Pathology of the digestive system organs in post-COVID syndrome according to autopsy data from 2021-2024

Background and purpose: The COVID-19 pandemic has resulted in severe symptoms for many patients, continuing into the formation of post-COVID syndrome which affects the quality of life of patients. This study aims to assess relationship between history of physical activity and COVID-19 severity with post-COVID-19 syndrome. Methods: This was a cross-sectional study involving 87 randomly selected adult COVID-19 patients treated at Udayana University Hospital from January 2022 to December 2023. Data collected were characteristics of the participants, the history of physical activity measured with IPAQ questionnaire, the severity of COVID-19 based on several indicators on the medical records, and post-COVID syndrome assessed with questionnaire. Data analysis method used for the Bivariate test is Chi-Square, and Multivariate uses the Logistic Regression Test to find the relationship between all variables. Results: Of the 87 patients, 56.3% were men with age range from 19 to 56 years. The majority, 83.9% of patients had severe COVID symptoms and 43.7% experienced post-COVID syndrome, with the highest distribution being fatigue, at 81.6%. Low physical activity was associated with post-COVID syndrome (p=0.004), 60.5% patients with low physical activity experience post-COVID syndrome compared to 27.3% with moderate physical activity. A significant relationship was also found between the severity of COVID-19 symptoms and the incidence of post-COVID syndrome (p=0.002). As many as 35.6% of patients who experienced mild COVID-19 experienced post-COVID syndrome, while 85.7% of COVID-19 patients who experienced moderate-severe COVID-19 experienced post-COVID syndrome. The multivariate test also provided significant results between history of physical activity and post-COVID syndrome (p=0.014) and the relationship between COVID-19 severity and post-COVID syndrome (p=0.011). Conclusion: A relationship was found between the history of pre-COVID physical activity and the severity of COVID symptoms with the incidence of post-COVID syndrome. On the other hand, there is no relationship between gender, age and comorbidity with post-COVID syndrome.

Coronavirus (COVID-19) is a highly severe infection caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2). The polymerase chain reaction (PCR) test is essential to confirm the COVID-19 infection, but it has certain limitations, including paucity of reagents, is computationally time-consuming, and requires expert clinicians. Clinicians suggest that the PCR test is not a reliable automated COVID-19 patient detection system. This study proposed a machine learning-based approach to evaluate the PCR role in COVID-19 detection. We collect real data containing 603 COVID-19 samples from the Pakistan Institute of Medical Sciences (PIMS) Hospital in Islamabad, Pakistan, during the third COVID-19 wave. The experiments are separated into two sets. The first set comprises 24 features, including PCR test results, whereas the second comprises 24 features without PCR test. The findings demonstrate that the decision tree achieves the best detection rate for positive and negative COVID-19 patients in both scenarios. The findings reveal that PCR does not contribute to detecting COVID-19 patients. The findings also aid in the early detection of COVID-19, mainly when PCR test results are insufficient for diagnosing COVID-19 and help developing countries with a paucity of PCR tests and specialist facilities.

