Coronavirus Disease 2019 Survivors Research Articles

Immune repertoire sequencing reveals an abnormal adaptive immune system in COVID-19 survivors.

Accumulating evidence suggests that severeacute respiratory syndrome coronavirus 2 (SARS-CoV-2) impairs the adaptive immune system during acute infection. Still, it remains largely unclear whether the frequency and functions of T and B cells return to normal after the recovery of CoronavirusDisease 2019 (COVID-19).Here, we analyzed immune repertoires and SARS-CoV-2-specific neutralization antibodies in a prospective cohort of 40 COVID-19 survivors with a 6-month follow-up after hospital discharge. Immune repertoire sequencing revealed abnormal T- and B-cell expression and function with large T cell receptor/B cell receptorclones, decreased diversity, abnormal class-switch recombination, and somatic hypermutation. A decreased number of B cells but an increased proportion of CD19+ CD138+ B cells were found in COVID-19 survivors. The proportion of CD4+ T cells, especially circulating follicular helper T (cTfh) cells, was increased, whereas the frequency of CD3+ CD4- T cells was decreased. SARS-CoV-2-specific neutralization IgG and IgM antibodies were identified in all survivors, especially those recorded with severe COVID-19 who showed a higher inhibition rate of neutralization antibodies. All severe cases complained of more than one COVID-19 sequelae after 6 months of recovery. Overall, our findings indicate that SARS-CoV-2-specific antibodies remain detectable even after 6 months of recovery. Because of their abnormal adaptive immune system with a low number of CD3+ CD4- T cells and high susceptibility to infections, COVID-19 patients might need more time and medical care to fully recover from immune abnormalities and tissue damage.

Neurological Complications of SARS-CoV-2 Infection and COVID-19 Vaccines: From Molecular Mechanisms to Clinical Manifestations.

Coronavirus Disease 2019 (COVID-19) is an infectious disease, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), that reached pandemic proportions in 2020. Despite the fact that it was initially characterized by pneumonia and acute respiratory distress syndrome, it is now clear that the nervous system is also compromised in one third of these patients. Indeed, a significant proportion of COVID-19 patients suffer nervous system damage via a plethora of mechanisms including hypoxia, coagulopathy, immune response to the virus, and the direct effect of SARS-CoV-2 on endothelial cells, neurons, astrocytes, pericytes and microglia. Additionally, a low number of previously healthy individuals develop a variety of neurological complications after receiving COVID-19 vaccines and a large proportion of COVID-19 survivors experience longlasting neuropsychiatric symptoms. In conclusion, COVID-19 is also a neurological disease, and the direct and indirect effects of the virus on the nervous system have a significant impact on the morbidity and mortality of these patients. Here we will use the concept of the neurovascular unit, assembled by endothelial cells, basement membrane, perivascular astrocytes, neurons and microglia, to review the effects of SARS-CoV-2 in the nervous system. We will then use this information to review data published to this date on the neurological manifestations of COVID-19, the post- COVID syndrome and COVID-19 vaccines.

The role of atherogenic index of plasma in the diagnosis long COVID

Objective: One of the well-known prolonged effects of coronavirus disease 2019 (COVID-19) is the gradual loss of pulmonary functions, known as ‘long COVID’. Due to the importance of this deleterious condition, several studies have been conducted to investigate predictors of long COVID throughout hospital admission and after hospital discharge. Recently introduced, the atherogenic index of plasma (AIP) has a better predictive value for the prediction of adverse events in COVID-19 patients compared to other biomarkers. This study aimed to explore the role of AIP in the prediction of long COVID among COVID-19 survivors.
 Material and Methods: We evaluated 52 eligible patients with a diagnosis of long COVID and 80 healthy control subjects with a prior history of COVID-19. To confirm long COVID diagnosis, all subjects underwent a standardized questionnaire which recount the presence or absence of COVID-19-related complaints. All participants’ past medical records and clinical, and demographic characteristics were scanned and underwent comprehensive physical examination and echocardiographic assessment
 Results: According to our study, body surface area, Troponin T, NT-pro-BNP, and AIP were the independent predictors of long COVID. AIP was the best predictor of long COVID among the aforementioned parameters (p=0.005). To determine the AIP cut-off value for predicting long COVID, the receiver operating characteristic (ROC) curve was drawn and the best cut-off value was determined as 0.113 by using the Youden index, (AUC:0.658, 95% CI:0.556-0.760, P=0.002).
 Conclusion: Our data indicate that AIP is an independent predictor of long COVID.

