Coronavirus Disease 2019 Survivors Research Articles

Evaluation of Mental Health and Quality of Life among Indian Professionals Embarked as COVID-19 Survivors.

Government guidelines for lockdown and quarantine measures impacted the daily lives and health of individuals amid the coronavirus disease 2019 (COVID-19) pandemic. The pandemic caused significant changes in the daily routine and lifestyles of individuals worldwide with the simultaneous emergence of mental health disorders. Stress caused by COVID-19 pandemic outbreaks and consequent social isolation significantly influenced the mental health and quality of life of professionals among Indian population. This study aimed to evaluate the mental health and quality of life among Indian professionals embarked as COVID-19 survivors. A 20-item self-administered questionnaire was developed and circulated among the participants with the following domains: helplessness, apprehension, mood swing, physical activity, restlessness, insomnia, irritation, mental stress, and emotional instability to assess their mental health and quality of life. Of the total 322 participants, 73.6% of individuals experienced helplessness, 56.2% felt the need for counseling, 65.5% reported feeling irritated even over minor issues, 62.1% experienced negative thoughts during isolation, 76.5% experienced difficulty in falling asleep, and 71.9% felt restless during their course of illness. The study concludes that mental health and quality of life among COVID-19 survivors was affected by sleep, physical activities, emotional instability, and job profile, as well as support from others, mood swings, and the need for counseling.

Influence of Deep Sedation in Intensive Care Medicine Memories of Critical COVID-19 Survivors.

Introduction: Critical care survivors sustain a variety of sequelae after intensive care medicine (ICM) admission, and the Coronavirus Disease 2019 (COVID-19) pandemic has added further challenges. Specifically, ICM memories play a significant role, and delusional memories are associated with poor outcomes post-discharge including a delayed return to work and sleep problems. Deep sedation has been associated with a greater risk of perceiving delusional memories, bringing a move toward lighter sedation. However, there are limited reports on post-ICM memories in COVID-19, and influence of deep sedation has not been fully defined. Therefore, we aimed to evaluate ICM-memory recall in COVID-19 survivors and their relation with deep sedation. Materials/Methods: Adult COVID-19 ICM survivors admitted to a Portuguese University Hospital between October 2020 and April 2021 (second/third "waves") were evaluated 1 to 2 months post-discharge using "ICU Memory Tool," to assess real, emotional, and delusional memories. Results: The study included 132 patients (67% male; median age = 62 years, Acute Physiology and Chronic Health Evaluation [APACHE]-II = 15, Simplified Acute Physiology Score [SAPS]-II = 35, ICM stay = 9 days). Approximately 42% received deep sedation (median duration = 19 days). Most participants reported real (87%) and emotional (77%) recalls, with lesser delusional memories (36.4%). Deeply sedated patients reported significantly fewer real memories (78.6% vs 93.4%, P = .012) and increased delusional memories (60.7% vs 18.4%, P < .001), with no difference in emotional memories (75% vs 80.4%, P = .468). In multivariate analysis, deep sedation had a significant, independent association with delusional memories, increasing their likelihood by a factor of approximately 6 (OR = 6.274; 95% confidence interval = 1.165-33.773, P = .032), without influencing real (P = .545) or emotional (P = .133) memories. Conclusions: This study contributes to a better understanding of the potential adverse effects of deep sedation on ICM memories in critical COVID-19 survivors, indicating a significant, independent association with the incidence of delusional recalls. Although further studies are needed to support these findings, they suggest that strategies targeted to minimize sedation should be favored, aiming to improve long-term recovery.

Post-acute COVID-19 symptom risk in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis.