The purpose of this study was to evaluate the level of cytokines in the blood serum of patients with acute coronary syndrome (ACS) who had and did not have COVID-19 in the dynamics of the disease and treatment. Our objectives were as follows: To identify groups of patients with ACS who had previously suffered from COVID-19 and who did not have this disease; to determine cytokine levels initially and over time in 2 groups of patients, i.e., those with and without previous COVID-19. Measurement of cytokine levels was carried out in 20 male patients with ACS without a history of COVID-19 and ACS patients with post-COVID syndrome. The contents of cytokines were determined by multiplex analysis on a MagPix 100 device using a test system from BioRad (USA) for 17 cytokines. As based on the data obtained, one may note that in patients who recovered from COVID-19, compared with persons without previous COVID-19, IL-10, IL-1β, IL-8 levels were significantly lower, and IL-13, IL-6, MCP-1 contents were increased. In the course of time, a statistically significant decrease (p 0.05) was found in patients who had previously had COVID-19 for IL-10, IL-13, IL- 2, IL-6, MCP-1, MIP-1β, TNFα, whereas IL-8 levels were increased (p 0.05). In patients without a history of COVID-19, a statistically significant decrease was revealed in dynamics for IFNγ, IL-6, MCP-1, MIP-1β, TNFα, along with increase in IL-8 contents (p 0.05). Patients with post-COVID syndrome, compared with those without a history of COVID-19, had a higher content of pro-inflammatory cytokines, in particular, IL-6, IL-8, MCP-1. In the time dynamics after complex therapy (drug and stenting of coronary arteries), there was an improvement in some indices 28 days later. In particular, in both groups (those previously ill, versus not exposed to COVID-19), the following pro-inflammatory cytokines were decreased significantly (p 0.05): IL-6, IL-8, MCP-1, MCP-1β, TNFα. Meanwhile, the anti-inflammatory cytokine IL-10 was increased (p 0.05). Hence, the disturbances in regulation of immunity and, first of all, in chemokine parameters, were obtained in the patients with post-COVID syndrome and ACS, in contrast to the persons with ACS who was not previously affected by COVID-19. In patients with acute coronary syndrome who have recovered from COVID-19, we have found a more pronounced disruption of cytokine regulation of immune system than in patients who did not suffer from the coronavirus infection.

Background Many patients seek medical help for COVID-19’s longer term physical and mental effects. The term post COVID syndrome is used by the World Health Organization (WHO) to identify individuals with a history of probable or confirmed COVID-19 infection, usually 3 months from the onset of infection with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Symptoms may be due to persistent chronic inflammation, sequelae of organ damage, and hospitalization and social isolation. These symptoms may persist from the initial infection, or appear after a period of recovery. RV dimensions (RVD) and RV function (RVF) are closely correlated to symptom occurrence and to exercise capacity in many clinical conditions. Consequently, a comprehensive and accurate evaluation of the RV is essential. Echocardiography is the modality of choice for the assessment of RVD and RVF in clinical practice owing to its numerous advantages. It is widely available, relatively cheaper than other modalities, non-invasive, and doesn’t require radiation or contrast injection. Nevertheless, the RV special anatomy, its retrosternal position and its complex architecture pose a challenge to conventional echocardiographic imaging. Novel modalities of echocardiography, such as myocardial deformation imaging by speckle tracking echocardiography (STE), provide the solution to overcome most of these challenges owing to the fact that it is independent of cardiac translation, angle-independent and load-independent. Aim and Objectives The aim was to study RV function in post COVID syndrome in recovered mild severity COVID-19 patients using 2D RV STE and correlate these findings with the patients’ symptomatology. Patients and Methods This study included 96 subjects divided into 3 age and gender matched groups; the first group consisted of 32 mild severity COVID-19 patients 3-6 months after recovery and not complaining of post COVID-19 syndrome, the second group consisted of 32 mild severity COVID-19 patients 3-6 months after recovery and complaining of post COVID-19 syndrome and the third group consisted of 32 healthy controls who didn’t get COVID-19. This study was conducted at Ain Shams University Hospitals. The patients were recruited from the outpatient ECHO clinic in the cardiology department during the period from March 2022 to August 2022. The entire study population was evaluated via 2D conventional echocardiography and STE imaging. Results Our study assessed RV functions at 3-6 months after recovery from mild severity COVID-19 disease. At the follow-up, TAPSE, RV-FAC, RV S’, RV-GLS and RV-FWLS parameters were significantly lower in patients with mild severity COVID-19 disease than healthy controls. They also showed lower values in patients with post COVID syndrome than those without post COVID syndrome with P-value = 0.032, 0.034, 0.003, 0.010 and 0.029 respectively. In addition, RV diameters (longitudinal, mid and basal RVEDD), RV MPI and sPAP values were significantly higher in patients with mild severity COVID-19 disease than healthy controls. They also showed higher values in patients with post COVID syndrome than those without post COVID syndrome with P-value = 0.043, 0.026, 0.014, 0.000 and 0.025 respectively. LV-GLS showed lower value in patients with post COVID syndrome than control group with P-value = 0.002. It also showed lower value in patients with post COVID syndrome than those without post COVID syndrome with P-value = 0.018. We also found that the most common symptom in post COVID syndrome was fatigue, with a percentage of 65.6%, followed by palpitations (40.6%) and chest pain (31%). These three symptoms showed a significant negative relation with RV 2D STE parameters. Additionally, a negative correlation between inflammatory markers including CRP, TLC, PLT, ferritin and D-dimer levels during active infection and long term echocardiographic parameters such as RV-GLS, RV-FWLS and LV-GLS was detected in our study. Conclusion We concluded that RV-GLS and RV-FWLS decreased at 3-6 month follow-up of patients with history of mild severity COVID-19 disease especially those complaining of post COVID syndrome. Additionally, it is demonstrated that increased CRP, TLC, PLT, ferritin and D-dimer levels during acute infection is related to RV-GLS, RV-FWLS and LV-GLS values. 2D STE may be used for both detection and follow-up for possible long term right ventricular dysfunction after mild severity COVID-19 disease. Key words: Post-COVID Syndrome, Speckle Tracking Echocardiography, RV-GLS, RV-FWLS, LV-GLS Abbreviations. Abbreviations: RV Right Ventricle STE Speckle Tracking Echocardiography 2D 2-Dimensional TAPSE Tricuspid Annular Plane Systolic Excursion RV-FAC Right Ventricular Fractional Area Change RV-GLS Right Ventricular Global Longitudinal Strain RV-FWLS Right Ventricular Free Wall Longitudinal Strain LV-GLS Left Ventricular Global Longitudinal Strain RVEDD Right Ventricular End Diastolic Dimension RV MPI Right Ventricular Myocardial Performance Index sPAP Systolic Pulmonary Artery Pressure CRP C – Reactive Protein TLC Total Leucocytic Count PLT Platelets WHO World Health Organization LVEDD Left Ventricular End Diastolic Dimension LVESD Left Ventricular End Systolic Dimension FS Fractional Shortening EF Ejection Fraction