Association between the levels of muscle-specific creatinine kinase (CK-MM) and the incidence of persistent myalgia in COVID-19 survivors

Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, may result in musculoskeletal tissue injury and is assumingly regulated through central and peripheral pathways. Muscle-specific creatinine kinase (CK-MM) is a specific biomarker used to indicate the presence of musculoskeletal tissue damage. This study aimed to investigate the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes. Methods: A cross-sectional study was conducted among COVID-19 survivors at the Faculty of Medicine and Clinical Pathology Laboratory, Universitas Airlangga, Surabaya from June - August 2022. The degree of pain of the myalgia was assessed using a visual analog scale (VAS), while CK-MM level was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). Pearson correlation test at α=0.05 was used to identify the correlation between the levels of CK-MM and the incidence of persistent myalgia in patients with post-COVID-19 syndromes. Results: A total of 84 participants were enrolled in the study and half (50%) of them reported persistent myalgia post-COVID-19 recovery. Fatigue was the patients' most common persistent symptom (63%). Of the total 42 patients with persistent myalgia, more than half (56%) had mild pain intensity (VAS score: 1–3), and almost all of them (41 patients) experienced myalgia during the COVID-19 diagnosis. All the patients with post-COVID-19 myalgia had normal levels of CK-MM (mean: 32.7 ng/mL; range: 12–93 ng/mL), suggesting no musculoskeletal tissue damage. Anova test suggested no significant different of CK-MM levels between those with and without myalgia in patients with post-COVID-19 syndromes p=0.054). Conclusion: There was no significant association between CK-MM levels and the incidence of persistent myalgia in patients with post-COVID-19 syndromes.

Post-intensive Care Unit COVID-19 Survivors: Functional Status and Respiratory Function Three Months After an Inpatient Rehabilitation Program.

Introduction and objectives Long-term coronavirus disease 2019 (COVID-19) sequelae have become an increasing concern, with persistent dyspnoea and fatigue being the most common and long-lasting symptoms reported.The aim of this study was to evaluate the functional status and respiratory function three months after discharge from an inpatient rehabilitation program. Materials and methods This was a prospective study including post-ICU COVID-19 survivors consecutively admitted to an inpatient and multimodal rehabilitation program in a rehabilitation center. Evaluation of functional status (brief balance evaluation systems test (brief-BESTEST), timed up and go (TUG) test, 1 min sit to stand test (1STST), 6 min walking test (6MWT)); respiratory muscle strength (maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP)); cough effectiveness (peak cough flow (PCF)); and fatigue (fatigue assessment scale (FAS)) were assessed at admission (T0), discharge (T1), and three months after discharge (T2). Results A total of 36 patients were included. Between T1 and T2, there was a significant improvement in MEP (84.47±20.89 vs 97.23±24.63 cmH2O, p<0.001), PCF (367.83±117.24 vs 441.33±132.90 L/min, p=0.003), functional capacity (1STST (19.90±6.37 vs 23.13±6.07, p=0.004), and 6MWT (459.25±153.70 vs 500.00±163.74 meters, p=0.003)). No differences were seen in MIP, brief-BESTEST, or TUG. Patients presented a higher median final FAS score at T2 compared to T1: 21.50±5 vs 18.60±2.65, p=0.002. Conclusions Post-ICU COVID-19 survivors admitted to an inpatient rehabilitation program maintained a good functional recovery at the three-month follow-up. Despite overall improvement, we found higher scores of FAS, suggesting worsefatigue levels.

