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.
After almost 2 years of fighting against SARS-CoV-2 pandemic, the number of patients enduring persistent symptoms long after acute infection is a matter of concern. This set of symptoms was referred ...to as "long COVID", and it was defined more recently as "Post COVID-19 condition" by the World health Organization (WHO). Although studies have revealed that long COVID can manifest whatever the severity of inaugural illness, the underlying pathophysiology is still enigmatic.
To conduct a comprehensive review to address the putative pathophysiology underlying the persisting symptoms of long COVID.
We searched 11 bibliographic databases (Cochrane Library, JBI EBP Database, Medline, Embase, PsycInfo, CINHAL, Ovid Nursing Database, Journals@Ovid, SciLit, EuropePMC, and CoronaCentral). We selected studies that put forward hypotheses on the pathophysiology, as well as those that encompassed long COVID patients in their research investigation.
A total of 98 articles were included in the systematic review, 54 of which exclusively addressed hypotheses on pathophysiology, while 44 involved COVID patients. Studies that included patients displayed heterogeneity with respect to the severity of initial illness, timing of analysis, or presence of a control group. Although long COVID likely results from long-term organ damage due to acute-phase infection, specific mechanisms following the initial illness could contribute to the later symptoms possibly affecting many organs. As such, autonomic nervous system damage could account for many symptoms without clear evidence of organ damage. Immune dysregulation, auto-immunity, endothelial dysfunction, occult viral persistence, as well as coagulation activation are the main underlying pathophysiological mechanisms so far.
Evidence on why persistent symptoms occur is still limited, and available studies are heterogeneous. Apart from long-term organ damage, many hints suggest that specific mechanisms following acute illness could be involved in long COVID symptoms.
KEY MESSAGES
Long-COVID is a multisystem disease that develops regardless of the initial disease severity. Its clinical spectrum comprises a wide range of symptoms.
The mechanisms underlying its pathophysiology are still unclear. Although organ damage from the acute infection phase likely accounts for symptoms, specific long-lasting inflammatory mechanisms have been proposed, as well.
Existing studies involving Long-COVID patients are highly heterogeneous, as they include patients with various COVID-19 severity levels and different time frame analysis, as well.
IntroductionThe pathophysiology and trajectory of multiorgan involvement in post-COVID-19 syndrome is uncertain. We aimed to adjudicate the likelihood of myocarditis in post-COVID-19 ...patients.MethodsA prospective, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated 28–60 days post-discharge (visit 2). Serial research blood tests (biomarkers), digital electrocardiography, and patient reported outcome measures were obtained at both visits. Chest computed tomography with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, were acquired at visit 2.Results159 patients (mean age 55 years, 43% female) and 27 controls with similar age, sex, ethnicity, and vascular risk factors were enrolled from 22 May 2020 to 2 July 2021 and had a primary outcome evaluation. Adjudicated likelihood of myocarditis was not (n=17; 11%), unlikely (n=56; 35%), probably (n=65; 41%) or very likely (n=21; 13%). Healthcare worker status (odds ratio, 95% confidence interval: 2.99 (1.01, 8.89); p=0.048), acute kidney injury (3.26 (1.00, 10.64); p=0.050) and HbA1c(0.64 (0.42, 0.99); p=0.044) were multivariable associates of adjudicated myocarditis. During convalescence, COVID-19 was associated with worse health-related quality of life (EQ5D-5L) (p<0.001), illness perception (p<0.001), anxiety and depression (p<0.001), physical activity (p<0.001) and predicted maximal oxygen utilization (ml/kg/min) (p<0.001). These measures were associated with adjudicated myocarditis.ConclusionThe illness trajectory of COVID-19 includes persisting cardio-renal inflammation, lung damage and hemostasis activation. Adjudicated myocarditis occurred in one in eight hospitalized patients and was associated with impairments in health status, physical and psychological wellbeing during community convalescence.Conflict of InterestNil
The purpose is to investigate the current status and future evolution of the workplace within the COVID-19 pandemic context. Documents, publications and surveys from numerous sources have been ...analyzed to find out more about the employees' and organizations' experience with remote working and the advantages and disadvantages of accessing the workplace during the pandemic. The analysis of the data made possible the identification of patterns within the available literature regarding what has happened and, especially, its influence on the workplace. The revolution initiated by COVID-19 has changed the way companies and employees work and will continue doing so, requiring a constant reinvention of how they operate and causing actions never seen before, generating deep changes in the workplace. Therefore, the idea of the workplace will never be what was expected before COVID-19, where reinvention of work, technology and safety are key points in its transformation process.