Post-acute coronavirus disease 2019 (COVID-19) symptoms occurred in most of the COVID-19 survivors. However, few studies have examined the issue of whether hospitalization results in different post-acute COVID-19 symptom risks. This study aimed to compare potential COVID-19 long-term effects in hospitalized and non-hospitalized COVID-19 survivors. This study is designed as a systematic review and meta-analysis of observational studies. A systematic search of six databases was performed for identifying articles published from inception until April 20th, 2022, which compared post-acute COVID-19 symptom risk in hospitalized and non-hospitalized COVID-19 survivors using a predesigned search strategy included terms for SARS-CoV-2 (eg, COVID, coronavirus, and 2019-nCoV), post-acute COVID-19 Syndrome (eg, post-COVID, post COVID conditions, chronic COVID symptom, long COVID, long COVID symptom, long-haul COVID, COVID sequelae, convalescence, and persistent COVID symptom), and hospitalization (hospitalized, in hospital, and home-isolated). The present meta-analysis was conducted according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement using R software 4.1.3 to create forest plots. Q statistics and the I 2 index were used to evaluate heterogeneity in this meta-analysis. Six observational studies conducted in Spain, Austria, Switzerland, Canada, and the USA involving 419 hospitalized and 742 non-hospitalized COVID-19 survivors were included. The number of COVID-19 survivors in included studies ranged from 63 to 431, and follow-up data were collected through visits in four studies and another two used an electronic questionnaire, visit and telephone, respectively. Significant increase in the risks of long dyspnea (OR = 3.18, 95% CI = 1.90-5.32), anxiety (OR = 3.09, 95% CI = 1.47-6.47), myalgia (OR = 2.33, 95% CI = 1.02-5.33), and hair loss (OR = 2.76, 95% CI = 1.07-7.12) risk were found in hospitalized COVID-19 survivors compared with outpatients. Conversely, persisting ageusia risk was significantly reduced in hospitalized COVID-19 survivors than in non-hospitalized patients. The findings suggested that special attention and patient-centered rehabilitation service based on a needs survey should be provided for hospitalized COVID-19 survivors who experienced high post-acute COVID-19 symptoms risk.

Increased Platelet Activation demonstrated by Elevated CD36 and P-Selectin Expression in 1-Year Post-Recovered COVID-19 Patients.

Coronavirus disease 2019 (COVID-19)-associated hypercoagulability and platelet hyperactivity are characteristic of COVID-19 infection and contribute to an increased thrombotic burden. This clinical phenomenon is observed during acute illness and the immediate post-recovery period. In addition to findings of hypercoagulability, endotheliopathy, and inflammation from our previous study of 39 COVID-19 survivors at a time point approximating 1 year after their recovery from COVID-19,[1] we evaluated the platelet activation profile of a subset of 36 patients, demonstrating increased platelet activation with elevated CD36 and P-selectin expression compared with healthy individuals without COVID-19 infection.

Cognitive and psychological outcomes and follow-up in severely affected COVID-19 survivors admitted to a rehabilitation hospital.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) represents the most recent severe pandemic resulting in coronavirus disease 2019 (COVID-19). COVID-19 can damage the central nervous system, requiring admission to intensive care units (ICU) and aggressive treatments (long-term ventilatory assistance and sedation) to stabilize vitals. Most post-COVID-19 patients experience cognitive impairments and mood or stress disorders. We aimed to study the frequency of cognitive deficits in COVID-19 survivors, the relationship between clinical factors in the acute phase and cognitive outcomes, affective states, and quality of life. We explored cognitive reserve (CR) role, as a post-COVID-19 resilience factor. Twenty-nine COVID-19 inpatients were assessed using a neuropsychological battery, mood scales, quality of life, and social integration questionnaires. Twenty-five were retained through telephone follow-up to monitor cognitive sequelae, affective states, and reintegration levels roughly 8months after hospital discharge. We administered the Cognitive Reserve Index questionnaire. We found most patients display no cognitive deficits. When they did, multi-domain impairment occurred most frequently, especially involving executive functions. Results revealed a significant correlation between depression levels and the interval between ICU admission and tracheal tube removal. We found increased levels of depression and anxiety at follow-up, a significant relationship between resuming daily life activities, high CR, and executive functions. These findings suggest the importance of psychological support in the long term and the modulating role of cognitive reserve in quality of life after infection.

