Coronavirus Disease 2019 Survivors Research Articles

Coronavirus disease 2019 and its impact on the cognition of older adults: Unraveling the role of inflammation

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic significantly impacted the older adult population globally. This study aimed to investigate cognitive function and its relationship with inflammation in older COVID-19 survivors over a three-month follow-up to address concerns about cognitive impairment and its risk factors. MethodsIn this descriptive-analytical study, 177 hospitalized COVID-19 patients aged >60 were assessed from July 2021 to February 2022. Psychiatric, global cognitive assessments and activities of daily living were conducted at discharge, 1 month, and 3 months post-discharge. Statistical analyses were conducted using SPSS Version 24. The evolution of cognitive status over time was evaluated using the Repeated Measures Test. The study probed into the association between inflammatory markers and cognitive function through the Pearson correlation test and the Mann–Whitney U test. Additionally, the link between anxiety/depression and cognitive performance was examined using the Pearson correlation. ResultsResults indicated that higher levels of C-reactive protein (CRP), D-dimer, and Lactate Dehydrogenase (LDH) were correlated to reduced cognitive performance. Conversely, Erythrocyte Sedimentation Rate (ESR) and Creatine Phosphokinase (CPK) did not exhibit a significant relationship with cognitive scores. A positive correlation was observed between improved cognitive function (reflected by higher GPCOG scores) and lower levels of anxiety and depression (indicated by lower scores on the Hospital Anxiety and Depression Scale). Over the study period, cognitive function and anxiety scores showed an upward trend, whereas symptoms of depression and challenges in daily activities remained consistent. ConclusionsThe study highlights the enduring effects and detrimental role of inflammation on overall cognitive abilities among older survivors of COVID-19. It underscores the urgent need for specialized interventions and rehabilitative strategies to facilitate sustained cognitive recuperation among these individuals.

Rehabilitation Strategies for COVID-19 Survivors: A Guide to Restoring Functional Independence

The pandemic of coronavirus disease 2019 (COVID-19) and the response to it are creating a tsunami of rehabilitation needs. This white paper offers a comprehensive guide to designing effective rehabilitation strategies for individuals recovering from COVID-19. With a focus on treating respiratory and neuromuscular dysfunctions, the rehabilitation demands of COVID-19 survivors are becoming more widely acknowledged. Focused on restoring functional independence, the paper addresses key considerations in the rehabilitation process, including musculoskeletal, respiratory, cardiovascular, and psychosocial aspects. This white paper serves as a valuable resource for healthcare professionals and individuals seeking guidance on effective rehabilitation strategies post-COVID-19, emphasizing the restoration of functional independence.

Psychiatric outcomes in outpatients affected by long COVID: A link between mental health and persistence of olfactory complaint.

Anosmia was one of the main symptoms of coronavirus disease 2019 (COVID-19). A psychiatric history (i.e., depression) may be an independent contributor to the risk of COVID-19 diagnosis, and COVID-19 survivors appear to have an increased risk of neuropsychiatric sequelae (bidirectional association). To compare the rate of psychiatric disorder among post-COVID patients without anosmia vs patients with persistent olfactory complaints. We conducted a prospective case control study from March 2020 to May 2021. Patients recruited at the ENT department of Nice University Hospital had a subjective olfactory complaint (visual analogue scale) for over 6 wk and a molecular or CT-proven severe acute respiratory syndrome coronavirus 2 diagnosis confirmed by serology. Post-COVID patients without persistent olfactory disorders were recruited at the university hospital infectiology department. Psychiatric medical histories were collected by a psychiatrist during the assessments. Thirty-four patients with post-COVID-19 olfactory complaints were included in the first group of the study. Fifty percent of the patients were female (n = 17). The group's mean age was 40.5 ± 12.9 years. The control group included 32 participants, of which 34.4% were female (n = 11), and had a mean age of 61.2 ± 12.2 years. The rate of psychiatric disorder among post-COVID patients with olfactory complaints was significatively higher (41.7%) than among patients without (18.8%) (χ2 = 5.9, P = 0.015). The presence of a psychiatric history may constitute a potential risk factor for the development of long COVID due to persistent anosmia. It therefore seems important to establish reinforced health monitoring after a COVID 19 infection in at-risk patients. Further prospective, translational, and collaborative studies are needed to extrapolate these results to the general population.

Two- and 3-year outcomes in convalescent individuals with COVID-19: A prospective cohort study.