In the wake of the SARS-CoV-2 pandemic, a novel condition, termed Post-COVID Syndrome (PCS) has emerged, impacting a significant portion of the global population. Concurrently, the global impact of the virus has extended beyond physical health, leading to the emergence of COVID-19 related stigma. This study investigates the link between PCS and self-stigma, shedding light on this underexplored phenomenon. To examine whether exposure to PCS is associated with higher levels of COVID-19–related self-stigma and to identify potential risk factors. A retrospective observational cohort study among adult Israeli citizens who tested positive for COVID-19 in a polymerase chain reaction (PCR) test at least twelve weeks before the interview, serving as a pivotal criterion for diagnosing PCS based on self-reported symptoms. The study sample was drawn from the Israeli Ministry of Health’s comprehensive COVID-19 database and data were obtained via a computerized telephone questionnaire conducted from June through December 2021. The quantification of self-stigma entailed the utilization of the COVID-19 self-stigma scale. The study examined the adjusted association between exposure to PCS and self-stigma, controlling for socio-economic characteristics. Seven hundred fifty-nine participants (48.7% male) responded, with a mean age of 47.2 years (SD = 14.9). A quarter (25.2%) of the study population met the criteria for PCS, and 28.1% met the criteria for self-stigma. A significant association was found between PCS and self-stigma, with individuals experiencing PCS reporting higher self-stigma (p < 0.001). Multivariable linear and logistic regression analyses confirmed that PCS was significantly associated with self-stigma modeled as both a continuous and a dichotomous outcome (R2 = 0.09, p < 0.001; OR = 2.5, p < 0.001, respectively). This study underscores a significant association between PCS and self-stigma, independently of sociodemographic factors. Given this association, it is imperative to develop comprehensive strategies aimed at stigma reduction among PCS patients. These findings have importance beyond COVID-19, providing lessons for future pandemics and emergencies.

