Antecedentes: Las secuelas cardiovasculares ocasionadas por la enfermedad por coronavirus 2019 (COVID-19) son frecuentes en una importante proporción de los pacientes recuperados del cuadro agudo de ...la enfermedad. Hasta el día de hoy el seguimiento cardiológico del síndrome agudo post-COVID-19 (SPC-19A) se ha realizado de forma heterogénea y sin directrices que permitan al clínico identificar oportunamente los cambios que preceden a enfermedades cardiológicas derivadas de los distintos mecanismos de daño inducidos por COVID-19. Objetivos: Estandarizar la atención y seguimiento cardiovascular de los supervivientes de COVID-19 en función de la gravedad de la enfermedad e identificar a los pacientes que desarrollen SPC-19A para su atención oportuna. Material y métodos: Mediante una revisión extensa de bibliografía, este documento tiene la intención de unificar y proporcionar la información necesaria para diagnosticar y dar seguimiento a las complicaciones cardiacas que se han documentado en los meses posteriores a la resolución de la COVID-19 aguda.
•Fatigue and cognitive impairment are amongst the most common and debilitating symptoms of post-COVID-19 syndrome.•Approximately 1 in 3 individuals experienced fatigue 12 or more weeks following ...COVID-19 diagnosis.•Approximately 1 in 5 individuals exhibited cognitive impairment 12 or more weeks following COVID-19 diagnosis.•There was an elevation in proinflammatory markers and functional impairment in a subset of post-COVID individuals.
COVID-19 is associated with clinically significant symptoms despite resolution of the acute infection (i.e., post-COVID-19 syndrome). Fatigue and cognitive impairment are amongst the most common and debilitating symptoms of post-COVID-19 syndrome.
To quantify the proportion of individuals experiencing fatigue and cognitive impairment 12 or more weeks following COVID-19 diagnosis, and to characterize the inflammatory correlates and functional consequences of post-COVID-19 syndrome.
Systematic searches were conducted without language restrictions from database inception to June 8, 2021 on PubMed/MEDLINE, The Cochrane Library, PsycInfo, Embase, Web of Science, Google/Google Scholar, and select reference lists.
Primary research articles which evaluated individuals at least 12 weeks after confirmed COVID-19 diagnosis and specifically reported on fatigue, cognitive impairment, inflammatory parameters, and/or functional outcomes were selected.
Two reviewers independently extracted published summary data and assessed methodological quality and risk of bias. A meta-analysis of proportions was conducted to pool Freeman-Tukey double arcsine transformed proportions using the random-effects restricted maximum-likelihood model.
The co-primary outcomes were the proportions of individuals reporting fatigue and cognitive impairment, respectively, 12 or more weeks following COVID-19 infection. The secondary outcomes were inflammatory correlates and functional consequences associated with post-COVID-19 syndrome.
The literature search yielded 10,979 studies, and 81 studies were selected for inclusion. The fatigue meta-analysis comprised 68 studies, the cognitive impairment meta-analysis comprised 43 studies, and 48 studies were included in the narrative synthesis. Meta-analysis revealed that the proportion of individuals experiencing fatigue 12 or more weeks following COVID-19 diagnosis was 0.32 (95% CI, 0.27, 0.37; p < 0.001; n = 25,268; I2 = 99.1%). The proportion of individuals exhibiting cognitive impairment was 0.22 (95% CI, 0.17, 0.28; p < 0.001; n = 13,232; I2 = 98.0). Moreover, narrative synthesis revealed elevations in proinflammatory markers and considerable functional impairment in a subset of individuals.
A significant proportion of individuals experience persistent fatigue and/or cognitive impairment following resolution of acute COVID-19. The frequency and debilitating nature of the foregoing symptoms provides the impetus to characterize the underlying neurobiological substrates and how to best treat these phenomena.
PROSPERO (CRD42021256965).
Neurological and neuropsychiatric symptoms that persist or develop three months after the onset of COVID-19 pose a significant threat to the global healthcare system. These symptoms are yet to be ...synthesized and quantified via meta-analysis.