As the long-term consequences of coronavirus disease 2019 (COVID-19) have not been defined, it is necessary to explore persistent symptoms, long-term respiratory impairment, and impact on quality of life over time in COVID-19 survivors. In this prospective cohort study, convalescent individuals diagnosed with COVID-19 were followed-up 2 and 3 years after discharge from hospital. Participants completed an in-person interview to assess persistent symptoms and underwent blood tests, pulmonary function tests, chest high-resolution computed tomography, and the 6-min walking test. There were 762 patients at the 2-year follow-up and 613 patients at the 3-year follow-up. The mean age was 60 years and 415 (54.5%) were men. At 3 years, 39.80% of the participants had at least one symptom; most frequently, fatigue, difficulty sleeping, joint pain, shortness of breath, muscle aches, and cough. The participants experienced different degrees of pulmonary function impairment, with decreased carbon monoxide diffusion capacity being the main feature; results remained relatively stable over the 2-3 years. Multiple logistic regression analysis demonstrated that female sex and smoking were independently associated with impaired diffusion capacity. A subgroup analysis based on disease severity was performed, indicating that there was no difference in other parameters of lung function except forced vital capacity at 3-year follow-up. Persistent radiographic abnormalities, most commonly fibrotic-like changes, were observed at both timepoints. At 3 years, patients had a significantly improved Mental Component Score compared with that at 2 years, with a lower percentage with anxiety. Our study indicated that symptoms and pulmonary abnormalities persisted in COVID-19 survivors at 3 years. Further studies are warranted to explore the long-term effects of COVID-19 and develop appropriate rehabilitation strategies.

Long-term outcome of pulmonary involvement in patients with coronavirus disease 2019: The role of high-resolution computed tomography and functional status – A prospective single-center observational study

BACKGROUND: Since its first outbreak, coronavirus disease 2019 (COVID-19) has led to a great deal of published literature highlighting the short-term determinants of morbidity and mortality. Recently, several studies have reported radiological and functional sequelae from 3 months to 1 year among hospitalized COVID-19 survivors; however, long-term (more than 1 year) respiratory consequences in this population remain to be evaluated. OBJECTIVE: To assess the long-term radiological and pulmonary function outcomes of patients with COVID-19 2 years after resolution of the initial infection. METHODS: Hospitalized COVID-19 patients with moderate to severe disease who survived acute illness were included in this prospective and partially retrospective study. Clinical assessment, laboratory tests, high-resolution computed tomography scans, and pulmonary function tests (PFTs) were performed at baseline, followed by radiological and lung function assessments at 6 and 24 months. RESULTS: Among 106 enrolled participants (mean age 62 ± 13.5 years; males: 61), 44 (41.5%) and 27 (25.4%) underwent radiological assessment at 6 and 24 months, respectively. Overall, 22.6% (24) of patients had residual radiological abnormalities. Overt fibrosis was observed in 12.2% of patients. Computed tomography disease severity and extent diminished significantly at 6 (13 ± 6, P < 0.001) and 24 months (11 ± 6, P < 0.001) from baseline. PFTs were performed in 65 (61.3%), 22 (20.7%), and 34 (32%) patients at baseline, 6 and 24 months, respectively. Impaired diffusion capacity (median diffusion capacity for carbon monoxide: 60%, interquartile range [IQR]: 51–80), restrictive lung defect (mean total lung capacity: 73.4% ± 18% predicted), and reduced exercise tolerance (median 6-min walk distance: 360 m, IQR: 210–400) were the predominant features at baseline. With the exception of exercise tolerance, a statistically significant improvement was observed in lung function parameters at the extended follow-up (2 years). CONCLUSIONS: Hospitalized COVID-19 survivors are at increased risk of developing long-term pulmonary complications, including lung fibrosis. A protocol-based approach to the management of post-COVID-19 patients is mandatory to improve future outcomes.