Analysis of complete blood count parameters throughout disease severity in COVID-19 survivors

Background: The pandemic of Coronavirus disease 2019 (COVID-19) represented a scientific and social crisis. Among the most pressing unmet needs for coronavirus disease in 2019 was its unpredictable clinical course, which resulted in an irreversible outcome. The presence of post-acute COVID-19 syndrome in survivors, as well as the exploration of different blood cell counts in Covid 19 survivors, seems to be unclear, and scientific data is still being summarized. Patients can be divided into three categories: mild, moderate, and severe in terms of infection severity. Platelets, white blood cell total count, lymphocytes, neutrophils and hemoglobin levels have all been linked to COVID-19 infection and severity. In this regard, evaluation of hematological abnormalities at the beginning, during and after COVID-19 infection and during COVID-19 that can be indicative of prognosis in the recovery phase. The purpose of this study was to analyze the complete blood picture among COVID-19 survivors &amp; co-relate it with disease severity which can be implemented as a prognostic biomarker of the disease.

Comparison of Post Vaccination Antibody Levels for Coronavirus Disease 2019 (COVID-19) between Survivors and Non-Survivors of COVID-19

Background: The COVID-19 vaccine is useful for protecting the body by causing or stimulating specific immunity in the body. COVID-19 survivors are a group of individuals who have been exposed to COVID-19 and have successfully recovered from COVID-19 infection. Exposure to COVID-19 causes the activation of memory cells and anti-SARS-CoV-2 IgG antibodies. In contrast to individuals who have never been exposed to COVID-19, the bodies of individuals who are not COVID-19 survivors have not had the experience of exposure to COVID-19, which causes the absence of memory cells and anti-SARS-CoV-2 IgG antibodies. This study is one of the first studies to explore differences in anti-SARS-CoV-2 IgG antibody levels in survivors and non-survivors of COVID-19 at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.&#x0D; Methods: This was an analytic observational study with a cohort approach. A total of 136 research subjects participated in this study. Observation of anti-SARS-CoV-2 IgG levels was carried out before vaccination, weeks 2, 12, and 24. Data analysis was carried out using SPSS univariate and bivariate.&#x0D; Results: The COVID-19 survivors group consistently from the time they were vaccinated, weeks 2, 12, and 24 showed a relatively higher average anti-SARS-CoV-2 IgG level than the non-COVID-19 survivors' group. The group of survivors of COVID-19 shows a trend of decreasing average anti-SARS-CoV-2 IgG levels over time. In contrast to the non-survivor group of COVID-19, which showed a trend of increasing anti-SARS-CoV-2 IgG levels.&#x0D; Conclusion: There were differences in anti-SARS-CoV-2 IgG levels between the COVID-19 survivor group and non-survivor COVID-19 group at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Long-term outcomes of COVID-19 survivors with hospital AKI: association with time to recovery from AKI.

Although coronavirus disease 2019 (COVID-19) patients who develop in-hospital acute kidney injury (AKI) have worse short-term outcomes, their long-term outcomes have not been fully characterized. We investigated 90-day and 1-year outcomes after hospital AKI grouped by time to recovery from AKI. This study consisted of 3296 COVID-19 patients with hospital AKI stratified by early recovery (<48hours), delayed recovery (2-7days) and prolonged recovery (>7-90days). Demographics, comorbidities and laboratory values were obtained at admission and up to the 1-year follow-up. The incidence of major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE), rehospitalization, recurrent AKI and new-onset chronic kidney disease (CKD) were obtained 90-days after COVID-19 discharge. The incidence of hospital AKI was 28.6%. Of the COVID-19 patients with AKI, 58.0% experienced early recovery, 14.8% delayed recovery and 27.1% prolonged recovery. Patients with a longer AKI recovery time had a higher prevalence of CKD (P<.05) and were more likely to need invasive mechanical ventilation (P<.001) and to die (P<.001). Many COVID-19 patients developed MAKE, recurrent AKI and new-onset CKD within 90days, and these incidences were higher in the prolonged recovery group (P<.05). The incidence of MACE peaked 20-40days postdischarge, whereas MAKE peaked 80-90days postdischarge. Logistic regression models predicted 90-day MACE and MAKE with 82.4±1.6% and 79.6±2.3% accuracy, respectively. COVID-19 survivors who developed hospital AKI are at high risk for adverse cardiovascular and kidney outcomes, especially those with longer AKI recovery times and those with a history of CKD. These patients may require long-term follow-up for cardiac and kidney complications.