To determine the prevalence of neurological and neuropsychiatric symptoms reported 12 weeks (3 months) or more after acute COVID-19 onset in adults.
A systematic search of PubMed, EMBASE, Web of Science, Google Scholar and Scopus was conducted for studies published between January 1st, 2020 and August 1st, 2021. The systematic review was guided by Preferred Reporting Items for Systematic Review and Meta-Analyses.
Studies were included if the length of follow-up satisfied the National Institute for Healthcare Excellence (NICE) definition of post-COVID-19 syndrome (symptoms that develop or persist ≥3 months after the onset of COVID-19). Additional criteria included the reporting of neurological or neuropsychiatric symptoms in individuals with COVID-19.
Two authors independently extracted data on patient characteristics, hospital and/or ICU admission, acute-phase COVID-19 symptoms, length of follow-up, and neurological and neuropsychiatric symptoms.
The primary outcome was the prevalence of neurological and neuropsychiatric symptoms reported ≥3 months post onset of COVID-19. We also compared post-COVID-19 syndrome in hospitalised vs. non-hospitalised patients, with vs. without ICU admission during the acute phase of infection, and with mid-term (3 to 6 months) and long-term (>6 months) follow-up.
Of 1458 articles, 18 studies, encompassing a total of 10,530 patients, were analysed. Overall prevalence for neurological post-COVID-19 symptoms were: fatigue (37%, 95% CI: 25%–48%), brain fog (32%, 10%–54%), memory issues (28%, 22%–35%), attention disorder (22%, 7%–36%), myalgia (17%, 9%–25%), anosmia (12%, 8%–16%), dysgeusia (10%, 6%–14%) and headache (15%, 4%–26%). Neuropsychiatric conditions included sleep disturbances (31%, 19%–42%), anxiety (23%, 14%–32%) and depression (17%, 10%–24%). Neuropsychiatric symptoms substantially increased in prevalence between mid- and long-term follow-up. Compared to non-hospitalised patients, patients hospitalised for acute COVID-19 had reduced frequency of anosmia, anxiety, depression, dysgeusia, fatigue, headache, myalgia, and sleep disturbance at three (or more) months post-infection. Cohorts with >20% of patients admitted to the ICU during acute COVID-19 experienced higher prevalence of fatigue, anxiety, depression, and sleep disturbances than cohorts with <20% of ICU admission.
Fatigue, cognitive dysfunction (brain fog, memory issues, attention disorder) and sleep disturbances appear to be key features of post-COVID-19 syndrome. Psychiatric manifestations (sleep disturbances, anxiety, and depression) are common and increase significantly in prevalence over time. Randomised controlled trials are necessary to develop intervention strategy to reduce disease burden.
•Question: How commonly are neurological and neuropsychiatric symptoms reported three months or more after acute COVID-19 onset in adults?•Findings: In a meta-analysis of 18 studies encompassing 10,530 patients (hospitalised and non-hospitalised), overall prevalence for neurological symptoms three months after COVID-19 onset was: fatigue (37%), brain fog (32%), memory issues (28%), attention disorder (22%), myalgia (17%), anosmia (12%), dysgeusia (10%), and headache (15%). The prevalence of neuropsychiatric symptoms was sleep disturbances (31%), anxiety (23%), and depression (17%).•Meaning: Given the high prevalence of neurological and neuropsychiatric post-COVID-19 syndrome, randomised controlled trials are necessary to develop intervention strategy to reduce disease burden.
Post-COVID symptoms are reported in 10–35 % of patients not requiring hospitalization, and in up to 80 % of hospitalized patients and patients with severe disease. The pathogenesis of post-COVID ...syndrome remains largely unknown. Some evidence suggests that prolonged inflammation has a key role in the pathogenesis of most post-COVID manifestations. We evaluated a panel of inflammatory and immune-mediated cytokines in individuals with altered HRCT features and in patients without any long-term COVID symptoms. Blood samples of 89 adult patients previously hospitalized with COVID-19 were collected and stratified as patients with and without HRCT evidence of fibrotic lung alterations. Serum analyte concentrations of IL-4, IL-2, CXCL10 (IP-10), IL-1β, TNF-α, CCL2 (MCP-1), IL-17A, IL-6, IL-10, IFN-γ, IL-12p70 and TGF-β1 (free active form) were quantified by bead-based multiplex assay. Clinical and functional data were recorded in a database.