Comparison of nailfold capillaroscopy findings in COVID-19 survivors with and without rheumatic disease: a case-control study

Purpose: The aim of this study was to evaluate the nailfold capillaroscopy (NFC) findings of patients with rheumatic disease and healthy controls (HCs) who survived coronavirus disease 2019 (COVID-19).
 Materials and Methods: This study included patients with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and rheumatoid arthritis (RA) who recovered from COVID-19 and HCs. NFC was performed for all participants. NFC findings of the three groups [patients with COVID-19 (group 1), HCs with COVID-19 (group 2), and HCs without COVID-19 (group 3)] were compared.
 Results: A total of 142 individuals (group 1, n = 42; group 2, n = 50; group 3, n = 50) were included in the study. Hospitalization and oxygen therapy were more common in group 1 than in group 2. The median time from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive real-time polymerase chain reaction (RT-PCR) test to NFC was 10.3 (6.3–24.4) weeks in group 1 and 17.1 (6.1–44.9) weeks in group 2. All NFC findings did not differ among the groups except for capillary ramifications, which were higher in group 1 than in groups 2 and 3. Underlying rheumatic disease was the only predictor that was significantly associated with capillary ramifications.
 Conclusion: The NFC findings of COVID-19 survivors with and without rheumatic disease were substantially similar to those of HCs who did not have COVID-19. Capillary ramifications may result from an underlying rheumatic disease in patients with axSpA, PsA, and RA.

A Prospective 1-Year Follow-Up of Glycemic Status and C-Peptide Levels of COVID-19 Survivors with Dysglycemia in Acute COVID-19 Infection.

We evaluated changes in glycemic status, over 1 year, of coronavirus disease 2019 (COVID-19) survivors with dysglycemia in acute COVID-19. COVID-19 survivors who had dysglycemia (defined by glycosylated hemoglobin [HbA1c] 5.7% to 6.4% or random glucose ≥10.0 mmol/L) in acute COVID-19 were recruited from a major COVID-19 treatment center from September to October 2020. Matched non-COVID controls were recruited from community. The 75-g oral glucose tolerance test (OGTT) were performed at baseline (6 weeks after acute COVID-19) and 1 year after acute COVID-19, with HbA1c, insulin and C-peptide measurements. Progression in glycemic status was defined by progression from normoglycemia to prediabetes/diabetes, or prediabetes to diabetes. Fifty-two COVID-19 survivors were recruited. Compared with non-COVID controls, they had higher C-peptide (P< 0.001) and trend towards higher homeostasis model assessment of insulin resistance (P=0.065). Forty-three COVID-19 survivors attended 1-year reassessment. HbA1c increased from 5.5%±0.3% to 5.7%±0.2% (P<0.001), with increases in glucose on OGTT at fasting (P=0.089), 30-minute (P=0.126), 1-hour (P=0.014), and 2-hour (P=0.165). At baseline, 19 subjects had normoglycemia, 23 had prediabetes, and one had diabetes. Over 1 year, 10 subjects (23.8%; of 42 non-diabetes subjects at baseline) had progression in glycemic status. C-peptide levels remained unchanged (P=0.835). Matsuda index decreased (P=0.007) and there was a trend of body mass index increase from 24.4±2.7 kg/m2 to 25.6±5.2 (P=0.083). Subjects with progression in glycemic status had more severe COVID-19 illness than non-progressors (P=0.030). Reassessment was not performed in the control group. Subjects who had dysglycemia in acute COVID-19 were characterized by insulin resistance. Over 1 year, a quarter had progression in glycemic status, especially those with more severe COVID-19. Importantly, there was no significant deterioration in insulin secretory capacity.

Evaluation of cognitive functions and dementia two years after COVID-19 infection

Background: The Coronavirus disease 2019 (COVID-19) causes high morbidity and mortality in the acute period. Some patients with COVID-19 continue to have symptoms for a long time. However, data on the long-term effects of COVID-19, particularly on cognitive disorders is scarce. We aimed to evaluate cognitive functions and dementia in patients who survived two years after discharge from hospital due to acute covid-19 infection. Methods: Two hundred and five patients who had neurological symptoms during index hospitalization for COVID-19 infection were evaluated two years after discharge, and 64 patients were included in the study. According to cognitive assessments, patients were grouped as having normal cognitive levels (48 patients) or impaired cognitive levels (16 patients). Results: The impaired cognitive level was found in 16 (25.0%) of patients who underwent cognitive tests. Age, the pre-existence of neurological comorbidity, mean intensive care unit day, and Beck’s Anxiety Inventory and Beck’s Depression Inventory scores in the impaired cognitive level group were significantly higher than the normal cognitive level group (p:0.001, p:0.013, p:0.015, p:0.004 and p:0.008). The frequency of cognitive impairment in patients who developed altered mental state during hospitalization was 36.0%, while it was 17.9% in patients with normal mental state. Age, the pre-existence of neurological comorbidity, and anxiety were determined as independent risk factors for impaired cognitive level. In addition, we detected new-onset dementia in 8 patients (12.5%). Conclusion: We found a high frequency of cognitive impairment and new-onset dementia among COVID-19 survivors who developed neurological manifestations during the acute infection phase.