Healthy outcomes of patients with COVID-19 two years after the infection: a prospective cohort study

ABSTRACT The long-term effect of coronavirus disease 2019 (COVID-19) has been rarely known. This study aimed to investigate healthy outcomes of COVID-19 survivors up to 2 years after the infection. A total of 155 COVID-19 patients, who were discharged from Shenzhen Third People's Hospital from February 2020 to April 2020, were enrolled and followed up until March 4, 2022. COVID-19 survivors received questionnaires of long COVID symptoms and psychological symptoms, pulmonary function tests, chest computed tomography (CT) scans and routine laboratory tests. Two years after infection, 36.6% of patients had at least one symptom of long COVID. Vision impairment and fatigue were the most common symptom. 35.0% of participants still had at least one psychological symptom of anxiety, depression, post-traumatic stress symptoms, and sleep difficulties. Radiographic abnormalities were presented in 50.7% of patients, with the most common features of fibrosis-like lesions and residual ground-glass opacity. Diffuse dysfunction (24.0%) was the main abnormalities of pulmonary function tests. Most laboratory parameters returned to normal range, while persistent abnormalities in kidney and liver function test were observed in a subset of participants after discharge. Two years after COVID-19 infection, persistent symptoms of long COVID and psychological symptoms, as well as abnormalities in pulmonary function tests and CT, were still common in a subset of recovering individuals. These findings were limited by the lack of a healthy control group and pre-COVID assessments, which should be confirmed by further large-scale studies.

Coronavirus disease 2019 and cardiovascular disease: what we have learnt during the last 2 years.

Coronavirus disease 2019 and cardiovascular disease: what we have learnt during the last 2 years.

Evaluation of the predictive factors of the short-term effects of a multidisciplinary rehabilitation in COVID-19 survivors

Functional impairments after coronavirus disease 2019 (COVID-19) constitute a major concern in rehabilitative settings; however, evidence assessing the efficacy of rehabilitation programs is lacking. The aim of this study was to verify the clinical characteristics that may represent useful predictors of the short-term effectiveness of multidisciplinary rehabilitation. In this real-practice retrospective pre-post intervention cohort study, the short-term effectiveness of a multidisciplinary patient-tailored rehabilitation program was assessed through normalized variations in the Functional Independence Measure in post-acute care patients who had overcome severe COVID-19. Biochemical markers, motor and nutritional characteristics, and the level of comorbidity were evaluated as predictors of functional outcome. Length of stay in the rehabilitation ward was also considered. Following rehabilitation, all participants (n = 53) reported a significant decrease in the level of disability in both motor and cognitive functioning. However, neither motor and nutritional characteristics nor comorbidities played a significant role in predicting the overall positive change registered after rehabilitation. The results support the existing sparse evidence addressing the importance of an early rehabilitation program for patients who received intensive care and post-acute care due to severe COVID-19.

A study on changes in lung function, neutralizing antibodies, and symptoms of adult patients hospitalized with COVID-19.

To identify changes in symptoms and pulmonary sequelae in patients with coronavirus disease 2019 (COVID-19). Patients with COVID-19 hospitalized at seven university hospitals in Korea between February 2020 and February 2021 were enrolled, provided they had ≥ 1 outpatient follow-up visit. Between January 11 and March 9, 2021 (study period), residual symptom investigations, chest computed tomography (CT) scans, pulmonary function tests (PFT), and neutralizing antibody tests (NAb) were performed at the outpatient visit (cross-sectional design). Additionally, data from patients who already had follow-up outpatient visits before the study period were collected retrospectively. Investigation of residual symptoms, chest CT scans, PFT, and NAb were performed in 84, 35, 31, and 27 patients, respectively. After 6 months, chest discomfort and dyspnea persisted in 26.7% (4/15) and 33.3% (5/15) patients, respectively, and 40.0% (6/15) and 26.7% (4/15) patients experienced financial loss and emotional distress, respectively. When the ratio of later CT score to previous ones was calculated for each patient between three different time intervals (1-14, 15-60, and 61-365 days), the median values were 0.65 (the second interval to the first), 0.39 (the third to the second), and 0.20 (the third to the first), indicating that CT score decreases with time. In the high-severity group, the ratio was lower than in the low-severity group. In COVID-19 survivors, chest CT score recovers over time, but recovery is slower in severely ill patients. Subjects complained of various ongoing symptoms and socioeconomic problems for several months after recovery.