Three SARS-CoV-2 PCR-negative cases of COVID-19 diagnosed using isothermal amplification methods

The polymerase chain reaction test, used in the diagnosis of COVID-19, can be positive with delay, and thorax tomography is used for the diagnosis of the disease. We aimed to compare the relation between thorax tomography findings, PCR test results, and neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume in COVID-19 patients. COVID-19 patients were divided into three groups, according to baseline laboratory and thorax tomography findings: Group A: thorax tomography finding positive - polymerase chain reaction test positive; Group B: thorax tomography finding negative - polymerase chain reaction test positive; and Group C: thorax tomography finding positive - polymerase chain reaction test negative. Neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume values were compared between these three groups. Group C neutrophil lymphocyte ratio level and polymerase chain reaction level were statistically higher than that of group B (p<0.001 in both). Mean platelet volume was not statistically significant between groups (p>0.005 for all). A positive correlation was detected between neutrophil lymphocyte ratio and C-reactive protein (r=0.421, p<0.001). Similarly, positive correlation was found with polymerase chain reaction and C-reactive protein (r=0.243, p=0.001). The thorax tomography finding can be detected earlier in the disease before the polymerase chain reaction test. The sensitivity of the polymerase chain reaction test varies according to the tester, the way of performing it, and the quality of the test. Therefore, especially in patients with polymerase chain reaction negative and thorax tomography findings, neutrophil lymphocyte ratio and platelet lymphocyte ratio levels should be evaluated, and patients should be followed up upon suspicion of COVID-19 diagnosis.

Aim of the studyTo evaluate the prevalence and the type of liver pathology in children at the time of diagnosis of celiac disease (CD).Material and methodsData from newly diagnosed children with CD hospitalized in the university hospital were retrospectively reviewed. Liver pathology was defined as elevated alanine transaminase (ALT) and/or gamma-glutamyl transpeptidase (GGT) serum activity and/or pathological changes of the organ in ultrasound.ResultsLiver pathology was detected in 17 of 149 children (11.4%). Ten patients (6.7%) had an elevated ALT serum activity, whereas no child had an elevated GGT activity. Pathological changes of liver in ultrasound (mainly enlargement or steatosis of the organ) were found in 12 patients (8.1%), of whom 5 children (3.4%) had simultaneously elevated ALT serum activity. Children with liver pathology had lower iron (Fe) (p = 0.02) and folic acid (p = 0.01) concentrations compared to the rest of the patients. There were no statistically significant differences between liver pathology existence and age, sex, serum immunoglobulin A anti-tissue transglutaminase type 2 antibodies (IgA anti-TG2), ferritin, vitamin B12, or vitamin D concentrations. Moreover, a positive correlation between IgA anti-TG2 concentration and ALT serum activity was found (p < 0.01, R = 0.29).ConclusionsLiver pathology is present at diagnosis in a significant proportion of children with CD in the form of hypertransaminasemia and pathological changes of the organ in ultrasound. There is a correlation between IgA anti-TG2 concentration and ALT serum activity.