With the use of machine learning approach, IL-32, IL-8, and IL-10 proved to be associated with the development of HRCT evidence of lung sequelae at follow-up. Direct comparison of cytokine levels in the two groups showed increased levels of IL-32 and decreased levels of IL-8 in patients with lung impairment. After further stratification of patients by severity (severe versus mild/moderate) during hospitalization, IL-10 emerged as the only cytokine showing decreased levels in severe patients. These findings contribute to a better understanding of the immune response and potential prognostic markers in patients with lung sequelae after COVID-19.
The COVID-19 pandemic has suddenly modified the lifestyle of a large portion of the population around the world. This pandemic is also the first one in decades that has severely impacted many ...countries of the Global North. Governments have had to adopt wide-scope and desperate measures to face the abnormal situation and to reduce the stress of their health care systems. These measures have been based on reducing the physical-social interaction and mobility (closing schools and some economic activities, or fostering telework, among others), increasing the physical distance between people, and recommending washing hands frequently and wearing masks. Thus, the COVID-19 may change many habits of people and the ways we interact with others after the current pandemic. It would also imply changes in mobility habits. Many questions arise about the willingness and acceptability of changes, and who would have to impulse them and how. This paper aims to study and understand individuals' acceptability towards a set of generic measures related to urban mobility in Spain, one of the countries most affected by the COVID-19 pandemic. To that end, we conducted an online survey during the lockdown in Spring (2020). More than 75% of respondents would accept restrictions on car use after the return to normal, and more than 90% agree on increasing the space for pedestrians and cyclists on streets. Furthermore, 75% of respondents would change the primary transport mode towards a more sustainable transport mode if it would decrease the incidence or severity of the COVID-19. These results show that the respondents are overall in favor of a new urban hierarchy that gives more importance to the most sustainable modes, reducing the public space devoted to the car, which means the possibility of turning the COVID-19 crisis into an opportunity to make Spanish cities more sustainable.
•Impacts of COVID-19 on mobility patterns and behavior in Spain.•Acceptance of policies to restrict car use and increase soft mode space in a post-COVID-19 scenario.•Policy measures are recommended based on the survey and the Binary Logit models rresults.
Abstract
Background
This study aims to examine the worldwide prevalence of post-coronavirus disease 2019 (COVID-19) condition, through a systematic review and meta-analysis.
Methods
PubMed, Embase, ...and iSearch were searched on July 5, 2021 with verification extending to March 13, 2022. Using a random-effects framework with DerSimonian-Laird estimator, we meta-analyzed post-COVID-19 condition prevalence at 28+ days from infection.
Results
Fifty studies were included, and 41 were meta-analyzed. Global estimated pooled prevalence of post-COVID-19 condition was 0.43 (95% confidence interval CI, .39–.46). Hospitalized and nonhospitalized patients had estimates of 0.54 (95% CI, .44–.63) and 0.34 (95% CI, .25–.46), respectively. Regional prevalence estimates were Asia (0.51; 95% CI, .37–.65), Europe (0.44; 95% CI, .32–.56), and United States of America (0.31; 95% CI, .21–.43). Global prevalence for 30, 60, 90, and 120 days after infection were estimated to be 0.37 (95% CI, .26–.49), 0.25 (95% CI, .15–.38), 0.32 (95% CI, .14–.57), and 0.49 (95% CI, .40–.59), respectively. Fatigue was the most common symptom reported with a prevalence of 0.23 (95% CI, .17–.30), followed by memory problems (0.14; 95% CI, .10–.19).
Conclusions
This study finds post-COVID-19 condition prevalence is substantial; the health effects of COVID-19 seem to be prolonged and can exert stress on the healthcare system.