Correlation Between Neutrophil to Lymphocyte Ratio Baseline with Spirometry Test in Severe Coronavirus Disease 2019 (COVID-19)

Background/aim: The sequelae of the post-COVID-19 syndrome can affect lung function. The neutrophil-lymphocyte ratio is one of the markers of increased inflammation in SARS-CoV-2 virus infection. Based on this, the researchers wanted to assess the relationship between baseline NLR levels and spirometry tests in severe COVID-19 survivors. Methods: This research is an observational analytic study with a cross-sectional design conducted at Prof. Dr. IGNG Ngoerah Hospital Denpasar from January 2022 to July 2022. Univariate analysis displays the mean, standard deviation, and relative frequency for categorical data. Bivariate analysis was performed by chi-squared test. The multivariate analysis used was multiple logistic regression to assess the relationship between baseline NLR levels and covariates with the spirometry test. Results: Subjects who participated in the study were 80. As many as 58 subjects (72.5%), the baseline NLR value was 3.58%, and the median NLR was 5.41% (1.19-514%). On spirometry examination, there were restrictions on 41 subjects (51.2%), mild Restriction in 38 subjects (47.5%), Obstruction in 8 subjects (10%), benign Obstruction in 5 subjects (6.3%). The multivariate correlation between baseline NLR and spirometry results (FVC, FEV1, FEV1/FVC, and FEF 25-75%) showed no relationship Conclusion: There is no relationship between high baseline NLR and FVC, FEV1, FEV1/FVC, and FEF25-75% values. Keywords: COVID-19, CRP, Lymphocyte, FVC, FEV1/FVC, FEF 25-75

Contrastive learning and subtyping of post-COVID-19 lung computed tomography images.

Patients who recovered from the novel coronavirus disease 2019 (COVID-19) may experience a range of long-term symptoms. Since the lung is the most common site of the infection, pulmonary sequelae may present persistently in COVID-19 survivors. To better understand the symptoms associated with impaired lung function in patients with post-COVID-19, we aimed to build a deep learning model which conducts two tasks: to differentiate post-COVID-19 from healthy subjects and to identify post-COVID-19 subtypes, based on the latent representations of lung computed tomography (CT) scans. CT scans of 140 post-COVID-19 subjects and 105 healthy controls were analyzed. A novel contrastive learning model was developed by introducing a lung volume transform to learn latent features of disease phenotypes from CT scans at inspiration and expiration of the same subjects. The model achieved 90% accuracy for the differentiation of the post-COVID-19 subjects from the healthy controls. Two clusters (C1 and C2) with distinct characteristics were identified among the post-COVID-19 subjects. C1 exhibited increased air-trapping caused by small airways disease (4.10%, p = 0.008) and diffusing capacity for carbon monoxide %predicted (DLCO %predicted, 101.95%, p < 0.001), while C2 had decreased lung volume (4.40L, p < 0.001) and increased ground glass opacity (GGO%, 15.85%, p < 0.001). The contrastive learning model is able to capture the latent features of two post-COVID-19 subtypes characterized by air-trapping due to small airways disease and airway-associated interstitial fibrotic-like patterns, respectively. The discovery of post-COVID-19 subtypes suggests the need for different managements and treatments of long-term sequelae of patients with post-COVID-19.

The SARS-CoV-2 S1 Spike Protein Promotes MAPK and NF-kB Activation in Human Lung Cells and Inflammatory Cytokine Production in Human Lung and Intestinal Epithelial Cells.

