Post-acute COVID-19 syndrome and its prolonged effects: An updated systematic review

ObjectiveThis systematic review aimed at estimating the demographics, clinical characteristics, and prevalence of post-acute COVID-19 symptoms in view of published literature that studied prolonged clinical manifestations after recovery from acute COVID-19 infection. MethodsAfter protocol setting, relevant articles were searched on various databases including PubMed, Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Web of Sciences using MeSH keywords. The data regarding demographic, clinical characteristics, and prevalence of each persisting symptom were carefully studied and tabulated. Data analysis was carried out using Statistical Package for Social Sciences (SPSS) version 26. ResultsOut of the 153 articles reviewed, 21 articles qualified for the final analysis. The most common persistent clinical manifestations were fatigue (54.11%), dyspnea (24.38%), alopecia (23.21%), hyperhidrosis (23.6%), insomnia (25.98%), anxiety (17.29%), and arthralgia (16.35%). In addition to these symptoms, new onset hypertension, diabetes, neuropsychiatric disorders, and bladder incontinence were also reported. ConclusionClinical features of post-acute COVID-19 infection can manifest even after 60 days of initial infection. Constitutional symptoms include fatigue, dyspnea, anosmia, and insomnia were the most commonly reported in literature. Multidisciplinary care along with regular follow-up must be a provided to such patients. Curation and modification of guidelines is required for the assessment of discharged hospitalized patients for better management of their post-acute COVID-19 syndrome.

Association of ABO blood group with COVID-19 severity, acute phase reactants and mortality

Background and objectiveThe ABO blood group system has been associated with infectious and noninfectious disease, including dengue, hepatitis B virus (HBV), and severe respiratory syndrome coronavirus (SARS), etc. Coronavirus disease 2019 (COVID-19) is the ongoing pandemic with multitude of manifestations and association of ABO blood group in South-East Asian population needs to be explored. MethodsIt was a retrospective study of patients with real time polymerase chain reaction (RT-PCR) diagnosis of COVID-19 at Advanced Diagnostics and Liver Center between April 2020 to January 2021. Blood group A, B, O, and AB were identified in every participant, irrespective of their RH type and allotted groups 1, 2,3, and 4, respectively. Cox regression and logistic regression were used for inferential statistics. ResultsThe cohort included 1067 patients: 521 (48.8%) of blood group O, 295 (27.6%) of blood group B, 202 (18.9%) of blood group A, and 49 (4.5%) of blood group AB. The majority of the patients were males 712 (66.7%) with an average body mass index (BMI) of 27.45 {+/-} 3.53. Patients with AB blood group stayed a median (IQR) of 14 (5, 27) days while A blood group cohort stayed 13 (6,27) days and overall 10.6% COVID-19-related mortality was observed at our center, with 13.9% in blood group A as the majority of COVID-19 deaths. Regarding severity of COVID-19 disease, there was a trend towards critical disease in blood group A and O (n=83, 41.1%; n=183, 35.1%; OR, 11.34 (95% CI, 46.79-53.22); p<0.001). Logistic regression demonstrates blood group O and AB as predictors for severe COVID-19 disease (O: OR: 0.438 (95% CI: 0.168-1.139) p=0.090; AB: OR: 0.415 (95% CI: 0.165-1.046) p=0.062) and cause-specific hazards ratio (HR) for survival function was 3.206 (p=0.361) among all blood groups. ConclusionAlthough the prevalence of blood group O was higher in this cohort, hospital stay, severity of disease, and mortality were associated with blood group A. Further studies are needed for understanding the underlying mechanism behind the association of blood groups with COVID-19.

Effect of COVID-19 on Lipid Profile and its Correlation with Acute Phase Reactants

Background and ObjectiveCoronavirus disease 2019 (COVID-19) manifests as multiple clinical and pathological organ dysfunctions. It also disrupts metabolic profile due to the release of pro-inflammatory cytokines causing a systemic inflammation reaction. However, the development and correlation of dyslipidemia with acute phase reactants is unknown. This investigation was performed to assess the pathological alterations of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein (HDL), triglycerides, and total cholesterol levels in COVID-19 patients. MethodsThis was a prospective study performed on real-world patients to assess serum levels of LDL-C, HDL, TG, TC on COVID-19 patients (mild: 319; moderate: 391; critical: 357) hospitalized at our center between April 2020 through January 2021. Age- and gender-matched controls who had their lipid profiles in the same period were included as the control group. ResultsLDL-C, HDL, TG, and TC levels were significantly lower in COVID-19 patients when compared with the control group (P < 0.001, 0.047, 0.045, < 0.001, respectively). All parameters decreased gradually with COVID-19 disease severity (LDL-C: median (IQR), mild: 98 (91,134); moderate: 97 (81,113); critical: 68 (68,83); HDL: mild: 45 (37,50); moderate: 46 (41,50); critical: 40 (37,46); TG: mild: 186 (150,245); moderate: 156 (109,198); critical: 111 (98,154); TC: mild: 224 (212,238); moderate: 212 (203,213); critical: 154 (125,187)). LDL-C, TC, and TG were inversely correlated with acute phase reactants (interleukin-6 (IL-6), Procalcitonin, C-reactive protein (CRP), and D-dimers). Logistic regression demonstrated lipid profile, thyroid profile, and acute phase reactants as predictors of severity of COVID-19 disease. ConclusionHypolipidemia develops in increasing frequency with severe COVID-19 disease. It inversely correlates with levels of acute-phase reactants, indicating SARS-COV-2 as the causative agent for alteration in lipid and thyroid levels.