Some reports suggest that coronavirus disease 2019 (COVID-19) may affect male reproductive function. There is also concern in Japan that COVID-19 may contribute to the pre-existing decline in male ...fertility; however, no studies have investigated the effects of COVID-19 on male reproductive function. In this study, we aimed to analyze the semen quality of men who had recovered from COVID-19. Male patients who had recovered from COVID-19 between February 2020 and September 2021 were recruited for this study. Participants were sent a semen collection kit; they were asked to collect semen at home and deliver it to a laboratory at Osaka University. We used these samples to analyze sperm concentration, total sperm count, and semen volume. In total, 125 participants were included in this study. The median age of all patients was 46 years (interquartile range (IQR): 38–52 years). The severity of COVID-19 was mild in 80 patients; 19 were moderate I, 22 were moderate II, and four were severe. The median semen volume was 2.5 mL (IQR: 1.8–3.1), the median sperm concentration was 98.9 million/mL (IQR: 43.8–162.2), and the median total sperm count was 212.1 million (IQR: 89.7–368.2). In a previous study in Japan, the median sperm count in adult men was reported to be 201 million. Participants in our study did not have lower sperm counts than this, despite their older age. Our results suggest that the long-term effects of COVID-19 on spermatogenesis are minimal.
Severe acute respiratory syndrome-coronavirus-2 (SARS‐CoV‐2), responsible for COVID-19, has caused a global pandemic. Observational studies revealed a condition, herein called as Long-COVID syndrome ...(PC), that affects both moderately and severely infected patients, reducing quality-of-life. The mechanism/s underlying the onset of fibrotic-like changes in PC are still not well defined. The goal of this study was to understand the involvement of the Absent in melanoma-2 (AIM2) inflammasome in PC-associated lung fibrosis-like changes revealed by chest CT scans. Peripheral blood mononuclear cells (PBMCs) obtained from PC patients who did not develop signs of lung fibrosis were not responsive to AIM2 activation by Poly dA:dT. In sharp contrast, PBMCs from PC patients with signs of lung fibrosis were highly responsive to AIM2 activation, which induced the release of IL-1α, IFN-α and TGF-β. The recognition of Poly dA:dT was not due to the activation of cyclic GMP-AMP (cGAMP) synthase, a stimulator of interferon response (cGAS-STING) pathways, implying a role for AIM2 in PC conditions. The release of IFN-α was caspase-1- and caspase-4-dependent when AIM2 was triggered. Instead, the release of pro-inflammatory IL-1α and pro-fibrogenic TGF-β were inflammasome independent because the inhibition of caspase-1 and caspase-4 did not alter the levels of the two cytokines. Moreover, the responsiveness of AIM2 correlated with higher expression of the receptor in circulating CD14+ cells in PBMCs from patients with signs of lung fibrosis.
Long-term physical and mental persistent symptoms after COVID-19 represent a growing global public health concern. However, there remains a substantial knowledge gap regarding their prevalence and ...risk factors.
To estimate the prevalence and risk factors for persistent symptoms after COVID-19.
We used a random-effects model to pool persistent symptom prevalence and risk ratios comparing COVID-19 patients with non-COVID-19 individuals.
Electronic databases were searched for studies published from December 2019 to January 2023.
Eligible studies that reported the prevalence and risk factors for persistent symptoms after COVID-19 were included.
Patients who recovered from COVID-19.
The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias in prevalence studies, whereas the risk of bias in cohort studies was evaluated with the Newcastle-Ottawa Scale.
After screening 4359 studies, a total of 211 eligible studies were included, covering a population of 13 368 074 individuals. Fatigue, dyspnoea, post-traumatic stress disorder, anxiety, and depression were the most frequently reported persistent symptoms after COVID-19. Subgroup analyses revealed that individuals with more severe illness in the acute phase or from Europe exhibited a higher prevalence of certain symptoms, whereas children demonstrated a lower prevalence. Furthermore, COVID-19 patients had a significantly higher prevalence of most persistent symptoms compared with non-COVID-19 individuals. Factors frequently associated with a higher prevalence of persistent symptoms included female gender, advanced age, severe illness during the acute phase of COVID-19, multiple comorbidities, an extended duration of hospital stay, and a high body mass index.