The coronavirus disease 2019 (COVID-19) pandemic began in January 2020 in Wuhan, China, with a new coronavirus designated SARS-CoV-2. The principal cause of death from COVID-19 disease quickly emerged as acute respiratory distress syndrome (ARDS). A key ARDS pathogenic mechanism is the “Cytokine Storm”, which is a dramatic increase in inflammatory cytokines in the blood. In the last two years of the pandemic, a new pathology has emerged in some COVID-19 survivors, in which a variety of long-term symptoms occur, a condition called post-acute sequelae of COVID-19 (PASC) or “Long COVID”. Therefore, there is an urgent need to better understand the mechanisms of the virus. The spike protein on the surface of the virus is composed of joined S1–S2 subunits. Upon S1 binding to the ACE2 receptor on human cells, the S1 subunit is cleaved and the S2 subunit mediates the entry of the virus. The S1 protein is then released into the blood, which might be one of the pivotal triggers for the initiation and/or perpetuation of the cytokine storm. In this study, we tested the hypothesis that the S1 spike protein is sufficient to activate inflammatory signaling and cytokine production, independent of the virus. Our data support a possible role for the S1 spike protein in the activation of inflammatory signaling and cytokine production in human lung and intestinal epithelial cells in culture. These data support a potential role for the SARS-CoV-2 S1 spike protein in COVID-19 pathogenesis and PASC.

New symptoms and prevalence of postacute COVID-19 syndrome among nonhospitalized COVID-19 survivors

The aim of this study was to assess postacute coronavirus disease 2019 (COVID-19) syndrome (PACS) symptoms according to the onset of the infection while evaluating the effect of COVID-19 vaccination on the symptoms of PACS. We conducted a retrospective single-center cohort study in which nonhospitalized COVID-19 survivors and healthy controls were compared for the occurrence of PACS. The total number of patients in this study was 472. At 6–12 and > 12 months after the infection, COVID-19 survivors had a significantly higher incidence of posttraumatic stress disorder (PTSD) and anxiety than the non-COVID-19 cohort. Furthermore, depression, cognitive deficit, tics, impaired quality of life and general health impairment were significantly more prevalent among COVID-19 survivors at < 6 months, 6–12 months and > 12 months than in the non-COVID-19 cohort. However, respiratory symptoms were significantly more prevalent among COVID-19 survivors only in the first 6 months after infection. In addition, cognitive deficit (OR = 0.15; 95% CI 0.03–0.87) and impaired quality of life (B = − 2.11; 95% CI − 4.21 to − 0.20) were significantly less prevalent among vaccinated COVID-19 survivors than among nonvaccinated survivors. Longitudinal studies are needed to establish the time that should elapse after COVID-19 infection for the symptoms of PACS to appear. Randomized clinical trials are needed to assess the possibility that COVID-19 vaccines might relieve PACS symptoms.

New‑onset neuropsychiatric sequelae and 'long‑COVID' syndrome (Review).

The ongoing coronavirus disease 2019 (COVID-19) pandemic has had a widespread impact on individuals' mental health through indirect psychological and social mechanisms, related to factors such as fear of infection or death, social isolation, lack of social support and financial instability. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has also been associated with the development or recurrence of neuropsychiatric symptoms, both during the acute phase, as well as during the post-acute 'long-COVID' phase. In addition to the COVID-19 survivors with a mental health history that are at a high risk of experiencing a range of neuropsychiatric symptoms following resolution of acute COVID-19, there is accumulating evidence that a diagnosis of COVID-19 may also be associated with new-onset neuropsychiatric morbidity among survivors without pre-existing mental health disorders. In particular, studies investigating the incidence of post-acute neuropsychiatric sequelae, based mostly on retrospective cohort study designs and data from national health registries, have reported the development of new-onset manifestations, including depression, anxiety, psychotic symptoms, sleep disturbances and fatigue. Nevertheless, when COVID-19 survivors were compared with SARS-CoV-2-negative controls and especially survivors of other disorders (such as influenza), the findings regarding the risk of incident neuropsychiatric manifestations varied among studies. While there is evidence of an association between SARS-CoV-2 infection and the subsequent occurrence of new-onset neuropsychiatric symptoms, especially among patients with increased disease severity, further research using methodological approaches less susceptible to confounding bias is required to establish causal relationships.