Thyroid dysfunction as a long-term post-COVID-19 complication in mild-to-moderate COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), may lead to thyroid disorders, including both thyrotoxicosis and suppression of thyroid function. The aim of the present study was to assess the post-COVID-19 effects on thyroid function in patients without history of thyroid disease after complete recovery from mild-to-moderate COVID-19. Thyroid function tests [thyroid-stimulating hormone (TSH), free thyroxine (fT4), antithyroid antibodies] were performed on 113 patients (median age of 43.0 years; 31.0% male) two months after initial SARS-CoV-2 infection. TSH and fT4 were determined again one month later in this observational, prospective study. Thyroid dysfunction was registered in 61.1% of the patients (78.3% subclinical hypothyroidism, 13% subclinical hyperthyroidism and 8.7% overt hypothyroidism) two months after COVID-19. Moderate rather than mild manifestation of COVID-19 was significantly associated with a higher risk of thyroid dysfunction (OR 5.33; 95% CI: 1.70–16.69, p = 0.002), presence of thyroglobulin antibodies and need for levothyroxine therapy. At the follow-up, the subclinical hypothyroidism persisted in 28.3% of the subjects. Moreover, the TSH level was significantly reduced in comparison to the second month after the initial COVID-19 infection in all the patients (p < 0.001), but not in those with subclinical hypothyroidism and without hormone replacement therapy. Our findings indicate that COVID-19 could have long-term, negative effects on thyroid function. Therefore, thyroid function testing should be included in the follow-up algorithm of COVID-19 survivors.

Post-traumatic stress among COVID-19 survivors: A descriptive study of hospitalized first-wave survivors.

The coronavirus Severe Acute Respiratory Syndrome Coronavirus Type 1 induces a severe respiratory disease, coronavirus disease 2019 (COVID-19). After Severe Acute Respiratory Syndrome Coronavirus Type 1 and Middle East Respiratory Syndrome infection, increased post-traumatic stress disorder (PTSD) rates were described. This single-centred, prospective study aimed to evaluate the rates of PTSD in patients who were hospitalized for COVID-19. Inclusion criteria were COVID-19 patients hospitalized in the intensive care unit (ICU) or in a standard unit with at least 2 L/min oxygen. Six months post-hospitalization, subjects were assessed for PTSD using a validated screening tool, the Post-Traumatic Stress Checklist-5 (PCL-5). A total of 40 patients were included. No demographic differences between the ICU and non-ICU groups were found. The mean PCL-5 score for the population was 8.85±10. The mean PCL-5 score was 6.7±8 in the ICU group and 10.5±11 in the non-ICU group (P=0.27). We screened one patient with a positive PCL-5 score and one with a possible PCL-5 cluster score. Nine patients had a PCL-5 score of up to 15. Seven patients reported no symptoms. Seven patients accepted a psychological follow-up: one for PTSD, three for possible PTSD and three for other psychological problems. The PCL-5 tool can be used by lung physicians during consultations to identify patients for whom follow-up mental health assessment and treatment for PTSD are warranted. Lung physicians should be aware of the risk of PTSD in patients hospitalized for COVID-19 and ensure appropriate screening and follow-up care.

