Recovery Phase Of COVID-19 Research Articles

Relationship between physical activity and neighborhood environment in preschool children during COVID-19.—A cross-sectional study using 24-hour activity records-

Maintaining physical activity and the development of physical and cognitive functions are essential especially in vulnerable populations such as children. Considering the substantial impact of the COVID-19 epidemic on preschool children and the lack of research focusing on this age group, this study examined the duration of physical activity among preschool-aged children on weekend days and its relationship with the environment. This study was conducted between October and November 2021, with the cooperation of 357 parents of preschoolers attending kindergartens, nurseries, and childcare centers. Physical activity was assessed using a 24h physical activity record. A questionnaire was used to collect basic data on the neighborhood environment. Stepwise multiple regression analysis was used to analyze the relationship between the five physical activity measures (sedentary time, screen time, indoor playing time, outdoor playing time, and going out time) and the questionnaire data. Our findings revealed a relationship between physical activity and the neighborhood environment; however, the R2 values were low. Despite low prediction accuracy, the results of this study were similar to those of previous studies, indicating a positive correlation of physical activity with the absence of undulating roads, a crime-free environment, and safety around the home. Overall, these findings emphasize the need for providing children with opportunities for outdoor physical activity and play in the context of the COVID-19 recovery phase for adherence to the relevant guidelines.

Knowledge, Attitude, and Practice of Sugar-Sweetened Beverage (SSB) Among University Students in Klang Valley, Malaysia

Introduction: Excessive sugar consumption is a major global health concerns as it plays a significant role in the development of non-communicable diseases. Sugar-sweetened beverages (SSB) are a major source of added sugar in daily life that can lead to many health concerns. Understanding of the knowledge, attitudes, and practices (KAP) related to SSB intake is a key component of healthy beverage intake. Therefore, this study aimed to determine the prevalence of SSBs intake and the level of knowledge, attitude, and practice (KAP) of university students during the recovery phase of COVID-19 in 2022. Methods: This cross-sectional study involved 176 young adults aged 18-26 years old who completed a self-administered questionnaire. The questionnaire consisted of demographic and KAP data related to SSBs. Descriptive statistics were outlined, and a chi-square test was conducted to compare categorical variables. Results: Based on the frequency of beverage intake, sugar-sweetened coffee, or tea (39.8%) was the most frequently consumed SSB daily (at least once daily) while regular soft drink (52.3%) was the most consumed SSB among the participants on a weekly basis (≤6 times per week). Overall, the majority of university students had a positive attitude towards SSB intake (90.6%) but poor knowledge (51.7%) and poor practice (80.7%) levels. Gender and weight status were significantly related to the attitude and knowledge scores (p< 0.05). Conclusion: The prevalence of SSB intake among young adults should be addressed. Comprehensive education and intervention are vital to improving the knowledge and practice about proper SSB intake as part of healthy eating lifestyles.

Colonic Mucormycosis In A Post Covid Patient: A Case Report

Mucormycosis is rare infection caused by fungi of order Mucorales which frequently involves rhino-cerebral or respiratory system with involvement of gastrointestinal (GI) tract being rare. Classically majority of patients with invasive mucormycosis are immunocompromised and/or have poor glycemic control. This happens especially during recovery phase of COVID-19 when patients are immunocompromised and simultaneously having poor glycemic control. While gastrointestinal (GI) mucormycosis is rare, stomach and colon are most commonly affected organs, and mortality can be as high as 85%. Diagnosis is difficult since signs and symptoms, imaging and intraoperative gross appearance may not suggest mucormycosis. Diagnosis is usually by histopathologic identification of fungal hyphae in biopsy specimen. A high index of suspicion is therefore necessary in post-COVID-19 patients presenting with mesenteric ischemia or bowel perforation especially if they were immunocompromised. Here we present a case of post COVID disseminated mucormycosis in a 59-year-old diabetic male patient.

Chronic inflammation, neutrophil activity, and autoreactivity splits long COVID

While immunologic correlates of COVID-19 have been widely reported, their associations with post-acute sequelae of COVID-19 (PASC) remain less clear. Due to the wide array of PASC presentations, understanding if specific disease features associate with discrete immune processes and therapeutic opportunities is important. Here we profile patients in the recovery phase of COVID-19 via proteomics screening and machine learning to find signatures of ongoing antiviral B cell development, immune-mediated fibrosis, and markers of cell death in PASC patients but not in controls with uncomplicated recovery. Plasma and immune cell profiling further allow the stratification of PASC into inflammatory and non-inflammatory types. Inflammatory PASC, identifiable through a refined set of 12 blood markers, displays evidence of ongoing neutrophil activity, B cell memory alterations, and building autoreactivity more than a year post COVID-19. Our work thus helps refine PASC categorization to aid in both therapeutic targeting and epidemiological investigation of PASC.