Comorbidities associated with 30-day readmission following index coronavirus disease 2019 (COVID-19) hospitalization: A retrospective cohort study of 331,136 patients in the United States.

Hospital readmission is unsettling to patients and caregivers, costly to the healthcare system, and may leave patients at additional risk for hospital-acquired infections and other complications. We evaluated the association between comorbidities present during index coronavirus disease 2019 (COVID-19) hospitalization and the risk of 30-day readmission. We used the Premier Healthcare database to perform a retrospective cohort study of COVID-19 hospitalized patients discharged between April 2020 and March 2021 who were followed for 30 days after discharge to capture readmission to the same hospital. Among the 331,136 unique patients in the index cohort, 36,827 (11.1%) had at least 1 all-cause readmission within 30 days. Of the readmitted patients, 11,382 (3.4%) were readmitted with COVID-19 as the primary diagnosis. In the multivariable model adjusted for demographics, hospital characteristics, coexisting comorbidities, and COVID-19 severity, each additional comorbidity category was associated with an 18% increase in the odds of all-cause readmission (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.17-1.19) and a 10% increase in the odds of readmission with COVID-19 as the primary readmission diagnosis (aOR, 1.10; 95% CI, 1.09-1.11). Lymphoma (aOR, 1.86; 95% CI, 1.58-2.19), renal failure (aOR, 1.32; 95% CI, 1.25-1.40), and chronic lung disease (aOR, 1.29; 95% CI, 1.24-1.34) were most associated with readmission for COVID-19. Readmission within 30 days was common among COVID-19 survivors. A better understanding of comorbidities associated with readmission will aid hospital care teams in improving postdischarge care. Additionally, it will assist hospital epidemiologists and quality administrators in planning resources, allocating staff, and managing bed-flow issues to improve patient care and safety.

The impact of long COVID on myocardial work performance

Abstract Background Long COVID emerged as a new condition, following the acute episode of coronavirus disease 2019 (COVID-19),exerting a significant impact on patients' quality of life [1]. Several studies involving COVID-19 survivors emphasized the presence of cardiac abnormalities following the acute infection. However, data on possible mechanisms associated to long COVID remain limited. Clinical applications of myocardial work (MW) analysis, assessed by transthoracic echocardiography (TTE) have expended recently, showing an additional value in detecting cardiac dysfunction compared to standard parameters such as left ventricle ejection fraction (LVEF) or global longitudinal strain (GLS) in various pathologies, including COVID-19 [2]. Nevertheless, its potential role in detecting subclinical cardiac dysfunction in long COVID remained unexplored. Purpose We assessed the association between subclinical cardiac dysfunction evaluated by global work index (GWI) and global constructive work (GCW) and long COVID. Methods We included 310 COVID-19 patients hospitalized between March and April 2020. All patients were invited to a systematic one-year follow-up, including clinical evaluation, TTE with MW assessment, chest-computed tomography and spirometry. 140 patients completed the follow-up. Normal values for GWI and GCW were defined as 1926±247 mmHg% and 2224±229 mmHg% [3]. The primary endpoint was long COVID, characterized by a cluster of symptoms such as fatigue or dyspnea more than 3 months after the acute infection, without any other explanation. Results 140 patients (57.1±13.9 years, 90 (64.3%) males) had a mean follow-up of 337.1±34.5 days.The mean values of LVEF, GWI and GCW were 55.2±3.2%, 2105.9±403.3 mmHg% and 2377.8±446.2 mmHg%. 83 (61%) patients had long COVID. No significant differences in terms of comorbidities, clinical evaluation and COVID-19 severity were found between patients with and without long COVID. GCW (2276.7±410.3 vs 2516.5±458.6, p=0.006) and GWI (2008.5±358.9 vs 2242.2±427.0, p=0.003) were the only TTE parameters different between patients with and without long COVID. Multivariable regression analysis showed that GWI &amp;lt;1926 mmHg% (OR 6.095; CI: 2.024–18.355, p=0.001) and GCW &amp;lt;2224 mmHg% (OR 3.205; CI: 1.181–8.694, p=0.022) were the only MW parameters independently associated with long COVID, irrespective of age or the severity of the acute infection, at one year. In a subgroup analysis of 77 patients without previous cardiovascular diseases, long COVID was diagnosed in 45 (58.4%)patients. GWI &amp;lt;1926 mmHg% (OR 8.015; CI: 2.149–29.887, p=0.002) remained independently associated with long COVID at 1 year follow-up. Conclusions Long COVID, frequently observed in recovered COVID-19 patients may indicate the presence of subclinical cardiac dysfunction, reflected by a decrease of the left ventricle performance, assessed by GWI and GCW.Long-term follow-up including cardiac screening should be performed in order to identify patients at risk who would benefit from cardiac rehabilitation programs. Funding Acknowledgement Type of funding sources: None.

