilitation programs can benefit patients facing respiratory pathologies caused by SARS-CoV-2 infection. Additional research on the long-term effects of the sequelae of Covid-19 is needed. A large sample of patients is needed to clarify the effects of therapy on respiratory function. CLINICAL REHABILITATION IMPACT: PR programs have positive effects on patients facing respiratory pathologies caused by SARS-CoV-2 infection.

Accelerated brain age in young to early middle-aged adults after mild to moderate COVID-19 infection (preprint)

Cognitive decline is a common adverse effect of the Coronavirus Disease of 2019 (COVID-19), particularly in the post-acute disease phase. The mechanisms of cognitive impairment after COVID-19 (COGVID) remain unclear, but neuroimaging studies provide evidence of brain changes, many that are associated with aging. Therefore, we calculated Brain Age Gap (BAG), which is the difference between brain age and chronological age, in a cohort of 25 mild to moderate COVID-19 survivors (did not experience breathlessness, pneumonia, or respiratory/organ failure) and 24 non-infected controls (mean age = 30 +/- 8) using magnetic resonance imaging (MRI). BAG was significantly higher in the COVID-19 group (F = 4.22, p = 0.046) by 2.65 years. Additionally, 80% of the COVID-19 group demonstrated an accelerated BAG compared to 13% in the control group (X2 = 20.0, p < 0.001). Accelerated BAG was significantly correlated with lower cognitive function (p < 0.041). Females in the COVID-19 group demonstrated a 99% decreased risk of accelerated BAG compared to males (OR = 0.015, 95% CI: 0.001 to 0.300). There was also a small (1.4%) but significant decrease in risk for accelerated BAG associated with longer time since COVID-19 diagnosis (OR = 0.986, 95% CI: 0.977 to 0.995). Our findings provide a novel biomarker of COGVID and point to accelerated brain aging as a potential mechanism of this adverse effect. Our results also offer further insight regarding gender-related disparities in cognitive morbidity associated with COVID-19.

Slight recovery of brain metabolic impairment in patients with persistent long COVID: a nine-month follow-up [18F]FDG-PET study (preprint)

Purpose A hypometabolic profile involving the limbic areas, brainstem and cerebellum has been identified in long COVID patients via cerebral [18F]fluorodeoxyglucose (FDG)-PET. This study was conducted to evaluate possible recovery of brain metabolism during the follow-up of patients with prolonged symptoms.Methods Fifty-six adults with long COVID who underwent two brain [18F]FDG-PET scans in our department in May 2020–October 2022 were retrospectively analysed and compared to 51 healthy subjects. On average, PET1 was performed 7 (range 3–17) months after acute COVID-19 infection, and PET2 was performed 16 (range 8–32) months after acute infection. PET was performed because of persistent symptoms, including the following conditions: asthenia, cognitive complaints, dyspnoea, and sleep disorders. Whole-brain voxel-based analysis compared PET1 and PET2 from long COVID patients to scans from healthy subjects (p-voxel < 0.001 uncorrected, p-cluster < 0.05 FWE-corrected) and PET1 to PET2 (with the same threshold and with a less constrained threshold of p-voxel < 0.005 uncorrected, p-cluster < 0.05 uncorrected).Results PET1 and PET2 scans revealed hypometabolism in the previously reported profile. The between-group analysis comparing PET1 and PET2 showed minor improvements in the pons and cerebellum (8.4 and 5.2%, respectively, only significant under the less constrained uncorrected p-threshold); for the pons, the improvement was correlated with the PET1-PET2 interval (r = 0.21, p < 0.05). Of the 14,068 hypometabolic voxels identified on PET1, 6,503 were also hypometabolic on PET2 (46%). Of the 7,732 hypometabolic voxels identified on PET2, 6,094 were also hypometabolic on PET1 (78%).Conclusion Subjects with persistent symptoms of long COVID exhibit durable changes in brain metabolism, with only slight improvement 9 months later.