Abstract #1413743: New Onset Diabetes and Acute Pancreatitis- A Sequela of Long COVID?

The association between worse COVID-19 outcomes and diabetes has been well-established in the literature. However, with more cases of new-onset diabetes and pancreatitis being reported with or after COVID-19 infection, it poses the question if there is a causal relationship between them. 31 y/o female with COVID-19 infection 4-6 weeks ago with moderate symptoms (not requiring hospital admission or monoclonal ab), presented to ED with bandlike epigastric pain radiating to back, which is worsened with food, associated with nausea, vomiting, polyuria, and fatigue. Workup showed lipase 232, AST 180, ALT 256. Blood glucose was 281 and HbA1c was 12. CT A/P showed post cholecystectomy status, normal pancreas with mesenteric adenitis. MRCP showed hepatic steatosis with trace fluid around the pancreas s/o inflammation, and no evidence of choledocholithiasis or biliary dilatation. She denied alcohol use and autoimmune workup for pancreatitis was unremarkable. Islet cell antibodies were negative. The patient improved with fluid resuscitation and was discharged home on insulin with plans to transition to oral agents outpatient. Long COVID is defined as a range of conditions or symptoms in patients recovering from COVID-19, lasting beyond 4 weeks after infection. A retrospective cohort study showed increased new-onset diabetes incidence in patients after COVID-19. This was redemonstrated in a systematic review and meta-analysis that showed a 14.4% increased proportion of new diagnoses of diabetes in patients hospitalized with COVID-19. Possible pathophysiology that have been attributed to this include undiagnosed pre-existing diabetes, hyperglycemia secondary to acute illness and stress from increased inflammatory markers during the cytokine storm, the effect of viral infections on the pancreas, and concurrent steroid use in patients with severe respiratory disease. The binding of SARS-CoV-2 to ACE2 receptors is thought to the other mechanism by which COVID can cause pancreatitis and hyperglycemia. Study showed increased lipase and amylase levels in patients with COVID and the increase in serum levels was proportional to the severity of the disease. Patients who died due to COVID-19 were also found to have degeneration of the islet cells. While, several studies have showed new onset diabetes and pancreatitis during an active COVID infections, we need larger cohort studies to comment on its true association or causation, especially in patients with long COVID symptoms. As more cases of new onset diabetes and pancreatitis with COVID-19 are being reported, there may be a need for more frequent blood sugar monitoring during the recovery phase of COVID-19.

Dietary and Physical Activity Behaviors in 2021 and Changes from 2019 to 2021 Among High School Students - Youth Risk Behavior Survey, United States, 2021.

The fall of 2021 was the first school semester to begin with widespread in-person learning since the COVID-19 pandemic began. Understanding dietary and physical activity behaviors of adolescents during this time can provide insight into potential health equity gaps and programmatic needs in schools and communities. This report uses data from the 2021 national Youth Risk Behavior Survey conducted among a nationally representative sample of U.S. public and private school students in grades 9-12 to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race and ethnicity. In addition, 2-year comparisons (2019 versus 2021) of these behaviors were examined. In 2021, daily consumption of fruits, vegetables, and breakfast during the past 7 days remained low and decreased overall with specific disparities by sex and race and ethnicity from 2019 to 2021. The overall prevalence of students attending physical education classes daily, exercising to strengthen muscles on ≥3 days/week (i.e., met the guideline for muscle-strengthening activity), and playing on at least one sports team decreased from 2019 to 2021; whereas being physically active for ≥60 minutes/day on all 7 days (i.e., met the guideline for aerobic activity) and meeting both aerobic and muscle-strengthening guidelines remained low but did not change. These findings underscore the need for strategies to increase healthy dietary and physical activity behaviors both in the recovery phase of COVID-19 and longer term.