Eight Weeks of Pilates Training Improves Respiratory Measures in People With a History of COVID-19: A Preliminary Study.

Coronavirus disease 2019 (COVID-19) can result in prolonged and severe damage to the lungs and quality of life (QoL). This study was designed to investigate the effects of 8-week Pilates and Aqua-Pilates training on pulmonary function and QoL in patients with COVID-19. Pilates and Aqua-Pilates training promotes similar changes on pulmonary function and QoL in people with a history of COVID-19. Randomized controlled trial. Level 3. A total of 45 participants (24 men and 21 women) with a history of COVID-19 were assigned randomly to 3 groups: Pilates training (standard Pilates), Aqua-Pilates training (Pilates in water), and Control. The training protocol was performed for 8 weeks (3 sessions per week). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the ratio of FEV1 to the FVC (FEV1/FVC) indices were measured by a spirometer. The 26-item questionnaire World Health Organization Quality of Life (WHOQOL) BREF was used to assess QoL. Data were analyzed using paired-sample t test and analysis of covariance with an alpha level <0.05. The mean age of the participants was 49.9 ± 6.4 years. After 8 weeks of Pilates and Aqua-Pilates training, there were significant increases in FVC (21.4% for Pilates and 22.1% for Aqua-Pilates, P < 0.05), FEV1 (32.3% for Pilates and 34.7% for Aqua-Pilates, P < 0.05), and FEV1/FVC% (9% for Pilates and 10.3% for Aqua-Pilates, P < 0.05) for the experimental groups, but not for control. Changes for Pilates and Acqua-Pilates were significantly higher than for control. The QoL scores were significantly different within and between the experimental groups, with greater improvements in the Aqua Pilates group than in the Pilates group. An 8-week Pilates or Aqua-Pilates training can improve pulmonary function as much as 34%, depending on the parameter, and QoL in people with a history of COVID-19. Aqua-Pilates training appears to be preferable to standard Pilates. The findings provide important insights into how healthcare professionals can prescribe exercise for COVID-19 survivors.

Role of Nintedanib in COVID-19-Related Lung Fibrosis

In December 2020, Indonesia was introduced to the long Coronavirus disease 2019 (COVID-19) phenomenon. The Centers for Disease Control and Prevention (CDC) introduced the term "post-COVID condition" as a health problem that persists after four weeks from the first exposure to COVID-19. The National Institute for Healthcare and Care Excellence (NICE) classifies COVID-19 infections into three categories based on disease duration: (1) acute infection for up to 4 weeks; (2) ongoing infection within 4-12 weeks; and (3) post-COVID-19 syndrome for more than 12 weeks and not associated with an alternative diagnosis. One of these phenomena is lung fibrosis. About 80% of COVID-19 survivors had mild to severe chest X-rays in 6 months of follow-up with decreasing lung function. COVID-19-related lung fibrosis is still not widely researched. COVID-19 survivors who develop lung fibrosis usually recover independently, but some develop persistent lung fibrosis. The use of antifibrotic agents, such as nintedanib, has long been approved for idiopathic pulmonary fibrosis (IPF). However, its use in the cases of lung fibrosis due to COVID-19 has not been widely studied. Nintedanib is a tyrosine kinase inhibitor. It inhibits receptor activity of vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and fibroblast growth factor (FGF). Those actions will eventually inhibit the proliferation, migration, and transformation of fibroblasts into myofibroblasts in lung fibrogenesis. Therefore, an antifibrotic agent is potentially needed to inhibit COVID-19-related lung fibrosis to improve quality of life and prevent further lung damage.