12-month risk factor evaluation for persistent pulmonary symptoms in long COVID-19 patients

BackgroundKnowledge of the sequelae of new coronavirus disease 2019 (COVID-19) is still limited owing to the relative recent onset of the disease. However, the study of other different types of coronavirus infections prior to COVID-19 infection reports that the patients may experience persistent symptoms following the infection.The aim of this studyAssessment and follow-up of persistent respiratory symptoms in patients recovered from acute COVID-19 infection.MethodsIn this prospective cohort study, COVID-19 patients diagnosed at Beni-Suef University hospital and followed up prospectively at 3, 6, and 12 months after discontinuation of quarantine. Patients were interviewed for persistent respiratory symptoms then underwent assessment by physical examination and routine labs.ResultsSeventy-one patients were evaluated and participated in this study. The mean age of the patients was 47 years and 46 (64%) of them were females. After 3 months, 77.5% of the patients had persistent dyspnea, 57.7% persistent fatigue, 15.5% persistent cough, and 8.5% persistent chest pain. At the 6th month, dyspnea and fatigue persisted in 33.8% and 22.5% of cases respectively while at the 12th month dyspnea persisted in 22.5% of cases. Old age, smoking, diabetes mellitus, severity of the disease, and hypoxemia on admission were associated factors with persistent symptoms.ConclusionOur result added to the growing evidence that there are pulmonary sequelae in COVID-19 survivors, which may become a significant chronic global pulmonary health problem.

Micronized/ultramicronized palmitoylethanolamide improves depression and fatigue in coronavirus disease 2019 (COVID-19) survivors.

Coronavirus disease 2019 (COVID-19) may lead to neuropsychiatric sequelae. Palmitoylethanolamide (PEA) is an anti-inflammatory and neuroprotective amide used in depressive syndromes. Here we investigate whether micronized/ultramicronized (m/um) PEA improves neuropsychiatric sequelae in COVID-19 survivors. Patients evaluated at our post-COVID-19 outpatient clinic between February and August 2021 and presenting neuropsychiatric manifestations (n = 98) were offered treatment with m/umPEA 600 mg twice daily for 3 months. Those accepting m/umPEA therapy (n = 57) were compared with those who did not (n = 41), in terms of depression, fatigue, chronic pain and subjective well-being, through validated scales administered pre- and posttreatment. The two groups did not differ in terms of demographics, comorbidities, psychiatric history, antidepressant therapy, acute COVID-19 severity and baseline neuropsychiatric status. Patients receiving m/umPEA showed a greater improvement in depression and fatigue (both P < 0.05). Conversely, no association was found with changes in chronic pain or subjective well-being. At multivariable logistic regression, m/umPEA predicted neuropsychiatric improvement independently of age, sex and baseline neuropsychiatric status. Worse pretreatment fatigue and subjective well-being identified those who most likely benefited from treatment. In conclusion, despite its retrospective nature, our study suggests that m/umPEA may improve depression and fatigue in COVID-19 survivors, justifying future research in this setting.

Long-term Radiological and Pulmonary Function Abnormalities at 3-year post COVID-19 Hospitalization: A Longitudinal Cohort Study.

This study aimed to evaluate the longitudinal progression of residual lung abnormalities (ground-glass opacities, reticulations, and fibrotic-like changes) and pulmonary function, three years following coronavirus disease 2019(COVID-19). This prospective, longitudinal cohort study enrolled COVID-19 survivors who exhibited residual lung abnormalities upon discharge from two hospitals. Follow-up assessments were conducted at 6 months, 12 months, 2 years, and 3 years post-discharge, and included pulmonary function tests, 6-minute walk distance (6MWD), chest CT scans, and symptom questionnaires. Non-COVID-19 controls were retrospectively recruited for comparative analysis. 728 COVID-19 survivors and 792 controls were included. From 6 months to 3 years, there was a gradual improvement in reduced diffusing capacity of the lungs for carbon monoxide (DLCO＜80% predicted, 49% versus 38%, p=0.001), 6MWD (496 m versus 510 m, p=0.002) and residual lung abnormalities(46% versus 36%, p<0.001), regardless of the disease severity. Patients with residual lung abnormalities at 3 years more commonly had respiratory symptoms (32% versus 16%, p<0.001), lower 6MWD (494 m versus 510 m, p=0.003), and abnormal DLCO (57% versus 27%, p<0.001) compared to those with complete resolution. Compared to the controls, the proportion of DLCO impairment (38% versus 17%, p<0.001) and respiratory symptoms (23% versus 2.2%, p<0.001) were significantly higher in the matched COVID-19 survivors at the 3-year follow-up. Most patients exhibited improvement in radiological abnormalities and pulmonary function over time following COVID-19. However, more than one-third continued to have persistent lung abnormalities at the 3-year mark, which were associated with respiratory symptoms and reduced diffusion capacity.