Molecular hydrogen for outpatients with Covid-19 (Hydro-Covid): a phase 3, randomised, triple-blinded, adaptive, placebo-controlled, multicentre trial (preprint)

Background: Due to its antioxidative, anti-inflammatory, anti-apoptosis, and antifatigue properties, molecular hydrogen (H2) is potentially a novel therapeutic gas for acute coronavirus disease 2019 (COVID-19) patients. Aim To determine the efficacy and safety profile of hydrogen rich water (HRW) to reduce the risk of progression of COVID-19. Design and settings We conducted a phase 3, triple-blind, randomized, placebo-controlled trial to evaluate treatment with HRW started within 5 days after the onset of signs or symptoms in primary care patients with mild-to-moderate, laboratory-confirmed COVID-19 and at least one risk factor for severe COVID-19 illness. Method Participants were randomly assigned to receive HRW or placebo twice daily for 21 days. The composite primary endpoint was the incidence of clinical worsening (dyspnea, fatigue) associated with a need for oxygen therapy, hospitalization or death at day-14; the incidence of adverse events was the primary safety end point. Results A total of 675 participants were followed up until day-30. 337 in the HRW group and 338 in the placebo group. Baseline characteristics were similar in the two groups. HRW was not superior to placebo in preventing clinical worsening at day-14: in H2 group, 46.1% met a clinical deterioration, 43.5% in the placebo group, Hazard Ratio 1.09, 90% confidence interval [0.90-1.31]. One death was reported in the H2 group and 2 in the placebo group at day-30. Adverse events were reported in 91 (27%) and 89 (26.2%) participants respectively. Conclusion Twice-daily ingestion of HRW from the onset of COVID-19 symptoms for 21 days did not reduce clinical worsening. Keywords: COVID-19; Molecular Hydrogen; Administration, Oral; Primary health care; Outcome Assessment;

Sustained mTOR inhibition with sirolimus improves respiratory outcomes in LAM patients with COVID-19 (preprint)

Background Lymphangioleiomyomatosis (LAM) is a rare lung disease that predominantly affects women and can lead to severe respiratory complications. The impact of COVID-19 on LAM patients, particularly regarding the use of mammalian target of rapamycin (mTOR) inhibitors, remains poorly understood. This study investigates the clinical outcomes of LAM patients with COVID-19 and evaluates the role of sustained mTOR inhibition in respiratory outcomes.Results Our cohort included 186 LAM patients with COVID-19. Prior to infection, 72.6% were on mTOR inhibitors, with 29.6% discontinuing therapy due to infection. The hospitalization rate was 1.1%, with no reported need for invasive ventilation or fatalities. Patients with FEV1 less than 70% predicted had a higher risk of dyspnea exacerbation and supplemental oxygen requirement. Continuation of mTOR inhibitor therapy was associated with a lower risk of SpO2 decline, especially among patients with impaired lung function. Vaccination status did not significantly affect the prognosis.Conclusions LAM patients with COVID-19 showed a low rate of severe illness and mortality, with impaired lung function correlating with worse respiratory outcomes. Continued mTOR inhibitor therapy during COVID-19 infection may improve respiratory outcomes, suggesting the importance of maintaining treatment during viral pandemics.

Exercise Intolerance in Long Covid After 24 Months From Severe Acute Disease: is There Room for Improvement? (preprint)

Introduction: Long COVID is a complex and multisystemic condition, where dyspnea, fatigue, post-exertional malaise, cognitive impairment, decreased functional capacity, and deterioration in quality of life are the most incident clinical features. Few studies have reported cardiopulmonary alterations 24 months after severe COVID-19 infection.  Objective: to evaluate the functional capacity of individuals with persistent symptoms after severe COVID-19 infection compared to control individuals without symptomatic COVID or mild COVID after 24 months.  Methods: This is a case-control study assessing 34 individuals divided into 2 groups (severe COVID-19 with long COVID and a control group consisting of asymptomatic/mild acute COVID-19 with no long COVID) regarding functional capacity by 6-minute walk test (6MWT) associated with gas analysis, spirometry, respiratory muscle strength and quality of life. Results: During the 6MWT, an important lower heart rate (HR) was observed for the COVID group, with greater exertional perception, a significant decrease in the distance covered, and a low value of O2 uptake (V̇O2) and minute ventilation, in addition to very low quality of life scores, especially in aspects of functional capacity and physical limitations.  Conclusion: individuals who have severe COVID-19 and persist with symptoms have low functional capacity, low V̇O2, low HR behavior, and low quality of life. 