Long-term hepatitis B virus (HBV) infection can cause recurrent inflammation in the liver, and then develop into liver fibrosis, cirrhosis, and liver cancer. The hepatic pathological change is one of the important criteria for guiding antiviral therapy in patients with chronic hepatitis B (CHB). Due to the limitations of liver biopsy, it is necessary to find valuable non-invasive indicators to evaluate the hepatic pathological changes in CHB patients and guide the antiviral therapy. This study aims to analyze the clinical characteristics of different pathological changes in CHB patients, and to explore the factors influnencing the degree of liver inflammation and fibrosis in CHB patients with normal alanine aminotransferase (ALT). This retrospective study was conducted on 310 CHB patients. Liver biopsy was performed in all these patients. The clinical data of the patients were collected. The liver biopsy pathological results were used as the gold standard to analyze the relationship between clinical indicators and liver pathological changes. Then CHB patients with normal ALT were screened, and the independent factors influencing the degree of liver inflammation and fibrosis were explored. Among the 310 patients with CHB, there were 249 (80.3%) patients with significant liver inflammation [liver inflammation grade (G) ≥2] and 119 (38.4%) patients with significant liver fibrosis [liver fibrosis stage (S) ≥2]. The results of univariate analysis of total samples showed that the ALT, γ-glutamyl transferase, alkaline phosphatase, and HBV DNA were related to the significant liver pathological changes. Among the 132 CHB patients with normal ALT, the patients with liver pathology G/S≥2, G≥2, and S≥2 were 80.3% (106/132), 68.2% (90/132), and 43.2% (57/132), respectively. The results showed that the independent influencing factor of significant liver inflammation was HBV DNA>2 000 U/mL (OR=3.592, 95% CI 1.534 to 8.409), and the independent influencing factors of significant liver fibrosis were elevated alkaline phosphatase level (OR=1.022, 95% CI 1.002 to 1.043), decreased platelet count (OR=0.990, 95% CI 0.982 to 0.998), and positive in hepatitis B e antigen (HBeAg) (OR=14.845, 95% CI 4.898 to 44.995). According to the multivariate analysis, a diagnostic model for significant liver fibrosis in CHB patients with normal ALT was established, and the area under the receiver operating characteristic curve was 0.844 (95% CI 0.779 to 0.910). The liver pathological changes should be evaluated in combination with different clinical indicators. A considerable number of CHB patients with normal ALT still have significant liver pathological changes, which need to be identified and treated with antiviral therapy in time. Among them, HBV DNA>2 000 U/mL suggests the significant liver inflammation, and the diagnostic model for significant liver fibrosis based on alkaline phosphatase, platelet count, and HBeAg can help to evaluate the degree of liver fibrosis.

Objective To analyze and investigate the relationship between Helicobacter pylori (Hp) infection and the gastric mucosa diseases and their pathological changes.Methods The gastric mucosa biopsy sections from 700 patients with gastric mucosa diseases were selected as the study objects.Hp infection of the biopsy sections was detected by Giemsa staining and Warthin-Starry staining method and the relationship between Hp infection and the gastric mucosa diseases and the pathological changes was analyzed.Results Among all 700 sections,there were 463 cases of Hp positive sections and the Hp positive detective rate was 66.14％.The Hp detection rates of the gastric mucosa biopsy sections from patients with chronic superficial gastritis,chronic atrophic gastritis,gastric ulcer and gastric cancer were 46.86％,69.46％,83.62％ and 98.65％.The overall difference of the Hp detection rates of the gastric mucosa biopsy sections from patients with each of the four diseases and the differences between every two diseases were significant (P ＜ 0.05) ; by analyzing the pathology changes and Hp infection of the gastric mucosa biopsy sections,the results showed the Hp infection rate of the gastric mucosa biopsy sections in which the pathological changes was atrophic changes,active changes,intestinal metaplasia,atypical hyperplasia of glandular epithelium,lymphoid follicles increased significantly (P ＜ 0.05).Conclusions Hp infection is correlated with the gastric mucosa diseases such as chronic gastritis,gastric ulcer and gastric cancer and their pathological changes.As the diseases progresses and the pathological structure changes,Hp infection rate showes a rising trend.Therefore,timely treatment of Hp infection is very important for prevention and treatment of gastric mucosal diseases and the progress of their pathological changes. Key words: Helicobacter pylori ; Gastritis ; Pathology

