Long COVID Clinical Phenotypes up to 6 Months After Infection Identified by Latent Class Analysis of Self-Reported Symptoms.

Background: The prevalence, incidence, and interrelationships of persistent symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection vary. There are limited data on specific phenotypes of persistent symptoms. Using latent class analysis (LCA) modeling, we sought to identify whether specific phenotypes of COVID-19 were present 3 months and 6 months post-infection. Methods: This was a multicenter study of symptomatic adults tested for SARS-CoV-2 with prospectively collected data on general symptoms and fatigue-related symptoms up to 6 months postdiagnosis. Using LCA, we identified symptomatically homogenous groups among COVID-positive and COVID-negative participants at each time period for both general and fatigue-related symptoms. Results: Among 5963 baseline participants (4504 COVID-positive and 1459 COVID-negative), 4056 had 3-month and 2856 had 6-month data at the time of analysis. We identified 4 distinct phenotypes of post-COVID conditions (PCCs) at 3 and 6 months for both general and fatigue-related symptoms; minimal-symptom groups represented 70% of participants at 3 and 6 months. When compared with the COVID-negative cohort, COVID-positive participants had higher occurrence of loss of taste/smell and cognition problems. There was substantial class-switching over time; those in 1 symptom class at 3 months were equally likely to remain or enter a new phenotype at 6 months. Conclusions: We identified distinct classes of PCC phenotypes for general and fatigue-related symptoms. Most participants had minimal or no symptoms at 3 and 6 months of follow-up. Significant proportions of participants changed symptom groups over time, suggesting that symptoms present during the acute illness may differ from prolonged symptoms and that PCCs may have a more dynamic nature than previously recognized. Clinical Trials Registration. NCT04610515.

On structural transitions in a discontinuous micellar cubic phase loaded with sodium diclofenac.

An intermediate mesophase of lyotropic liquid crystalline structure from the ternary mixtures of glycerol monooleate, water, and ethanol was recently characterized in our lab. This mesophase, termed Q(L), consists of discrete discontinuous micelles arranged in a cubic array. The Q(L) phase can solubilize very significant loads of water-insoluble anti-inflamatory drug sodium diclofenac (Na-DFC). Close examination of the internal structures of the lyotropic liquid structure upon increasing the solubilization loads reveals the existence of three structural transitions controlled by the Na-DFC levels. Up to 0.4 wt% Na-DFC, the Q(L) structure remains intact with some influence on the hydration of the headgroups and on the intermicellar forces. However, at 0.8 to 1.2 wt% Na-DFC, the discontinuous micellar cubic phase is transformed into a more condensed mesophase of a bicontinuous cubic phase. At > or =1.2 wt% Na-DFC, the cubic phase is converted into a lamellar phase (L(alpha)). Within 5.5 to 7.3 wt% Na-DFC the mesophase is progressively transformed into a less ordered lamellar structure. At 12 wt% Na-DFC crystals tend to precipitate out. At low Na-DFC concentrations the drug behaves like a lyotropic or kosmotropic salt and can salt-out the surfactant from its water layer, but at higher levels it behaves like a hydrotropic, chaotropic salt and can salt-in the surfactant. The Na-DFC location and position within the interface as well as its polarization and partial ionization are strongly affected by its solubilization contents and the structure that it is inducing. In the cubic phase the drug is located less close to the hydration layer while once transition occurs it is exposed more to the water layer and the surfactant headgroups.

Ginseng improves pulmonary functions and exercise capacity in patients with COPD.

Ginseng is a root that has been used to treat patients with various illnesses for the last 2000 years. The purpose of this study was to evaluate the effects of Ginseng extract (G115) on Pulmonary Function Tests (PFTs), Maximum Voluntary Ventilation (MVV), Maximum Inspiratory Pressure (MIP) and Maximal Oxygen Consumption (VO2max) in patients with moderately-severe Chronic Obstructive Pulmonary Disease (COPD). Ninety-two adults were randomly divided into the experimental (n = 49, G115 100 mg bid for three months) and placebo-control (n = 43) groups. PFTs, MVV and MIP were studied before treatment and every two weeks for the 3-month-study period. Exercise test and VO2max measurements were performed before the beginning and after six weeks and three months. P lower than 0.05 was considered significant. Baseline demographics and pulmonary parameters were similar between the groups. In the experimental, but not in the control group, all parameters significantly increased above baseline and compared with the placebo group. Maximum increase, compared with baseline was FVC-32.5%, FEV1.0-27.0%, PEF-27.5%, FEF50-45.4%, FEF75-56.9%, MVV-40.4%, MIP-47.0% and VO2max-37.5%. No side effects were observed. G115 100 mg bid for three months, but not placebo, improved PFTs, MVV, MIP and VO2 max in patients with moderately-severe COPD with no side effects.

Nitrous oxide inhalation as sedation for flexible sigmoidoscopy.

BACKGROUND: Flexible sigmoidoscopy is usually performed without sedation in screening programs for colorectal cancer. Most patients report some degree of discomfort or pain during the procedure. The aim of this study was to evaluate self-administered nitrous oxide as a method to reduce patient discomfort, thereby improving the procedure and conceivably increasing patient compliance and motivation. METHODS: In a double-blind, randomized, placebo-controlled study, 38 patients undergoing sigmoidoscopy self-administered 60% nitrous oxide (n = 18) or oxygen (n = 20) by mask. The endoscopist recorded the depth of insertion of the sigmoidoscope, duration of the procedure, and time to patient recovery. Patients scored the degree of pain and discomfort felt during the examination. RESULTS: There were no significant differences between the groups with regard to patients' age, gender, pain or discomfort, duration of procedure, or depth of insertion. Recovery time was significantly longer in the nitrous oxide group (3.3 +/- 0.6 minutes vs 0.5 +/- 0.5 minutes; p = 0.02), but this finding was of no practical or clinical consequence. CONCLUSIONS: The addition of "on demand" nitrous oxide did not improve sigmoidoscopy performance or diminish pain and discomfort. However, further studies using improved administration techniques and larger study groups are justified in the search for ways to increase compliance with and motivation for colorectal cancer screening.