Myocarditis and Pericarditis Following the COVID-19 Vaccination: A Single-Centre Case Seriese (preprint)

The Surveillance of rare adverse events following vaccination, particularly related to COVID-19 vaccines, requires thorough examination. This paper investigates vaccine-associated myocarditis and/or pericarditis (VAMPS), presenting insights into clinical manifestations, management, and outcomes. Conducted at the Prince Sultan Cardiac Center in Saudi Arabia from March 2021 to May 2022, this retrospective case series comprises 20 patients with an average age of 27.9 ± 14.0 years, predominantly males (70%). Pfizer-BioNTech, AstraZeneca, and Moderna vaccines were administered in 74%, 21%, and 5% of cases, respectively, with 53% receiving the second dose, 26% the booster, and 21% the initial dose. Common symptoms included shortness of breath (60%), chest pain (50%), palpitations (40%), premature ventricular contractions (35%), and fever (25%). Cardiac magnetic resonance imaging revealed preserved left ventricular function (80%), subepicardial and/or mid-wall late gadolinium enhancement (65%), and lateral (39%), anterolateral (15%), inferolateral (15%), and anteroseptal (15%) segments affected. Myocarditis, pericarditis, and myopericarditis were diagnosed in 40%, 20%, and 40% of cases, respectively. C-reactive protein was elevated in two-thirds of patients. Recovery was achieved with anti-inflammatory medications, primarily colchicine (72%), aspirin(39%), and ibuprofen (33%). While no fatalities occurred, 30% experienced severe complications, and 15% had minor complications. In conclusion, VAMPS exhibits distinct characteristics and may lead to serious complications. Cardiologists should consider VAMPS in the differential diagnosis for symptomatic patients recently vaccinated against COVID-19, emphasizing the importance of ongoing surveillance and understanding of rare adverse events.

Characteristics and Determinants of Pulmonary Long COVID (preprint)

RATIONALE: Persistent cough and dyspnea are prominent features of post-acute sequelae of SARS-CoV-2 (termed 'Long COVID'); however, physiologic measures and clinical features associated with these pulmonary symptoms remain poorly defined. OBJECTIVES: Using longitudinal pulmonary function testing (PFTs) and CT imaging, this study aimed to identify the characteristics and determinants of pulmonary Long COVID. METHODS: The University of Alabama at Birmingham Pulmonary Long COVID cohort was utilized to characterize lung defects in patients with persistent pulmonary symptoms after resolution primary COVID infection. Longitudinal PFTs including total lung capacity (TLC) and diffusion limitation of carbon monoxide (DLCO) were used to evaluate restriction and diffusion impairment over time in this cohort. Analysis of chest CT imaging was used to phenotype the pulmonary Long COVID pathology. Risk factors linked to development of pulmonary Long COVID were estimated using univariate and multivariate logistic regression models. MEASUREMENTS AND MAIN RESULTS: Longitudinal evaluation 929 patients with post-COVID pulmonary symptoms revealed diffusion impairment (DLCO ≤80%) and restriction (TLC ≤80%) in 51% of the cohort (n=479). In multivariable logistic regression analysis (adjusted odds ratio; aOR, 95% confidence interval [CI]), invasive mechanical ventilation during primary infection conferred the greatest increased odds of developing pulmonary Long COVID with diffusion impaired restriction (aOR=10.9 [4.09-28.6]). Finally, a sub-analysis of CT imaging identified evidence of fibrosis in this population. CONCLUSIONS: Persistent diffusion impaired restriction was identified as a key feature of pulmonary Long COVID. Subsequent clinical trials should leverage combined symptomatic and quantitative PFT measurements for more targeted enrollment of pulmonary Long COVID patients.