This meta-analysis provides a thorough review of the prevalence and risk factors for persistent symptoms following COVID-19. The findings underscore the importance of long-term monitoring and support for individuals recovering from COVID-19.
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PurposeThis study aims to explore green hotel visitors’ afforestation intentions by extending the theory of planned behavior, including post-COVID-19 personal norms (PCPN) and post-COVID-19 ...environmental concerns (PCECs). Moreover, this study examines the mediating effect of PCECs from the post-COVID-19 perspective.Design/methodology/approachThis study is based on existing literatures and collection of 384 usable responses using the convenience sampling technique. The partial least square structural equation modeling is used to analyze data using Smart PLS3.3.3.FindingsThe findings reveal that post-COVID-19 afforestation attitudes, subjective norms (SN), perceived behavioral control (PBC) and PCPN significantly influence post-COVID-19 afforestation intentions (PCAI) and PCECs. Further, PCEC partially mediates the between post-COVID-19 afforestation attitudes, SN, PBC and PCPN and PCAI.Practical implicationsThe findings of this study may be useful to green hotel operators in formulating business strategies enhancing visitors’ positive perceptions toward green hotels and afforestation intentions coping with new normal environment and hospitality industry.Originality/valueThis research presents a distinguished case highlighting how the green hotel guests’ perceptions toward afforestation for mitigating carbon emissions are changing because of COVID-19 pandemic. This study provides crucial insights for green hotel practitioners by integrating post-COVID-19 afforestation attitudes, SN, PBC, PCPN and PCEC of green hotel visitors in examining PCAI.
Following recovery from COVID-19, an increasing proportion of individuals have reported the persistence and/or new onset of symptoms which collectively have been identified as post-COVID-19 syndrome ...by the National Institute for Health and Care Excellence. Although depressive symptoms in the acute phase of COVID-19 have been well characterized, the frequency of depression following recovery of the acute phase remains unknown. Herein, we sought to determine the frequency of depressive symptoms and clinically-significant depression more than 12 weeks following SARS-CoV-2 infection. A systematic search of PubMed, Ovid Medline and Google Scholar for studies published between January 1, 2020 and June 5, 2021 was conducted. Frequency and factors associated with depression in post-COVID-19 syndrome were recorded and qualitatively assessed through narrative synthesis. Methodological quality and risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS) for prospective cohort studies. Of 316 articles identified through our systematic search, eight studies were included. The frequency of depressive symptoms +12 weeks following SARS-CoV-2 infection ranged from 11 to 28%. The frequency of clinically-significant depression and/or severe depressive symptoms ranged from 3 to 12%. The severity of acute COVID-19 was not associated with the frequency of depressive symptoms. However, the component studies were highly heterogeneous with respect to mode of ascertainment, time of assessment, and location and age of patients. The majority of studies did not include an unexposed control group. Future research should endeavour to produce a standardized classification of post-COVID-19 syndrome, and as well as include unexposed control groups.
A growing number of individuals report prolonged symptoms following acute Coronavirus-19 (COVID-19) infection, known as post-COVID-19 condition (post-COVID-19). While studies have emerged ...investigating the symptom sequelae of post-COVID-19, there has been limited investigation into the characterization of pain, fatigue, and function in these individuals, despite initial reports of a clinical phenotype similar to fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This study aimed to characterize multiple symptom domains in individuals reporting post-COVID-19 and compare its clinical phenotype with those with FMS and CFS. A total of 707 individuals with a single or comorbid diagnosis of post-COVID-19, FMS, and/or CFS completed multiple surveys assessing self-reported pain, fatigue, physical and cognitive function, catastrophizing, kinesiophobia, anxiety, depression, dyspnea, and sleep quality. In all 3 diagnoses, elevated pain, fatigue, anxiety, depression, catastrophizing, and kinesiophobia were reported. Physical and cognitive function were similarly impacted among individuals with post-COVID-19, FMS, and CFS; however, individuals with post-COVID-19 reported lower pain and fatigue than FMS and CFS. The comorbid diagnosis of post-COVID-19 with FMS and/or CFS further exacerbated pain, fatigue, and psychological domains when compared with post-COVID-19 alone. In summary, individuals with post-COVID-19 report a symptom phenotype similar to FMS and CFS, negatively impacting cognitive and physical function, but with less severe pain and fatigue overall. These findings may help direct future investigations of the benefit of a biopsychosocial approach to the clinical management of post-COVID-19.
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