Insomnia among coronavirus disease 2019 survivors: A single-center cross-sectional study.

Since the coronavirus disease 2019 (COVID-19) epidemic, insomnia has become one of the longer COVID-19 symptoms. This study aimed to investigate insomnia among COVID-19 survivors and explore the occurrence and influencing factors of insomnia. A cross-sectional study was performed from December 2022 to February 2023 through an online questionnaire star survey with 8 questions. The insomnia severity index scale (ISI) was used to assess the severity of insomnia. Univariate analysis was used to analyze the factors related to COVID-19 infection. A total of 564 participants (183 males and 381 females) were surveyed in the present study. The prevalence of insomnia was 63.12%. Among these insomnia patients, there were 202 (35.82%) with sub-threshold symptoms, 116 (20.57%) with moderate symptoms, and 38 (6.74%) with severe symptoms. Univariate analysis indicated that there were statistically significant differences in the prevalence of insomnia among COVID-19 survivors of different ages, occupations, and educational levels (P < .05). Of the 356 insomnia patients, 185 (51.97%) did not take any measures against insomnia, while those who took drugs only, physical exercise only, drugs and physical exercise, and other measures were 90 (25.28%), 42 (11.80%), 17 (4.78%), and 22 (6.18%), respectively. Additionally, of the 107 insomnia patients with drug therapy, 17 (15.89%) took estazolam, 16 (14.95%) took alprazolam, 39 (36.45%) took zopiclone, and 35 (32.71%) took other drugs to improve insomnia symptoms. The prevalence of insomnia symptoms remains high among COVID-19 survivors in China. Education level and occupation may be the influencing factors. Unfortunately, most patients with insomnia do not take corresponding treatment measures.

The effectiveness of glucocorticoid treatment in post-COVID-19 pulmonary involvement

RationalePersistent respiratory symptoms following Coronavirus Disease 2019 (COVID-19) are associated with residual radiological changes in lung parenchyma, with a risk of development into lung fibrosis, and with impaired pulmonary function. Previous studies hinted at the possible efficacy of corticosteroids (CS) in facilitating the resolution of post-COVID residual changes in the lungs, but the available data is limited.AimTo evaluate the effects of CS treatment in post-COVID respiratory syndrome patients.Patients and methodsPost-COVID patients were recruited into a prospective single-center observational study and scheduled for an initial (V1) and follow-up visit (V2) at the Department of Respiratory Medicine and Tuberculosis, University Hospital Olomouc, comprising of pulmonary function testing, chest x-ray, and complex clinical examination. The decision to administer CS or maintain watchful waiting (WW) was in line with Czech national guidelines.ResultsThe study involved 2729 COVID-19 survivors (45.7% male; mean age: 54.6). From 2026 patients with complete V1 data, 131 patients were indicated for CS therapy. These patients showed significantly worse radiological and functional impairment at V1. Mean initial dose was 27.6 mg (SD ± 10,64), and the mean duration of CS therapy was 13.3 weeks (SD ± 10,06). Following therapy, significantly better improvement of static lung volumes and transfer factor for carbon monoxide (DLCO), and significantly better rates of good or complete radiological and subjective improvement were observed in the CS group compared to controls with available follow-up data (n = 894).ConclusionBetter improvement of pulmonary function, radiological findings and subjective symptoms were observed in patients CS compared to watchful waiting. Our findings suggest that glucocorticoid therapy could benefit selected patients with persistent dyspnea, significant radiological changes, and decreased DLCO.

Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

Background: Coronavirus disease 2019 (COVID-19) is the etiology of acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is used to support gas exchange in patients who have failed conventional mechanical ventilation. However, there is no clear consensus on the timing of ECMO use in severe COVID-19 patients. Objective: The aim of this study is to compare the differences in pre-ECMO time and ECMO duration between COVID-19 survivors and non-survivors and to explore the association between them. Methods: PubMed, the Cochrane Library, Embase, and other sources were searched until 21 October 2022. Studies reporting the relationship between ECMO-related time and COVID-19 survival were included. All available data were pooled using random-effects methods. Linear regression analysis was used to determine the correlation between pre-ECMO time and ECMO duration. The meta-analysis was registered with PROSPERO under registration number CRD42023403236. Results: Out of the initial 2473 citations, we analyzed 318 full-text articles, and 54 studies were included, involving 13,691 patients. There were significant differences between survivors and non-survivors in the time from COVID-19 diagnosis (standardized mean difference (SMD) = −0.41, 95% confidence interval (CI): [−0.53, −0.29], p &lt; 0.00001), hospital (SMD = −0.53, 95% CI: [−0.97, −0.09], p = 0.02) and intensive care unit (ICU) admission (SMD = −0.28, 95% CI: [−0.49, −0.08], p = 0.007), intubation or mechanical ventilation to ECMO (SMD = −0.21, 95% CI: [−0.32, −0.09], p = 0.0003) and ECMO duration (SMD = −0.18, 95% CI: [−0.30, −0.06], p = 0.003). There was no statistical association between a longer time from symptom onset to ECMO (hazard ratio (HR) = 1.05, 95% CI: [0.99, 1.12], p = 0.11) or time from intubation or mechanical ventilation (MV) and the risk of mortality (highest vs. lowest time groups odds ratio (OR) = 1.18, 95% CI: [0.78, 1.78], p = 0.42; per one-day increase OR = 1.14, 95% CI: [0.86, 1.52], p = 0.36; HR = 0.99, 95% CI: [0.95, 1.02], p = 0.39). There was no linear relationship between pre-ECMO time and ECMO duration. Conclusion: There are differences in pre-ECMO time between COVID-19 survivors and non-survivors, and there is insufficient evidence to conclude that longer pre-ECMO time is responsible for reduced survival in COVID-19 patients. ECMO duration differed between survivors and non-survivors, and the timing of pre-ECMO does not have an impact on ECMO duration. Further studies are needed to explore the association between pre-ECMO and ECMO time in the survival of COVID-19 patients.

Navigating sarcopenia in COVID-19 patients and survivors: Understanding the long-term consequences, transitioning from hospital to community with mechanisms and interventions for future preparedness.

The coronavirus disease 2019 (COVID-19) pandemic has caused widespread devastation, with millions of confirmed cases and deaths worldwide. Although there were efforts made to develop treatments and vaccines for COVID-19, the coexistence of sarcopenia, a muscle disorder, has been largely overlooked. It is while new variants of this disease (eg, BA.2.86) are challenging the current protocols. Sarcopenia is associated with increased mortality and disability, and shares common mechanisms with COVID-19, such as inflammation, hormonal changes, and malnutrition. This can worsen the effects of both conditions. Furthermore, survived patients with COVID-19 who have elevated risk, as well as aging, which increases the process of sarcopenia. Therefore, addressing sarcopenia in patients with COVID-19 and surviving individuals can be crucial for improving outcomes and preventing long-term disability. During hospital stays, assessing sarcopenia through indicators like muscle wasting and malnutrition is important. Nutritional interventions, such as malnutrition screening and enteral feeding, play a critical role in preventing sarcopenia in hospitals. Mental health and physical activity evaluations and interventions are also necessary. Even after recovering from COVID-19, there is a risk of developing sarcopenia, requiring continued monitoring. Nutrition and physical activity considerations are vital for prevention and management, necessitating tailored training programs and diet therapy. Mental health should not be overlooked, with regular screening, and community-based interventions. Infrastructure should support physical activity, and mental health services must become more accessible. Community engagement through support groups and peer networks can foster resilience and social connection. Efforts are needed to promote healthy diets and ensure access to nutritious foods.

Acute Myocardial Infarction during the COVID-19 Pandemic: Long-Term Outcomes and Prognosis-A Systematic Review.