Can COVID-19 Lead to Differences in COPD Patients' Exacerbations and Clinical Evolution? (preprint)

Background COPD patients show higher mortality and worse prognosis in the acute phase of COVID-19, and survivors may suffer persistent symptoms that could make them more vulnerable to exacerbations.Objectives We aimed to evaluate the impact of COVID-19 on the exacerbations, symptoms, quality of life, and mental health of a cohort of COPD patients.Methods Retrospective case-control single-centre study including all COPD patients from the pulmonary consultation of University Hospital Santa Maria (Lleida, Spain) surviving COVID-19 between March 2020 and September 2021, and similar propensity-score-matched (1:2) COPD patients. Differences in COPD exacerbations, COPD clinical evolution (lung function, dyspnoea, CAT and symptoms), long COVID-19 symptoms, quality of life, and mental health, were assessed at the end of 2021.Results We included 39 COVID-19 COPD patients and 78 similar non-COVID-19. No differences were found on exacerbations (46(59%) vs 27(69.2%), p = 0.380), dyspnoea (2 [1; 3] vs 2 [1; 3], p = 0.921) CAT (14.5 [10.0; 18.8] vs 13.0 [10.0; 16.0], p = 0.432). Only the prevalence of smell or taste disorders, hair loss and tingling was higher in COVID-19 patients. No differences were found in quality of life or mental health.Conclusions COPD patients surviving COVID-19 were not at a higher risk of COPD exacerbations nor showed significant changes in COPD clinical evolution, and only showed differences in a few very specific COVID-19 symptoms. These unexpected results suggest that the conditions triggered by the pandemic and its management could have affected COPD patients as much as actually having had COVID-19.

COVID-related Constrictive Pericarditis Requiring Pericardiectomy: A Case Report (preprint)

Background The COVID-19 pandemic was primarily considered a respiratory malady in the early phases of the outbreak. However, as more patients suffer from this illness, a myriad of symptoms emerge in organ systems separate from the lungs. Among those patients with cardiac involvement, myocarditis, pericarditis, myocardial infarction, and arrhythmia were among the most common manifestations. Pericarditis with pericardial effusion requiring medical or interventional treatments has been previously reported in the acute setting. Notably, chronic pericarditis with pericardial thickening resulting in constriction requiring sternotomy and pericardiectomy has not been published to date.Case Presentation A patient with COVID-19-associated constrictive pericarditis three years after viral infection requiring pericardiectomy was reported. The COVID-19 infection originally manifested as anosmia and ageusia. Subsequently, the patient developed dyspnea, fatigue, right-sided chest pressure, bilateral leg edema, and abdominal fullness. Following recurrent right pleural effusions and a negative autoimmune work-up, the patient was referred for cardiothoracic surgery for pericardiectomy when radiographic imaging and hemodynamic assessment were consistent with constrictive pericarditis. Upon median sternotomy, the patient’s pericardium was measured to be 8 mm thick. Descriptions of the clinical, diagnostic, and therapeutic features are provided. Within the first week after the operation, the patient’s dyspnea resolved; one month later, leg edema and abdominal bloating were relieved.Conclusions Although an association between COVID-19 and cardiac complications has been established, this case adds another element of virus severity and chronic manifestations. The need for sternotomy and pericardiectomy to treat COVID-19-related constrictive pericarditis is believed to be the first reported diagnosis.

Treadmill Exercise Stress Echocardiography Exposes Impaired Left Ventricular Function in Patients Recovering from Hospitalization with COVID-19 Without Overt Myocarditis Versus Historical Controls (preprint)

Background: Usual clinical testing rarely reveals cardiac abnormalities persisting after hospitalization for COVID-19. Such testing may overlook residual changes responsible for increased adverse cardiac events post-discharge. Methods: To further elucidate long-term status, we performed exercise stress echocardiography (ESE) in 15 patients age 30-63 without myocarditis 3 to 31 months after hospital discharge. We compared patient outcomes to published data in healthy comparisons (HC) exercising according to the same protocol. Results: Patients' treadmill exercise (Bruce protocol), averaging 8.2 min, was halted by dyspnea or fatigue. Pre-stress baselines in recovering patients (RP) matched HC except for higher heart rate: mean 81 bpm for RP and 63 for HC (p<0.0001). At peak stress, RP had significantly lower mean left ventricular (LV) ejection fraction (67% vs 73%, p<0.0017) and higher peak early mitral inflow velocity/early mitral annular velocity (E/e', 9.1 vs 6.6, p<0.006) compared with HC performing equal exercise (8.5 min). Thus, when stressed, patients without known cardiac impairment showed modest but consistently diminished systolic contractile function and diastolic LV compliance during recovery vs HC. Peak HR during stress was significantly elevated in RP vs HC; peak SBP also trended higher. Average pulmonary artery systolic pressures among RP remained normal. Conclusions: Our measurements during ESE uniquely identified residual abnormality in cardiac contractile function not evident in the unstressed condition. This finding exposes a previously-unrecognized residual influence of COVID-19, possibly related to underlying autonomic dysfunction, microvascular disease, or diffuse interstitial changes after subclinical myocarditis; it may have long-term implications for clinical management and later prognosis.