Efficacy of Hydroxychloroquine versus Clarithromycin in the Improvement of Dyspnea and Cough in Patients after the Treatment of Acute-Phase COVID-19

Background: Post-acute COVID-19 syndrome involves the persistence of the patient’s symptoms due to the residual inflammation of the acute phase. Objectives: In the current study, we aimed to evaluate medication intervention to accelerate the improvement of prolonged respiratory symptoms in this phase. Methods: Thirty-four patients, aged 20-50 years, in the recovery phase of COVID-19, were enrolled, who still suffered from respiratory problems even two weeks after being discharged from Rasool Akram Hospital, Tehran, Iran. They were divided into three groups based on the type of treatment for eliminating the remaining symptoms: hydroxychloroquine (HCQ, 200 mg twice daily for four weeks), clarithromycin (500 mg twice daily for four weeks), and control (receiving a placebo similar to the last two groups). At the beginning and end of the treatment, patients’ dyspnea and cough were assessed using Medical Research Council and visual analog scale (VAS), respectively, their laboratory tests were checked, and they took a 6-min walk test. Results: At the end of the treatment, the VAS of cough was 0.74 in the HCQ group, which was higher than that in the clarithromycin group. In addition, dyspnea decreased in the HCQ and clarithromycin groups by 64% and 40%, respectively, compared to the control group. Furthermore, there was a significant relationship between residual dyspnea at the end of the treatment and the severity of initial lung involvement in the acute phase. Conclusion: Based on these findings, it can be concluded that HCQ was more effective in reducing dyspnea, compared to clarithromycin, in the recovery phase, especially in patients with milder lung involvement in the acute phase. Additionally, clarithromycin was found to be more effective in improving coughs.

Near-Peer-Teaching Revision Series During the COVID-19 Recovery Phase: An Experience From a UK Medical School.

Background The COVID-19 pandemicled to a significant disruption in clinical attachments for final-year medical students which can result in gaps in clinical knowledge and lower confidence levels. We developed a targeted near-peer-teaching (NPT) revision series to bridge this gap. Method A one-week virtual revision series was developed by the postgraduate doctors (PD and AT) and supervised by the final year written paper lead (NS) as per curriculum requirements. The series focused on eight key common clinical presentations. It was delivered via Leicester Medical School's virtual platform by PD and AT a week before the finals.Multiple-choice surveys were sent out prior to the commencement of the seriesto gauge participation and baseline confidence. Surveys were also sent out before and after each session evaluating teaching, confidence levels, and improvement points. Results This NPT experience was the first comprehensive revision series during the COVID-19 recovery phase. Between 30 and 120 students attended each session. From the pre-series survey (n=63), almost all students indicated that their clinical attachments had been affected by the pandemic and that they (100%) would be interested in participating in the NPT series. From the post-session surveys, 93% of students reported that the session enhanced their confidence in recognizing and managing the clinical presentation, and 100% considered the quality of teaching to be good to excellent. From the post-series survey, a significant improvement was seen in confidence based on the Likert scale (from a combined 35% to 83%, pre, and post-series, respectively). Conclusion The series evaluation demonstrates that students found it a valuable experience and benefited from the social and cognitive congruence afforded by near-peer teachers. Furthermore, the results support the continued use and development of a virtual pre-exam revision series within the medical school curriculumas an adjunct to normal teaching.

The moderating role of industry clockspeed on the relation between supply chain integration practices and new product flexibility

This study assessed the firm's new product flexibility in the recovery phase of COVID-19. Using the theoretical lens of organizational information processing theory, it established the relationship between supply chain integration practices (supply chain planning, internal integration, and supplier involvement) and new product flexibility. It also explained the moderating effect of industry clockspeed on supply chain integration practices and new product flexibility with the help of contingency theory. This study used an online survey method to collect data from plant managers, and we received 256 useable responses. We conducted a confirmatory factor analysis to test the validity and reliability of the scales, and we tested hypotheses using moderated multiple regression technique. The results showed significant positive relationships between supply chain integration practices and new product flexibility. The moderating effects hypotheses showed that industry clockspeed significantly and positively moderated on supply chain planning-new product flexibility and internal integration-new product flexibility links. But it negatively moderated on supplier involvement and new product flexibility. Our study departs from earlier studies in the field that were conducted under normal circumstances. We conducted our study in the recovery phase of COVID-19 in Pakistan, when firms, after fourteen days of complete lockdown, resumed their operations and experienced a new business landscape.

Blended Learning in Animal Biotechnology during Pre-COVID-19, COVID-19 and Post COVID-19 Recovery Phase Periods across the Globe: A Step Forward or Backward

Blended learning is a learning method that combines both Information and Communications Technology (ICT) with traditional teaching. Since the COVID-19 pandemic strikes globally, the application of blended learning has increased exponentially and significantly. E-learning is a critical part of blended learning and the animal biotechnology is one of the subjects that necessitates blended learning. In this review, we described several animal biotechnology blended learning research across the globe over the past five years (pre-COVID-19, COVID-19 and post COVID-19 recovery phase periods), highlighted their methodologies and outcomes before providing future insights to move this learning method forward and to greater heights.