BackgroundStarting in December 2019, the current pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confronts the world with an unprecedented challenge. With no vaccine or drug being currently available to control the pandemic spread, prevention and PCR (Polymerase chain reaction) testing becomes a crucial pillar of medical systems. Aim of the present study was to report on the first results of the measures taken in a large German Department of Radiation Oncology, including PCR testing of asymptomatic cancer patients.MethodsPandemic-adapted hygiene regulations and prevention measures for patients and staff were implemented. A visiting ban on both wards was implemented from the beginning and medical staff and patients were required to wear face masks at all times. The waiting rooms were rearranged to ensure distance between patients of at least 1.5 m. Clinical follow up was mainly done by telephone and all patients had to complete a questionnaire regarding symptoms and contacts with COVID-19 patients before entering our department. Educational documents were created for patients to raise awareness of symptoms and avoidance strategies for interactions with other people. Indications for therapy and fractionation schemes were adapted when possible. In a subsequent step, all new asymptomatic patients were tested via nasopharyngeal swab at our screening station shortly before their simulation CT.ResultsAll these measures and implementations have been well accepted semiquantitatively measured by the consent received from patients and staff. Regarding the PCR testing, only 1 out of 139 asymptomatic patients of our cohort so far tested positive for SARS-CoV-2, reflecting a prevalence of 0.72% in this cancer patient population. Up to this point no staff members was tested positive. The start of the treatment for the PCR-positive patient was deferred for 2 weeks.ConclusionDue to the pandemic-adapted implementations, our department seems well prepared during this crisis. The initial screening helps to identify asymptomatic COVID-19 patients in order to protect other patients and our staff from infection and the observed PCR prevalence is in line with comparable studies. A regular PCR testing (e.g. twice a week) of all patients and staff would in principle be desirable but is limited due to testing capacities at present.

Hippocampal subfield abnormalities and biomarkers of pathologic brain changes: from SARS-CoV-2 acute infection to post-COVID syndrome.

SARS-CoV-2 persistence and non-protective immunity in infected haematological patients.

The term „post-COVID syndrome“ refers to a variety of long-lasting symptoms that have been reported in a significant number of patients after SARS-CoV-2 infection. Computed tomography (CT) scans of the chest in patients with post-COVID syndrome often reveal various pathological changes. A visual evaluation by radiologists serves as the foundation for CT examination of the chest in modern clinical practice; yet this diagnostic process may lead to subjectivity, interpretation variability, and is often time-consuming due to the complexity and volume of data that must be thoroughly assessed. For this reason, the medical industry is searching for innovations that have the potential to automate the diagnostic process of CT analysis and serve as an assistive tool for radiologists. CT scans have shown to be useful for quantifying pathologically altered lung parenchyma in patients with post-COVID syndrome. The aim of this research is to demonstrate an approach for automatic segmentation of pathologically altered lung parenchyma based on the chest CT scans. In this research DeepLabv3+ with Xception_65, MobileNetV2, and ResNet101 as backbones are used in order to perform semantic segmentation. Performances of the proposed approach based on CT scans have achieved an average mIOU of 0.86299 ± 0.00614, F1 of 0.92259 ± 0.00397, accuracy of 0.98421 ± 0.00106, precision of 0.91931 ± 0.00453, sensitivity of 0.92614 ± 0.0047, and specificity of 0.99144 ± 0.00062. Based on the obtained results, the proposed approach proved to be successful in terms of quantifying pathologically altered lung parenchyma in patients with post-COVID syndrome and has promising potential for clinical use.

Abstract: Corona virus Disease 2019 (COVID-19) has spread worldwide and has become a global public health emergency. The World Health Organization declared the outbreak a pandemic. Pulmonary Rehabilitation has shown good impact on Quality of life , Functional capacity and health status of patients with Chronic Respiratory Disease Recently there are various guidelines and consensus available for Pulmonary Rehabilitation in Post – COVID patients that has been extrapolated from other respiratory condition. There is paucity of literature that has shown the effect of Exercise training program on Physical capacity and Health status of patient with Post COVID 19 syndrome. So the present study uses the available evidence on COVID 19 patients to prepare the exercise program and implement it on post COVID syndrome patients.Thus, the aim of this study is to evaluate the effect of supervised Exercise Training Program on Post COVID-19 syndrome patients Methodology: In this experimental study total 70 patients with Post Covid Syndrome will be included and they will be equally divided into two groups. Group A will receive supervised exercise training, while Group B will receive unsupervised exercise training. Participant will be evaluated at the beginning of therapy or after 6 weeks. Discussion: This study is conducted to evaluate effectiveness of structured exercise training program and its feasibility on physical capacity and health status of patients with Post COVID19 syndrome. Conclusion: Its effectiveness of a structured exercise program and its feasibility on physical capacity and health status of patients with Post COVID19 syndrome will be evaluated.