Coronavirus disease 2019 (COVID-19) was a global pandemic with high mortality and morbidity that led to an increased health burden all over the world. Although the virus mostly affects the pulmonary tract, cardiovascular implications are often observed among COVID-19 patients and are predictive of poor outcomes. Increased values of myocardial biomarkers such as troponin I or NT-proBNP were proven to be risk factors for respiratory failure. Although the risk of acute coronary syndromes (ACSs) was greater in the acute phase of COVID-19, there were lower rates of hospitalization for ACSs, due to patients' hesitation in presenting at the hospital. Hospitalized ACSs patients with COVID-19 infection had a prolonged symptom-to-first-medical-contact time, and longer door-to-balloon time. The mechanisms of myocardial injury in COVID-19 patients are still not entirely clear; however, the most frequently implicated factors include the downregulation of ACE2 receptors, endothelial dysfunction, pro-coagulant status, and increased levels of pro-inflammatory cytokines. The aim of this paper is to evaluate the long-term outcomes and prognosis of COVID-19 survivors that presented an acute myocardial infarction, by reviewing existing data. The importance of the association between this infectious disease and myocardial infarction arises from the increased mortality of patients with SARS-CoV-2 infection and AMI (10-76%, compared with 4.6% for NSTEMI patients and 7% for STEMI patients without COVID-19). The literature review showed an increased risk of cardiovascular events in COVID-19 survivors compared with the general population, even after the acute phase of the disease, with poorer long-term outcomes.

Cardiac Autonomic Dysfunction Measured as Reduced Heart Rate Variability, in the Intermediate Post-Covid State in Men

Abstract Background: A critical illness such as severe coronavirus disease 2019 (COVID-19) activates autonomic, endocrine, and emotional stress responses. Whether the manifestations of excessive stress experience persist beyond full recovery into the intermediate post-COVID period (3–6 months after recovery) is not known and was the question we addressed in the current study. Methods: An analytical observational cross-sectional study compared the heart rate variability (HRV), 8 AM serum cortisol concentration, and the Depression, Anxiety, and Stress Scale–21 (DASS-21) scores between COVID-19 recovered participants and their age-matched control subjects (21 male participants, 30–70 years of age, in each group). Results: The median (Q1–Q3) of low frequency (LF), high frequency (HF), and total powers of HRV was significantly reduced in those who recovered from severe COVID-19, compared to control subjects (respectively LF power: 410.871 [245.10–861.94], 947.57 [536.11–1778.55], P = 0.011; HF power: 192.916 [87.66–564.43], 705.18 [248.67–1192.19] P = 0.013; Total power: 646.33 [308.72–1518.28], 1613.33 [956.14–4022.55] P = 0.015, Mann–Whitney U-test). Serum cortisol and DASS-21 scores were not different from the control group. Conclusions: Impaired cardiac autonomic function, evidenced by reduced HRV, was observed in the intermediate period following recovery from severe COVID-19. However, psychological stress and elevated serum cortisol were not noted. Our result that exposes the effect of COVID-19 on cardiac autonomic responsiveness is important as diminished HRV increases the vulnerability of COVID-19 survivors to diseases. These findings may also suggest a focus of therapy in them, as specific interventions are known to improve HRV and cardiac autonomic functioning.

Factors associated with small airway obstruction in COVID-19 survivors: A cross-sectional study among health-care providers.

Coronavirus disease 2019 (COVID-19) has been identified for more than two years, yet studies assessing post-infection lung function are limited. Reports on lung function in COVID-19 patients indicate that patients have restrictive defects and small airway dysfunction that can persist and are not necessarily related to the severity of the disease. The aim of this study was to assess the incidence of small airway obstruction and its incidence-associated factors among COVID-19 survivors to better describe the long-term effects of COVID-19. A cross-sectional study was conducted among COVID-19 survivors who less than 50 years at Medan Adventist Hospital between 2020-2022. The data were collected through interview, direct assessment and respiratory examination. A total of 89 COVID-19 survivors were recruited of which the majority of them were female with a mean age of 32.6-year-old with the largest group was 19-30 years. The comorbidities found among the survivors were heart and thyroid disorders, with the most common symptom of post-COVID-19 was fatigue. Most of them had mild COVID-19. The mean forced mid-expiratory flow (FEF25-75%) was 96.3±20.22, with an incidence rate of small airway obstruction was 19.1%. Univariate and multivariate analyses indicated no significant association between age, gender, comorbidities, history of oxygenation during COVID-19 treatment, COVID-19 severity and the type of post COVID-19 syndrome symptoms with the incidence of small airway obstruction. In conclusion, among COVID-19 survivors who were less than 50 years old, those studied variables seems have less association with the incidence of small airway obstruction. Nevertheless, a further study with a bigger sample size is important to be conducted.

Factors associated with the quality of life and persistent dyspnea severity in COVID-19 survivors: A cross-sectional study among healthcare workers.