Characterization of severe and critical COVID-19 infected individuals outside of Wuhan, China (preprint)

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly transmissible among people，and the critical cases are still tough to treat, even leading to death. METHODS We retrospectively collected the clinical data of all the critical patients admitted to the Three Gorges Hospital(Chongqing, China) from Jan 20, 2020 to Feb 16, 2020 , whom were divided into improved group and worsen group. At last, we analyzed and compared the differences in laboratory indexes and length of hospital stay of the two groups. RESULT 46 cases were enrolled in the study. Comorbid conditions were present in 25 cases (54.3%). Most cases had symptoms, such as fever, cough, sputum, shortness of breath and dyspnea. The worsen group had a higher APACHE II score of 14(range from 5 to 23) than improved group(5, range from 3 to 7)(p<0.05). 32(69.6%) cases had low level lymphocyte counts (<1.0×109/L), including 8(66.7%) worsen group patients and 24(70.6%) improved group patients. The worsen group was 14.3(range from 8.21 to 18) with the ratio of neutrophil counts to lymphocyte counts, higher than that in improved group((7.33, range from 4.71 to 14.35)(p<0.05). There were faster respiratory frequencies in worsen group(23, range from 20 to 24.75) (p<0.05). And the worsen group had a lower OI(156.5, range from 74.25 to 233) than the other group(206, range from 177.5 to 242.75)(p<0.05). CONCLUSIONS Initial lower lymphocytes and higher APACHE II scores might be relative to the poor prognosis. And most of severe or critical patients had underlying diseases.

An atypical cause of dyspnea in times of COVID-19 pandemic: a case report (preprint)

COVID-19 is a disease that has changed the scenario in emergency departments worldwide. Cardiac involvement should be considered in certain cases making ultrasound a mandatory tool to aid in diagnosis, follow-up, and treatment.

Menstrual Symptom Disorders After COVID-19 in Relation To Anxiety and Long COVID Symptoms (preprint)

Aim: and objectives: Coronavirus disease (COVID-19) can affect the menstrual cycle and menstrual volume. We aimed to examine the changes in menstrual symptoms of women who had recovered from COVID-19 and determine the factors affecting these changes. Methods: A questionnaire, prepared using Google Forms, was completed online in May 18-31, 2021 by 180 women (26.08±6.62 years) who had recovered from COVID-19. Menstrual symptoms, menstrual pain severity, fatigue severity and anxiety levels of the participants were assessed with Menstrual Symptom Questionnaire (MSQ), Visual Analogue Scale (VAS) and Fatigue Severity Scale (FSS), Coronavirus Anxiety Scale (CAS), respectively. Results: Post-COVID-19 individuals’ MSQ total scores and subgroup scores, FSS scores and menstrual pain showed a statistically significant increase compared to pre-COVID-19 (p < 0.001 for all). Multiple linear regression analysis identified age at menarche and change in FSS and VAS scores as significant contributors to 38.4% of the variance explained in the significant regression for change in MSQ score (F (3.176) = 38.23, p < 0.001). Individuals with prolonged fatigue, muscle–joint pain and dyspnea symptoms showed increased MSQ total scores (p = 0.006, p = 0.009, p = 0.046 respectively) and negative effects/somatic complaints subgroup scores (p = 0.004, p = 0.002, p = 0.017 respectively). Also, individuals with prolonged gastrointestinal symptoms showed increased pain symptoms (p = 0.029) and coping methods subgroup scores (p = 0.002), while those with prolonged muscle and joint pain showed increased coping methods (p = 0.022) subgroup scores. Conclusion: In this study, we observed worsened menstrual symptoms, fatigue, and menstrual pain severity in women recovered from COVID-19. In addition, age at menarche and fatigue and menstrual pain scores differences after COVID-19 were determiners of the changes in menstrual symptoms. Menstrual symptoms were more severe in women who have prolonged fatigue, dyspnea, muscle–joint pain, and gastrointestinal symptoms.