Detection rate and characteristics of heart failure, depending on the diagnostic criteria in COVID-19 survivors one year after hospitalization

Aim. To estimate the detection rate of heart failure (HF), using various diagnosis criteria, among patients aftr 12 months after hospital treatment for coronavirus disease 2019 (COVID-19).Material and methods. The study included 185 patients from the TARGET-VIP registry who came for a visit 12 months after hospitalization for COVID-19. To identify HF with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction (EF), the European Society of Cardiology (ESC) criteria (2016 and 2021) were used. To identify HF with preserved EF (HFpEF), we used the ESC criteria (2016 and 2021), as well as the 2018 Russian guidelines and H2FPEF score.Results. In the analyzed group, there were no patients with EF &lt;40%, while one patient had EF of 48% and 184 patients — ≥50%. The patient with EF of 48% was not diagnosed with HF due to the absence of HF signs and symptoms. The presence of HFpEF was confirmed in 31,4% of patients according to 2018 Russian criteria and 2021 ESC criteria (first version of the diagnosis), in 12,5% according to the 2016 ESC criteria, 11% according to ESC 2021 criteria (second version of the diagnosis) and in 2,2% on the H2FPEF score. The proportion of HF diagnosed for the first time according to the 2016 ESC criteria was 78% of the total number of HF cases.Conclusion. Among the examined patients 12 months after hospital treatment for COVID-19, there were no cases of HFrEF and HFmrEF. The proportion of HFpEF cases, depending on the diagnostic criteria used, varied significantly from 2,2 to 31,4%. The previously established diagnosis of HF was confirmed in 83% of cases at a visit 12 months after discharge from the hospital. Using the 2016 ESC criteria and the corresponding 2020 Russian Society of Cardiology guidelines, the proportion of newly diagnosed HF was 78% of all patients.

Cardiovascular complications in coronavirus disease-2019 patients

Background and Aims: Cardiovascular (CV) complications of coronavirus disease 2019 (COVID-19) are neither well-defined nor comprehensively characterized. Hence, long-term studies are required to monitor silent but progressive CV complications postrecovery in COVID-19 patients. Our aim of the study was to assess and determine the presence of CV morbidity and mortality in COVID-19 patients.Materials and Methods: A retrospective study was conducted at our institute. All COVID-19-positive patients who were admitted in the intensive care unit during April 3, 2020–May 23, 2021, were recruited for the study. A total of 1460 patients were enrolled and monitored until discharge/death. Patients were evaluated based on demographics, clinical data, and laboratory values and 42 patients among them underwent coronary angiography for an adequate understanding of CV complications.Results: The total reported deaths among the study sample were 453 (31%). Common preexisting clinical conditions among them were hypertension 520 (35.6%), diabetes 211 (14.45%), CV disease 88 (6.02%), and hypothyroidism 61 (4.17%). A total of 149 patients displayed elevated creatine phosphokinase-MB (CPK-MB) levels, while 141 patients displayed elevated hs-TnI levels. The absolute rise of cardiac troponin (hs-TnI) and CPK-MB displayed a technically positive correlation, but a weaker relationship (r: 0.2113, P < 0.01 for correlation). Twenty-two out of 42 patients showed the presence of single/multivessel disease and 31 patients displayed mild-to-severe left ventricular dysfunction.Conclusions: The results of the current study provide evidence for the risk and burden of CV complications among COVID-19 patients. Hence, attention to long-term CV health and disease among COVID-19 survivors is necessary.

Proposing an #EASIER Cardiopulmonary Rehabilitation Protocol for Coronavirus Disease 2019 Survivors

The economic and social impact that coronavirus disease 2019 (COVID-19) can bring is undeniable since high numbers of active workers in production and service provision are being contaminated. In addition, those infected may have long-term sequelae, impairing their functional capacity, and consequently, their work activities. It considers that intervention in cardiopulmonary rehabilitation is of great importance, especially in the recovery stage, and should be carried out mainly with the aim of improving dyspnea, severe muscle weakness, and fatigue, to promote functional independence, and increase quality of life. Based on the limitations demonstrated in COVID-19 survivors, we developed a protocol based on the acronym #EASIER, which is divided into six phases. Such a study will be able to early identify the impact of COVID-19 in different severities as well as provide subsidies to guide physiotherapists early, through the correct prescription of rehabilitative interventional measures.