Since the spread of the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection much progress has been made in understanding the disease process. However, we are still ...facing the complications of coronavirus disease 19 (COVID-19). Multiple sequelae may appear as a consequence of acute infection. This set of entities called post-COVID-19 syndrome involves a wide variety of new, recurrent or persistent symptoms grouped together as a consequence of the acute disease process. One of those that has attracted the most attention is the liver and bile duct involvement called post-COVID-19 cholangiopathy. This is characterized by elevation of liver markers such as alkaline phosphatase, bilirubin and transaminases as well as alterations in the bile ducts in imaging studies. Thus, a narrative review of the cases reported until the end of 2021 was carried out. From the findings found, we concluded that patients who have had COVID-19 or during the process have required hospitalization should remain under follow-up for at least 6 months by a multidisciplinary team.
Desde la propagación de los primeros casos del síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2) se ha avanzado mucho en la comprensión del proceso de enfermedad. Sin embargo, todavía nos enfrentamos a las complicaciones del coronavirus 19 (COVID-19). Se han reportado múltiples secuelas como consecuencia de la infección aguda. Este conjunto, denominado síndrome post-COVID-19, involucra una amplia variedad de síntomas nuevos, recurrentes o persistentes agrupados como consecuencia del proceso agudo de la enfermedad. Una de las que más ha llamado la atención es la afectación hepática y de vías biliares denominada colangiopatía post-COVID-19. Esta se caracteriza por elevación de marcadores hepáticos tales como fosfatasa alcalina, bilirrubina y transaminasas, así como alteraciones en las vías biliares en los estudios de imagen. Así, se realizó una revisión narrativa de los casos reportados hasta finales de 2021. De los hallazgos encontrados concluimos que los pacientes que han tenido COVID-19 o que han requerido hospitalización deben permanecer en seguimiento durante al menos 6 meses por parte de un equipo multidisciplinario.
Post COVID-19 sequelae are a constellation of symptoms often reported after recovering from COVID-19. There is a need to better understand the clinical spectrum and long-term course of this clinical ...entity. The aim of this study is to describe the clinical features and risk factors of post COVID-19 sequelae in the North Indian population. This prospective observational study was conducted at a tertiary healthcare centre in Northern India between October 2020 and February 2021. Patients aged >18 years with laboratory-confirmed COVID-19 were recruited after at least two weeks of diagnosis, and details were captured. A total of 1234 patients were recruited and followed up for a median duration of 91 days (IQR: 45-181 days). Among them, 495 (40.1%) had persistent symptoms post-discharge or recovery. In 223 (18.1%) patients, the symptoms resolved within four weeks; 150 (12.1%) patients had symptoms till 12 weeks, and 122 (9.9%) patients had symptoms beyond 12 weeks of diagnosis/symptom-onset of COVID-19. Most common symptoms included myalgia (10.9%), fatigue (5.5%), shortness of breath (6.1%), cough (2.1%), insomnia (1.4%), mood disturbances (0.48%) and anxiety (0.6%). Patients who were hospitalized were more likely to report fatigue as a feature of long COVID. Hypothyroidism (OR: 4.13, 95% CI: 2.2-7.6, p-value < 0.001) and hypoxia (SpO2 ≤ 93%) (OR: 1.7, 95% CI: 1.1-2.4, p-value 0.012) were identified as risk factors for long COVID sequelae. In conclusion, long COVID symptoms were common (22%), and 9.9% had the post COVID-19 syndrome. Myalgias, fatigue and dyspnoea were common symptoms. Patients with hypothyroidism and hypoxia during acute illness were at higher risk of long COVID.
Individuals with post COVID-19 conditions risk to develop short and/or mid term neuromuscular sequels that may involve changes on balance control. The POST-COVID-19 Functional Scale (PCFS) has the ...potential to evaluate the general functional capacity, however, if the PCFS can also be used to measure the impact on the balance control over the post COVID-19 functionality, remains unclear.
To investigate if COVID-19 may impact the balance control and if possible, changes are associated with the functional status of the individual estimated by PCFS.