Bilateral spontaneous pneumothorax as a late complication of COVID-19, a case report (preprint)

The first case of sever pneumonia caused by coronavirus (COVID-19) was detected in Wuhan, China in December 2019 and spread rapidly around the world. Pneumothorax has been reported as an uncommon complication following COVID-19 infection which caused by alveolar rupture, air leakage and interstitial emphysema after alveolar damages. Bilateral pneumothorax is also an uncommon life threatening complication induced by COVID-19 which has to be considered in patients present with late sudden dyspnea after Coronavirus infection. In this case report, we are presenting a patient with mild COVID-19 pneumonia with a left massive pneumothorax following a late sudden dyspnea in third week of the disease, during the hospitalization, in addition to aggravating the respiratory condition, right pneumothorax was also added.

Analysis of long-term antibody response in COVID-19 patients by symptoms grade, gender, age, BMI, and treatments regimens (preprint)

Objective: The severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) and the resulting COVID-19 pandemic pose significant challenges in terms of diagnosis and recurrent infections. Literature data suggest that age, gender and BMI factors are associated with immune response. The first aim of the study was to analyze the change in antibody titer at 15-day intervals until 60 days post symptom onset (PSO) The second aim was to analyze relationship between antibody titer and symptom grade, gender, age, BMI, therapeutic drugs, vitamin supplements, and herbal therapies. Materials and methods: Blood samples were collected from 43 patients (5 mild, 21 moderate, 17 severe diseases), 18 women (41.9 %), and 25 men (58.1 %), on 15, 30, 45, and 60 days PSO after COVID-19 infection. The serum antibody titers were determined by measuring the COVID-19 IgG antibodies by ELISA. Associations between the duration of symptoms, demographic and clinical parameters, medications and vitamins used, and herbal therapies were evaluated by interviewing the participants. Results: Within the first 15 days of illness, 81.4% of the patients were positive. From day 45 PSO, seropositivity was 89.5%. The anti-SARS-CoV-2 antibody titers were statistically higher in men than women at all-time (p<0.01). Antibody titer was higher in older participants compared to younger participants (p<0.02). Plaquenil or Favipiravir use did not effect antibody response (p>0.05). Men had higher fever (p=0.006), shortness of breath (p=0.004), and chest pain (p=0.03) than women. Conclusion: We found powerful antibody response by sixty days PSO, as well as higher antibody response and severity of symptoms in men gender. Data also showed that SARS-CoV-2 antibodies are higher in individuals with older age, whereas BMI, coexisting chronic disease, and drug used had no effect on antibody titers.

WHAT THE COVID-19 PANDEMIC TAUGHT US IN CHILDREN (preprint)

Objective: The COVID-19 pandemic is an important cause of morbidity and mortality, which has had a negative impact worldwide. We aimed to contribute to the medical literature by sharing the knowledge and experience of pediatric patients who were diagnosed as having COVID-19 in a one-year period. Method: Patients aged 1 month to 18 years who were diagnosed as having COVID-19 in our clinic, between March 2020 and April 2020, from when COVID-19 was declared as a pandemic, were included in the study. Results: Four hundred sixty-seven children were included in the study. There were 34 (7.3%) patients under one year of age, 111 (23.8%) between 1-5 years, 98 (30.4%) between 5-10 years, 142 (30.4%) between 11-15 years, and 82 (17.6%) age over 15 years. Fever (88.2%), vomiting (32.4%), and diarrhea (29.4%) in patients aged under 1 year, sore throat (36.6%) in patients aged 11-15 years, and dysgeusia (11%), anosmia (14.6%), headache (18.3%), malaise (40.8%), myalgia (28%), and dyspnea (17.1%) in those aged over 15 years of age were found significantly more common compared with the other age groups. Thirty-five (7.5%) patients were asymptomatic, 365 (78.1%) had mild disease, 35 (7.5%) were moderate, 27 (5.8%) were severe, and five (1.07%) were critical. Leukocyte count, erythrocyte sedimentation rate, ferritin, and C-reactive protein values were significantly higher in hospitalized patients. Four patients died during the study period (0.8%, 4/494). Conclusion: Although COVID-19 has an asymptomatic and mild course in children, it should be kept in mind that it may have a severe course.