The interplay between severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and the hypothalamic and endocrinal disorders: A Mini-review

The worldwide medical systems are still being severely impacted by the coronavirus disease-2019 (COVID-19) pandemic, which is responsible for catastrophic mortality and morbidity. It becomes more and more obvious that this unique respiratory virus's impacts go beyond the respiratory system as time goes on and our comprehension of it deepens. The transmembrane serine protease 2 (TMPRSS2) protein is necessary for the severe acute respiratory syndrome coronavirus 2, which is the cause of COVID-19, to gain cellular entry through the angiotensin-converting enzyme 2 (ACE2) receptor. Most endocrine glands exhibit high levels of expression for ACE2 and TMPRSS2. This pays the attention to the effect of COVID-19 on the endocrine system. Besides its capability to pass to the central nervous system especially the hypothalamus inducing a lot of functional disorders in COVID-19 individuals. Although effective vaccines became widely available, and mortality declined but attention is shifting more and more to the lengthy health impacts on COVID-19 survivors. To inform suitable research and effective management, this review provides an overview of the data examining the impacts of COVID-19 on the endocrine glands besides the hypothalamus. In addition, we reported if the endocrinal and thalamic disorders could affect the incidence and progress of COVID-19.

Complications of COVID-19 on the Central Nervous System: Mechanisms and Potential Treatment for Easing Long COVID.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invades human cells by binding to the angiotensin-converting-enzyme-2 (ACE-2) using a spike protein and leads to Coronavirus disease-2019 (COVID-19). COVID-19 primarily causes a respiratory infection that can lead to severe systemic inflammation. It is also common for some patients to develop significant neurological and psychiatric symptoms. The spread of SARS-CoV-2 to the CNS likely occurs through several pathways. Once spread in the CNS, many acute symptoms emerge, and such infections could also transpire into severe neurological complications, including encephalitis or ischemic stroke. After recovery from the acute infection, a significant percentage of patients develop "long COVID," a condition in which several symptoms of COVID-19 persist for prolonged periods. This review aims to discuss acute and chronic neurological problems after SARS-CoV-2 infection. The potential mechanisms by which SARS-CoV-2 enters the CNS and causes neuroinflammation, neuropathological changes observed in post-mortem brains of COVID-19 patients, and cognitive and mood problems in COVID-19 survivors are discussed in the initial part. The later part of the review deliberates the causes of long COVID, approaches for noninvasive tracking of neuroinflammation in long COVID patients, and the potential therapeutic strategies that could ease enduring CNS symptoms observed in long COVID.

Effect of Soft Tissue Manual Technique and Breathing Exercises on Pulmonary Function, Chest Expansion and Functional Status in Post COVID-19 Survivors: A Quasi-experimental Study