Symptom persistence and recovery among COVID-19 survivors during a limited outbreak in Canterbury, New Zealand: a prospective cohort study.

BackgroundIn Canterbury, near complete identification of coronavirus disease 2019 (COVID‐19) cases during a limited outbreak provides unique insights into sequelae.AimsThe current study aimed to measure symptom persistence, time to return to normal activity, generalised anxiety and health‐related quality of life (HrQoL) among COVID‐19 survivors compared with uninfected participants.MethodsThe authors conducted a prospective cohort study of people tested for COVID‐19 by reverse transcriptase polymerase chain reaction of nasopharyngeal swabs from 1 March to 30 June 2020. They enrolled participants who tested positive and negative at a 1:2 ratio, and administered community‐acquired pneumonia, 7‐item generalised anxiety disorder (GAD‐7) and HrQoL (RAND‐36) questionnaires.ResultsThe authors recruited 145 participants, 48 with COVID‐19 and 97 without COVID‐19. The mean time from COVID‐19 testing to completing the health questionnaire was 306 days. The mean age of patients was 46.7 years, and 70% were women. Four (8%) COVID‐19–positive and eight (8%) COVID‐19–negative participants required hospitalisation. Fatigue (30/48 [63%] vs 13/97 [13%]; P < 0.001), dyspnoea (13/48 [27%] vs 6/97 [6%]; P < 0.001) and chest pain (10/48 [21%] vs 1/97 [1%]; P < 0.001) were persistent in those with COVID‐19. Fewer COVID‐19–positive participants returned to normal activity levels (35/48 [73%] vs 94/97 97%; P < 0.001), with longer times taken (median 21 vs 14 days; P = 0.007). The GAD‐7 and RAND‐36 scores of both groups were similar across all anxiety and HrQoL subscales.ConclusionsPersistent symptoms and longer recovery times were found in COVID‐19 survivors, but not impaired generalised anxiety levels or HrQoL compared with COVID‐19–uninfected participants.

Correlation between alveolar-arterial oxygen tension difference gradient baseline with spirometry test in severe coronavirus disease 2019 (COVID-19)

Alveolar-arterial Oxygen Tension Differences are one of the oxygenations that can increase SARS-CoV-2 virus infection. Based on this, the researchers wanted to assess the relationship between the baseline AaDO2 gradient and spirometry tests in severe COVID-19 survivors. This research is an observational analytic study with a cross-sectional design. The analysis was carried out in bivariate and multivariate tests assisted by using SPSS 26. The subjects who participated in the study were 80 people. Subjects with AaDO2 values ​​&gt; 39.4 mmHg 70% (n=56), median AaDO2 gradient was 60.45 (2.75 - 548.2 mmHg). The relationship between baseline AaDO2 analysis and spirometry results showed that it was associated with FVC and FEF25-75% results, respectively (PR) 18.6 (95% CI 3.978-87.401 p = &lt;0.001) and (PR) 7.7 (95% CI 1.606-3.724 p = 0.011) and no significant with FEV1 and FEV1/FVC values. This study concludes a relationship between a high baseline AaDO2 gradient with FVC and FEF values ​​of 25-75% in severe adult COVID-19 survivors. There was no relationship between a high baseline AaDO2 gradient and FEV1 and FEV1/FVC values.