[Epidural analgesia for postoperative pain in infants and children].

Until recently it was thought that children do not suffer as much from postoperative pain as adults. Coupled with the fear of administering systemic opiates to young children, this meant that babies were often left "to cry it out." Lately it has been acknowledged that children and even babies not only feel pain, but similar to adults, suffer from the physiologic consequences of the untreated stress response. It has also been shown that preventing this response improves the postoperative period in babies after undergoing cardiac surgery. Regional analgesia is commonly used to provide postoperative pain control in adults and children. Following minor lower abdominal surgery, pain relief is often provided by caudal analgesia or specific nerve blocks. Epidural and spinal anesthesia are also gaining popularity for young children and even babies. We describe 3 cases of continuous epidural analgesia in babies, and review other methods for postoperative pain relief. These cases are representative of the many which we have treated over the past 2 years. We use epidural analgesia in children who undergo major thoracic, abdominal, pelvic and major lower limb surgery, and are expected to suffer significant postoperative pain for more than 24 hours. We have not encountered any major complications or inadvertent dural punctures. We judiciously monitor these children, especially their respiratory function, as long as they receive epidural narcotics.

The laryngeal mask airway in pediatric anesthesia: experience with 120 patients undergoing elective groin surgery.

The laryngeal mask airway (LMA) was recently introduced in pediatric anesthesia as an alternative to the face mask or tracheal intubation for airway maintenance. The authors report their experience with LMA on 120 consecutively treated children who underwent elective inguinal herniorrhaphy or orchidopexy. The patients were monitored with electrocardiograms, noninvasive blood pressure determinations, pulse oxymetry, and capnometry. Anesthesia was induced and maintained with halothane, nitrous oxide, and oxygen. There were 96 males and 24 females; the age range was 1 month to 14 years (average, 3.2 years). They weighed between 2.5 and 46 kg (mean, 14 kg). Patients were allowed to breath spontaneously until anesthesia was deep enough (average, 6.3 minutes; range, 2 to 15 minutes). The appropriate-size LMA was inserted and inflated, and patients were divided into three groups. Group I patients (n = 24) weighed 2.6 to 6 kg and received LMA size no. 1. Group II (n = 84) weighed 6 to 30 kg and received LMA size no. 2. Group III (n = 12) weighed more than 30 kg and received LMA size no. 3. Patients in groups II and III breathed spontaneously; those in group I were on volume-controlled ventilation. The LMA was easily inserted in 115 patients (95.8%)--on the first attempt in 100, and on the second attempt in 15. In five patients, LMA was successfully inserted on the third attempt. The ease of insertion was not significantly different between the groups. Anesthesia was maintained by halothane (mean, 1.34%; range, 0.8% to 2.54%) for an average of time of 39.2 minutes (range, 15 to 90 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Regional versus general anesthesia for bone marrow harvesting.

STUDY OBJECTIVE: To compare regional versus general anesthesia for bone marrow harvesting. DESIGN: Retrospective study. SETTING: Inpatients at a bone marrow transplantation unit of a university medical center. PATIENTS: One hundred sixty-two donors: 63 healthy patients donating heterologous marrow, 99 patients donating autologous marrow. INTERVENTIONS: Anesthesia and patient charts from 1986 to 1990 were reviewed. MEASUREMENTS AND MAIN RESULTS: Regionally anesthesized patients required less transfused blood in the perioperative period, even though more bone marrow was aspirated. This group also required less postoperative analgesia. We found no difference between the groups with regard to length of hospitalization or amount of colloid required in the perioperative period. CONCLUSIONS: Our data suggest that both modes of anesthesia can be safely administered. Further investigations should be carried out to determine whether the two types of anesthesia, regional and general, are equivalent.

Computerized tomography of the brain in children with chronic renal failure.

We performed computerized tomography (CT) of the brain in 22 patients, 2 to 18 years of age, with stable chronic renal failure (n = 6), on dialysis (n = 14) and after renal transplantation (n = 2). None suffered from a systemic disease known to affect the central nervous system (CNS) and none had overt CNS dysfunction at the time of the CT examination. The most striking pathological finding was brain atrophy, which was present in 13 patients (59%). In two patients cortical infarcts were present and one patient was found to have a hypodense area in the basal ganglia. The brain atrophy could not be related to the type of basic renal disease, the age of the patient, corticosteroid dosage, the duration of the renal failure or the presence of hypertension However, the mode of treatment, i.c. hemodialysis, seemed to be a risk factor. We assume that metabolic derangements and/or the accumulation of toxic substances due to the uremic state may be responsible for the brain atrophy in young patients with CRF. Recurrent osmotic changes of the brain during hemodialysis may aggravate the process of brain atrophy.

Unusual presentation of Bruton's agammaglobulinemia--Pseudomonas sepsis.

A case of Pseudomonas sepsis and meningitis is described in a family in which the first child died in the first year of life after a fulminant Pseudomonas sepsis. In our patient, the second son, treatment was begun immediately after admission with clinical and bacteriological signs of Pseudomonas sepsis and continued for a 4-week period. Subsequent cessation of the treatment resulted in a relapse, with meningeal involvement. After specific therapy was added for his immunologic incompetence, as well as subsequent antibiotic treatment, the patient was cured of his prolonged illness.