Introduction: It is known that around one third of Coronavirus Disease-2019 (COVID-19) patients develop severe pulmonary complications and acute respiratory distress syndrome, leading to long-term impairments in Pulmonary Function Test (PFT) and physical performance. Due to deteriorating health status of the COVID-19 survivors after their recovery, rehabilitation is must. Aim: To evaluate the effect of soft tissue manual technique and breathing exercises on PFT, chest expansion and functional status in Post COVID-19 Survivors. Materials and Methods: This quasi-experimental study was carried out in the Department of Cardiorespiratory Physiotherapy, MGM hospital, Aurangabad, Maharashtra, India, from November 2021 to July 2022. Total 54 subjects diagnosed with COVID-19 who required oxygen therapy and had persistent respiratory symptoms for three weeks to six months after the infection, were included. All the subjects received one week of soft tissue manual techniques which included proprioceptive neuromuscular function, muscle energy technique for recruitment of diaphragm, muscles of respiration and the ribcage. Breathing exercises were inculcated at the end of the session to ensure relaxation of the subjects. Subjects were assessed for PFT, chest expansion and post COVID-19 Functional Status Scale (PCFS) pre and post-treatment. Data were analysed through Wilcoxon signed-rank Test. Results: Amongst total 54 subjects included, 10 (18.6%) males and 44 (81.4%) females with mean age of 29.92±11.94. After one week of intervention p-value was 0.0001 for Forced Expiratory Volume (FEV1), FEV1/Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF) with mean values for FEV1 at baseline was 1.91±0.51 and post-treatment was 2.45±0.34, FVC was 2.25±0.50 before the treatment whereas it was 2.73±0.36 post-treatment with p-value of 0.002, FEV1/FVC and PEF was 83.99±12.03 and 4.36±1.78 at baseline whereas, post-treatment it was 87.76±7.29 and 5.88±0.95 respectively. The p-value of 0.0001 was also similar for chest expansion. No statistically significant difference was found in post COVID-19 functional status (p-value=0.013). Conclusion: Positive changes in the ribcage’s activation and integration with its muscles were seen in all of the study variables. Therefore, it is concluded that soft tissue manipulation techniques and breathing exercise improves functional status, thoracic expansion, in post COVID-19 survivors.

Posttraumatic stress disorder and depression in coronavirus disease-2019 survivors among resident doctors

Abstract Background: Posttraumatic stress disorder (PTSD) is a severe but treatable mental disorder that usually develops after a life-threatening traumatic event. Coronavirus disease-2019 (COVID-19) especially when the patient requires hospitalization can be a potentially traumatic experience. Many people experienced it to be physically as well as emotionally exhausting and suffered from symptoms suggestive of PTSD. Secondary depression may also occur due to losses and suffering associated with COVID-19 infection. This study aimed at finding the prevalence of PTSD and depression in COVID-19 survivors. Materials and Methods: After permission from the Institutional Ethics Committee, 70 participants (resident medical doctors) who recovered from COVID-19 infection were interviewed after obtaining their written informed consent, along with the semi-structured proforma and the Post-Traumatic Stress Disorder Scale Self Report for DSM 5 (PSS-SR5) and Hamilton Depression Rating Scale (HDRS). Data collected were analyzed statistically and results were obtained. Results: Out of 70 participants, 1.42% had PTSD and 2.85% had subthreshold PTSD. The most common symptom of PTSD was unwanted upsetting memories about the time spent during the COVID-19 infection. Approximately 5.7% had depression (HDRS score &gt;7); out of which 75% were males and 25% were females. The most common depressive symptom reported was insomnia. There was a positive correlation between a family history of COVID-19, hospitalization, and PTSD. Conclusion: A total of 4.2% participants had PTSD symptoms and 5% had depression. Although the prevalence is less, it is important to assess the patients with COVID-19 even after recovery for the development of psychiatric disorders like PTSD and depression so as to intervene at the earliest.

The Impact of the COVID-19 Pandemic on Mental Health Among the General Population: A Narrative Review

