Several reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of ...cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome.
A cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis.
A total of 200 patients (mean age 48.8±14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO
(25.8±8.1mL/min/kg vs. 28.8±9.6mL/min/kg, p=0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p<0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p=0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders.
Our data suggest that post-COVID-19 syndrome was associated with less peak VO
, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value.
Post-COVID-19 condition refers to persistent or new onset symptoms occurring three months after acute COVID-19, which are unrelated to alternative diagnoses. Symptoms include fatigue, breathlessness, ...palpitations, pain, concentration difficulties ("brain fog"), sleep disorders, and anxiety/depression. The prevalence of post-COVID-19 condition ranges widely across studies, affecting 10-20% of patients and reaching 50-60% in certain cohorts, while the associated risk factors remain poorly understood. This multicentre cohort study, both retrospective and prospective, aims to assess the incidence and risk factors of post-COVID-19 condition in a cohort of recovered patients. Secondary objectives include evaluating the association between circulating SARS-CoV-2 variants and the risk of post-COVID-19 condition, as well as assessing long-term residual organ damage (lung, heart, central nervous system, peripheral nervous system) in relation to patient characteristics and virology (variant and viral load during the acute phase). Participants will include hospitalised and outpatient COVID-19 patients diagnosed between 01/03/2020 and 01/02/2025 from 8 participating centres. A control group will consist of hospitalised patients with respiratory infections other than COVID-19 during the same period. This study aims to understand post-COVID-19 syndrome's incidence and predictors by comparing pandemic waves, utilising retrospective and prospective data. Gender association, especially the potential higher prevalence in females, will be investigated. Symptom tracking via questionnaires and scales will monitor duration and evolution. Questionnaires will also collect data on vaccination, reinfections, and new health issues. Biological samples will enable future studies on post-COVID-19 sequelae mechanisms, including inflammation, immune dysregulation, and viral reservoirs.
A significant proportion of COVID-19 patients experience debilitating symptoms for months after the acute infection. According to recent estimates, approximately 1 out of 10 COVID-19 convalescents ...reports persistent health issues more than 3 months after initial recovery. This 'post-COVID-19 condition' may include a large variety of symptoms from almost all domains and organs, and for some patients it may mean prolonged sick-leave, homestay and strongly limited activities of daily life. In this narrative review, we focus on the symptoms and signs of post-COVID-19 condition in adults - particularly those associated with cardiovascular and respiratory systems, such as postural orthostatic tachycardia syndrome or airway disorders - and explore the evidence for chronic autonomic dysfunction as a potential underlying mechanism. The most plausible hypotheses regarding cellular and molecular mechanisms behind the wide spectrum of observed symptoms - such as lingering viruses, persistent inflammation, impairment in oxygen sensing systems and circulating antibodies directed to blood pressure regulatory components - are discussed. In addition, an overview of currently available pharmacological and non-pharmacological treatment options is presented.
Background
Post‐COVID‐19 symptoms and diseases appeared on many survivors from COVID‐19 which are similar to that of the post‐severe acute respiratory syndrome (SARS) fatigue. Hence, the study aims ...to investigate and characterise the manifestations which appear after eradication of the coronavirus infection and its relation to disease severity.
Method
About 287 survivors from COVID‐19 were included in the study, each received a questionnaire divided into three main parts starting from subjects’ demographic data, data about the COVID‐19 status and other comorbidities of the subject, and finally data about post‐COVID‐19 manifestations. Response surface plots were produced to visualise the link between several factors.
Results
Only 10.8% of all subjects have no manifestation after recovery from the disease while a large percentage of subjects suffered from several symptoms and diseases. The most common symptom reported was fatigue (72.8%), more critical manifestations like stroke, renal failure, myocarditis and pulmonary fibrosis were reported by a few percent of the subjects. There was a relationship between the presence of other comorbidities and severity of the disease. Also, the severity of COVID‐19 was related to the severity of post‐COVID‐19 manifestations.
Conclusion
The post‐COVID‐19 manifestation is largely similar to the post‐SARS syndrome. All subjects recovered from COVID‐19 should undergo long‐term monitoring for evaluation and treatment of symptoms and conditions that might be precipitated with the new coronavirus infection.
Inducible laryngeal obstruction (ILO) is the adduction of the true vocal folds during inspiration or, less frequently, expiration. Its etiology is unknown.
This study aimed to identify ILO as a ...possible cause of shortness of breath (SOB) in post-COVID-19 patients.
A retrospective study was conducted on 59 post-COVID-19 adults complaining of SOB. We collected the cases' clinical and chest imaging data, including demographic data, pulmonary function test (PFT), CT chest, and laryngeal endoscopic examination. A visual score was used to assign the severity of the glottic obstruction. The grades of this score ranged from 0 (complete patency) to 3 (almost complete closure).
ILO was detected in 8 out of 59 cases (13.5%). Two cases out of eight had glottic closure grade 1, while five cases had glottic closure grade 2, and one had glottic closure grade 3. There was a positive correlation between ILO grades (the severity of glottic closure) and PFT results (the degree of upper airway restriction). PFTs in ILO have a specific pattern. It was typical for the expiratory loop to be normal and the inspiratory loop to be flattened.
ILO is a possible cause of SOB in post-COVID-19 adult cases. It should be considered during evaluation and management.
Some patients with COVID-19 who have recovered from the acute infection after experiencing only mild symptoms continue to exhibit persistent exertional limitation that often is unexplained by ...conventional investigative studies.