60 adults were spited into two groups: 30 patients on control group and 30 on post COVID-19 group. Both groups underwent clinical evaluation of balance control based on the following tests: Functional Reach Test (FRT), Berg Balance Scale (BBS), Time Up and Go (TUG), Tinetti Balance Test (TINETTI) and Mini-BESTest (MBT). Besides, the post COVID group answered the PCFS questionnaire. For data statistical analysis, it was used the Student's T Test, comparing the score found on groups’ balance tests. The Pearson's correlation test was used to correlate the balance tests and PCFS. The multiple linear regression was used to identify which balance variable may play important role on PCFS’ prevision, with significancy level of 5%.
It wasn't found significative differences (p>0,05) between groups for: BBS (average ± control standard deviation and post COVID-19: 49.200±7.863 and 49.300±8.322 points); TUG (12.500±4.925 and 11.033±5.109 seconds); TINETTI (24.467±4.890 and 25.633±3.873 points); and MBT (22.500±5.361 and 22.967±4.716 points). But, for FRT, there was significative difference (p=0,046) between groups post COVID-19 (31,333±6,563 cm) and control (28,083±5,748 cm). The balance variables showed significative correlation (p<0,05) and moderated with PCFS: TINETTI (r=0.584), FRT (r=±-0.542), MBT (r=-0.53), BBS (r=0.415) and TUG (r=0.368). TINETTI was the independent variable that significantly played important role on PCFS’ determination (R² value was set from 0,368, p = 0.004).
The results showed that significative changes on postural stability wasn't observed among groups for most balance tests applied, except FRT. Both groups, however, presented reach on FRT above reference value, indicating low fragility and fall risk for the patients. Minor changes on functional status of post COVID-19 group (23 of 30 patients presented grade between 0 and 1) may explain similarities on body balance among groups. Moderated correlations were observed between PCFS and balance tests and, the TINETTI, seems to play important role on PCFS’ determination.
In rehabilitation field, the research results indicate the PCFS’ implementation to monitor functionality, covering changes on postural balance and other functional outcomes, aiming to improve evaluation methods and intervention on neuromuscular function rehabilitation on the context of post COVID-19.
Since the spread of the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection much progress has been made in understanding the disease process. However, we are still ...facing the complications of coronavirus disease 19 (COVID-19). Multiple sequelae may appear as a consequence of acute infection. This set of entities called post-COVID-19 syndrome involves a wide variety of new, recurrent or persistent symptoms grouped together as a consequence of the acute disease process. One of those that has attracted the most attention is the liver and bile duct involvement called post-COVID-19 cholangiopathy. This is characterized by elevation of liver markers such as alkaline phosphatase, bilirubin and transaminases as well as alterations in the bile ducts in imaging studies. Thus, a narrative review of the cases reported until the end of 2021 was carried out. From the findings found, we concluded that patients who have had COVID-19 or during the process have required hospitalization should remain under follow-up for at least 6 months by a multidisciplinary team.
Desde la propagación de los primeros casos del síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2) se ha avanzado mucho en la comprensión del proceso de enfermedad. Sin embargo, todavía nos enfrentamos a las complicaciones del coronavirus 19 (COVID-19). Se han reportado múltiples secuelas como consecuencia de la infección aguda. Este conjunto, denominado síndrome post-COVID-19, involucra una amplia variedad de síntomas nuevos, recurrentes o persistentes agrupados como consecuencia del proceso agudo de la enfermedad. Una de las que más ha llamado la atención es la afectación hepática y de vías biliares denominada colangiopatía post-COVID-19. Esta se caracteriza por elevación de marcadores hepáticos tales como fosfatasa alcalina, bilirrubina y transaminasas, así como alteraciones en las vías biliares en los estudios de imagen. Así, se realizó una revisión narrativa de los casos reportados hasta finales de 2021. De los hallazgos encontrados concluimos que los pacientes que han tenido COVID-19 o que han requerido hospitalización deben permanecer en seguimiento durante al menos 6 meses por parte de un equipo multidisciplinario.
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