The Coronavirus Disease-2019 (COVID-19) has infected millions of people worldwide, resulting in a global burden for long-term care of sufferers. The impact of COVID-19 has affected the mental health of innumerable people. Emotional, psychological, and social well-being are all parts of our mental health, influencing our thoughts, emotions, and behaviours. Additionally, it affects how people respond to stress and make good decisions. For instance, depression raises the risk of a wide range of physical health issues, especially chronic illnesses like diabetes, heart disease, and stroke. The COVID-19 pandemic has infected millions worldwide, leaving a global burden for the long-term care of COVID-19 survivors. Therefore, it is imperative to study the shortterm (post-COVID) and long-term effects of COVID-19, specifically as the local and systemic pathophysiological outcomes of other coronavirus-related diseases (such as Middle East Respiratory Syndrome - MERS and Severe Acute Respiratory Syndrome Coronavirus 2 - SARS-CoV-2) have been well-documented. Mental health was evaluated using four psychological measurement scales to assess fear of COVID-19, depression, general anxiety, and post-traumatic stress. The worldwide social and economic upheaval has resulted in the worst recession since the Great Depression. The Impact of Event Scale-Revised and the Depression, Anxiety, and Stress Scale can be used to evaluate the psychological impact and mental health status. The main themes include the biology of stress and the effect of infection on the brain. Adversity can cause anatomical and functional changes in the brain. Although cortisol, for example, can alter brain architecture, tolerable stress is mitigated by protective systems and interpersonal connections that promote adaptive coping. The risk of physical and mental illness, as well as cognitive decline, may increase due to toxic stress, which is often caused by prolonged activation. From a behavioural standpoint, it is essential to understand burnout, compassion fatigue, grief, and other psychological processes and strategies in the context of the COVID-19 pandemic. COVID-19 has adversely affected the mental states of people. The COVID-19 pandemic is associated with significantly high levels of psychological distress that meet the threshold for clinical relevance. Mitigating the harmful effects of COVID-19 on mental health is an international public health priority

Omicron, Long-COVID, and the Safety of Elective Surgery for Adults and Children: Joint Guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services

Background: Active and recent coronavirus disease 2019 (COVID-19) infections are associated with morbidity and mortality after surgery in adults. Current recommendations suggest delaying elective surgery in survivors for four to 12 weeks, depending on initial illness severity. Recently, the predominant causes of COVID-19 are the highly transmissible/less virulent Omicron variant/subvariants. Moreover, increased survivability of primary infections has engendered the long-COVID syndrome, with protean manifestations that may persist for months. Considering the more than 600,000,000 COVID-19 survivors, surgeons will likely be consulted by recovered patients seeking elective operations. Knowledge gaps of the aftermath of Omicron infections raise questions whether extant guidance for timing of surgery still applies to adults or should apply to the pediatric population. Methods: Scoping review of relevant English-language literature. Results: Most supporting data derive from early in the pandemic when the Alpha variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) predominated. The Omicron variant/subvariants generally cause milder infections with less organ dysfunction; many infections are asymptomatic, especially in children. Data are scant with respect to adult surgical outcomes after Omicron infection, and especially so for pediatric surgical outcomes at any stage of the pandemic. Conclusions: Numerous knowledge gaps persist with respect to the disease, the recovered pre-operative patient, the nature of the proposed procedure, and supporting data. For example, should the waiting period for all but urgent elective surgery be extended beyond 12 weeks, e.g., after serious/critical illness, or for patients with long-COVID and organ dysfunction? Conversely, can the waiting periods for asymptomatic patients or vaccinated patients be shortened? How shall children be risk-stratified, considering the distinctiveness of pediatric COVID-19 and the paucity of data? Forthcoming guidelines will hopefully answer these questions but may require ongoing modifications based on additional new data and the epidemiology of emerging strains.

The potential impact of nanomedicine on COVID-19-induced thrombosis

Extensive reports of pulmonary embolisms, ischaemic stroke and myocardial infarctions caused by coronavirus disease 2019 (COVID-19), as well as a significantly increased long-term risk of cardiovascular diseases in COVID-19 survivors, have highlighted severe deficiencies in our understanding of thromboinflammation and the need for new therapeutic options. Due to the complexity of the immunothrombosis pathophysiology, the efficacy of treatment with conventional anti-thrombotic medication is questioned. Thrombolytics do appear efficacious, but are hindered by severe bleeding risks, limiting their use. Nanomedicine can have profound impact in this context, protecting delicate (bio)pharmaceuticals from degradation en route and enabling delivery in a targeted and on demand manner. We provide an overview of the most promising nanocarrier systems and design strategies that may be adapted to develop nanomedicine for COVID-19-induced thromboinflammation, including dual-therapeutic approaches with antiviral and immunosuppressants. Resultant targeted and side-effect-free treatment may aid greatly in the fight against the ongoing COVID-19 pandemic.