The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on global health. The alterations in quality of life (QoL) and the persistent symptoms of dyspnea have been the healthcare workers' challenges during and after the pandemic. The aim of this study was to assess factors associated with the QoL and persistent dyspnea experienced by COVID-19 survivors, particularly among healthcare workers. A cross-sectional study was conducted among healthcare workers at H. Adam Malik General Hospital, Medan, Indonesia, using direct interviews to collect the data. The EuroQol 5-dimensional 5-level (EQ-5D-5L) and the self-assessment EuroQol-visual analog scale (EQ-VAS) were employed to assess the QoL of the healthcare workers; and persistent dyspnea was evaluated using the modified Medical Research Council (mMRC) scale. Several possible risk factors such as demographic characteristics (gender and age), clinical characteristics (comorbidities, history of hospitalization, oxygen usage, history of COVID-19 vaccination, the severity of previous COVID-19, existence of post-COVID syndrome) and the symptoms of the post-COVID syndrome were collected. Chi-squared test or Fisher's exact test was used to identify the risk factors associated with the QoL and persistent dyspnea. A total of 100 healthcare workers were included in the study. The EQ-5D-5L assessment found that 2% of healthcare workers experienced pain/discomfort and 4% experienced anxiety/depression. The average healthcare worker's EQ-VAS score was 87.6±8.1. There was no significant association between studied demographics and clinical characteristics with QoL dimensions. However, post-COVID symptoms of activity limitation (p=0.004), sore throat (p=0.026), headache (p=0.012), myalgia (p=0.006), and arthralgia (p=0.001) were associated with pain/discomfort dimension of QoL. In addition, there was a significant association between activity limitation (p=0.012), headache (p=0.020), myalgia (p=0.015) and arthralgia (p=0.032) with anxiety/depression dimension of QoL. Our data suggested that the presence of post-COVID syndrome (p=0.006) and the presence of post-COVID syndrome symptoms of cough (p=0.021) and fatigue (p=0.015) were associated with persistent dyspnea. In conclusion, this study suggests that the presence of post-COVID syndrome and its symptoms are associated with low quality of health-related QoL and persistent dyspnea. Therefore, cautions are needed for such patients to prevent low QoL in the future.

Proportion of COVID-19 survivors in 2020-2022 in the Russian population (according to the ESSE-RF3 study)

Aim. To study the proportion of coronavirus disease 2019 (COVID-19) survivors and hospitalization cases of the Russian population for the period 2020-2022, depending on socio-demographic characteristics.Material and methods. The work was performed on random samples of the population aged 35-74 years from 15 regions participating in the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation-3 (ESSE-RF3) study. The examination was carried out from February 2020 to March-April 2022 (n=28718, 47% men).Results. According to a survey of sample participants, the proportion of respondents who had COVID-19 by the spring of 2022 among all surveyed was 26,0%. Among 45-54-year-old respondents, this parameter was maximum (28,0%), while among those aged 65-74-year-old — minimal (22,3%). The following categories of people were more likely to have COVID-19: women (27,9 vs 23,9% of men, p&lt;0,001), persons with higher education (30 vs 22,6% persons without higher education, p&lt;0,001), persons with high income (30,0 vs 24,3% low-income, p=0,002), persons with family (26,6 vs 24,8% single, p&lt;0,001), employed persons (28,4 vs 21,7% non-employed, p&lt;0,001), as well as those living in urban areas (26,5 vs 24,5% country people, p=0,003). But those less likely to have COVID-19 (men, people without higher education, low-income, single, unemployed or rural residents) had more severe disease course. The following categories of people had higher hospitalization rates: men (26,0 vs 20,9% women, p&lt;0,001), patients without higher education (27,1 vs 19,6% those with higher education, p&lt;0,001), non-employed (34,3 vs 18,4% workers), p&lt;0,001) and rural residents (27,2 vs 22,0% of city residents, p&lt;0,001). Hospitalization rate was not associated with the level of income and marital status. However, low-income and single people were more likely to require mechanical ventilation.Conclusion. The results obtained by survey reflect the following population data: the proportion of patients after COVID-19, hospitalization rate and the development of severe acute respiratory failure requiring mechanical ventilation among Russians for the period 2020-2022. This can complement the population data demonstrated by state statistics. Special attention from the healthcare system, both during treatment and prevention of COVID-19, requires males, people aged ≥65 years, low-income people, single people (widowers, divorced), unemployed people (pensioners, disabled people, nonemployed), rural residents and people without higher education.