What is the pathophysiologic mechanism of exercise intolerance that underlies the post-COVID-19 long-haul syndrome in patients without cardiopulmonary disease?
This study examined the systemic and pulmonary hemodynamics, ventilation, and gas exchange in 10 patients who recovered from COVID-19 and were without cardiopulmonary disease during invasive cardiopulmonary exercise testing (iCPET) and compared the results with those from 10 age- and sex-matched control participants. These data then were used to define potential reasons for exertional limitation in the cohort of patients who had recovered from COVID-19.
The patients who had recovered from COVID-19 exhibited markedly reduced peak exercise aerobic capacity (oxygen consumption VO
) compared with control participants (70 ± 11% predicted vs 131 ± 45% predicted; P < .0001). This reduction in peak VO
was associated with impaired systemic oxygen extraction (ie, narrow arterial-mixed venous oxygen content difference to arterial oxygen content ratio) compared with control participants (0.49 ± 0.1 vs 0.78 ± 0.1; P < .0001), despite a preserved peak cardiac index (7.8 ± 3.1 L/min vs 8.4±2.3 L/min; P > .05). Additionally, patients who had recovered from COVID-19 demonstrated greater ventilatory inefficiency (ie, abnormal ventilatory efficiency VE/VCO
slope: 35 ± 5 vs 27 ± 5; P = .01) compared with control participants without an increase in dead space ventilation.
Patients who have recovered from COVID-19 without cardiopulmonary disease demonstrate a marked reduction in peak VO
from a peripheral rather than a central cardiac limit, along with an exaggerated hyperventilatory response during exercise.
Objective The long-lasting persistence of autoantibodies stands as one of the hypotheses explaining the multisystemic manifestations seen in individuals with post-COVID-19 condition. The current ...review offers restricted insights into the persistence of autoantibodies in plasma/serum in people with post-COVID symptoms. Methods PubMed/MEDLINE, CINAHL, EMBASE, and Web of Science databases, as well as on medRxiv and bioRxiv preprint servers were searched up to January 5 th , 2024. Papers investigating the presence of autoantibodies in plasma/serum samples in people with post-COVID symptoms were included. The Newcastle-Ottawa Scale (NOS) was used to assess methodological quality. Results From 162 identified records, five articles met all inclusion criteria; four studies included infected controls with no post-COVID symptoms whereas all five studies included non-infected controls (410 COVID-19 survivors with post-COVID symptoms, 223 COVID-19 survivors with no post-COVID symptoms as controls and 266 non-infected healthy controls). Four studies concluded that the presence of autoantibodies had a potential (but small) role in post-COVID-19 condition whereas one study concluded that autoantibodies were not associated. Quality assessment showed all studies had high methodological quality. Conclusion Although evidence suggests that persistent autoantibodies can be associated with post-COVID symptoms, the clinical relevance of their presence seems modest at this stage. Current results highlight further research to clarify the role of autoantibodies in the development of post-COVID symptoms, guiding the development of tailored diagnostic and treatment approaches to enhance patient outcomes. Systematic review registration https://osf.io/vqz28 .
Long-term sequel of acute COVID-19, commonly referred to as long COVID, has affected millions of patients worldwide. Long COVID patients display persistent or relapsing and remitting symptoms that ...include fatigue, breathlessness, cough, myalgia, arthralgia, sleep disturbance, cognitive impairment and skin rashes. Due to the shared clinical features, laboratory and imaging findings, long COVID could mimic rheumatic disease posing a diagnostic challenge. Our comprehensive literature review will help rheumatologist to be aware of long COVID manifestations and differentiating features from rheumatic diseases to ensure a timely and correct diagnosis is reached.
Globally, there are now over 160 million confirmed cases of COVID-19 and more than 3 million deaths. While the majority of infected individuals recover, a significant proportion continue to ...experience symptoms and complications after their acute illness. Patients with ‘long COVID’ experience a wide range of physical and mental/psychological symptoms. Pooled prevalence data showed the 10 most prevalent reported symptoms were fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell, altered taste and diarrhoea. Other common symptoms were cognitive impairment, memory loss, anxiety and sleep disorders. Beyond symptoms and complications, people with long COVID often reported impaired quality of life, mental health and employment issues. These individuals may require multidisciplinary care involving the long-term monitoring of symptoms, to identify potential complications, physical rehabilitation, mental health and social services support. Resilient healthcare systems are needed to ensure efficient and effective responses to future health challenges.
The study aims to test the nexus of green financing with renewable electricity generation and energy efficiency. The study used data envelopment analysis (DEA) technique during the year of 2016 to ...2020 in developed and developing countries. The findings show that there is a 24% possibility of worldwide rise in expenditures in renewable energy through energy efficiency projects and probably could fall around 17% much further in 2017 and 2018. This may jeopardize the Sustainable Development Goals (SDGs) and the Paris climate change agreement. Lack of access to private financing slows the development of green initiatives. Now that sustainable energy is not about science and technology, it is all about getting financing in developed and developing countries. As policy measure, the study suggested to value environmental initiatives, like other infrastructure initiatives, for greater electricity generation and energy efficiency in developed and developing countries. Such infrastructural projects need long-term financing and capital intensiveness. It is further suggested to sustain growth, development, and energy poverty reduction, and around $26 trillion would be required, in terms of green financing, in the developed and developing countries alone by the year 2030 to enhance energy efficiency. To achieve energy sustainability goals in developed and developing countries, recent research suggested some policy implication considering the post COVID-19 time. If such policy implications are implemented successfully, there are chances that green financing would make energy generation and energy efficiency effective.
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