Blended Learning in Animal Biotechnology during Pre-COVID-19, COVID-19 and Post COVID-19 Recovery Phase Periods across the Globe: a Step Forward or Backward?

Blended Learning in Animal Biotechnology during Pre-COVID-19, COVID-19 and Post COVID-19 Recovery Phase Periods across the Globe: a Step Forward or Backward?

Post-pandemic revisit intentions: how shopping value and visit frequency matters

PurposeThis paper examines the effect of shopping value (utilitarian, hedonic and social) on shopping satisfaction and store revisit intention in the post-pandemic phase. Additionally, the authors investigate how shoppers’ COVID-responsible behaviour and visit frequency are contingent on their shopping value evaluations.Design/methodology/approachData were collected (n = 527) using the store intercept method during March 2022 (a recovery phase from the third wave of COVID-19 in India). The authors adopted structural equation modelling to test the proposed model.FindingsShopping values significantly impacted shopping satisfaction and store revisit intentions. The effects of utilitarian and hedonic value on satisfaction were stronger for frequent shoppers than infrequent shoppers. While utilitarian value contributes to stronger satisfaction of COVID-responsible shoppers, COVID-non-responsible shoppers are better satisfied with social value. The impact of hedonic and social value on satisfaction has reduced significantly from the pre- to post-pandemic phase.Practical implicationsPractising managers should recognise that positive shopping value evaluations are important for generating satisfaction. Notably, the utilitarian value becomes more important in times of environmental exigencies. The study provides insights to devise strategies to attract and retain frequent shoppers who are major contributors to the store’s profit.Originality/valueThis study is one of the few studies which focuses on in-store shopping and consumers’ shopping value evaluations in a COVID-19 recovery phase. This study is one of the first that compares the post-pandemic shopping value judgement to a pre-pandemic phase. The authors provide valuable insights into store revisit intentions of shoppers who behave responsibly in a challenging environment.

EGS P21 A review of emergency laparoscopic cholecystectomies during the COVID-19 pandemic compared to pre-pandemic. Is there a difference in patient and financial outcomes?

Abstract Background The COVID-19 pandemic was declared the greatest challenge the NHS would face since its creation. As a means of combatting the unprecedented strains COVID-19 was expected to force upon hospitals and their staff, NHS England sanctioned the postponement of all non-urgent elective surgery during the first wave of the COVID-19 pandemic. Approximately 70 000 cholecystectomies are performed every year in the UK, with the vast majority of these being elective laparoscopic cholecystectomies (LC). However, in the early stages of the pandemic, both national and international surgical bodies warned of the potential risks of aerosol virus transmission with the use of laparoscopy. Therefore, conservative management for emergency general surgical pathologies was recommended where possible. Delays in performing LC are associated with recurrent cholecystitis, pancreatitis and cholangitis; all of which present as emergencies with significant associated morbidity and mortality. This in turn has an economic impact on the NHS. We aimed to evaluate if patients undergoing emergency LC during the COVID-19 pandemic at our site, had different outcomes compared to those treated prior to the pandemic. Has the COVID-19 pandemic negatively impacted their patient journey? Furthermore, has the pandemic led to increased costs for our site? Methods A retrospective data collection was performed to identify all patients who had an emergency LC from March 2019 – March 2021. Patients were subsequently categorised into ‘pre-COVID-19’ and ‘during COVID-19’ groups. Hospital computer systems were used to review operative admission length of stay (LoS), rate of conversion to open surgery/subtotal cholecystectomy, operative time, post-operative complications/return to theatre and readmission rate. Histopathology reports were analyzed to assess if the ‘during COVID-19’ cohort had a higher rate of complicated cholecystitis. Finally costs of the operative admission and associated admissions (pre and post-operatively), as well as the tariff for investigations performed for gallstone disease were calculated for each cohort of patients. Results 158 patients were included in the study. A 42% reduction in emergency LC cases was observed during the COVID-19 pandemic compared to pre-pandemic. No statistically significant differences were seen between the two groups when reviewing the rate of conversion to open surgery or the incidence of post-operative complications/need to return to theatre. The rate of subtotal cholecystectomy was higher in the ‘during COVID-19’ group (12% vs. 3%) and this was found to be statistically significant (p-value 0.024). Operating times were longer during the pandemic (93 vs. 80 mins), as was the LoS for the operative admission (5 vs. 6 days), however these results were not statistically significant. Interestingly, same day emergency care (SDEC) reviews were more frequent in the ‘during COVID-19’ group (13.1 vs. 29.3%) and this was statistically significant (p-value 0.015). There was no statistically significant difference between the groups in relation to histopathology results. The most prevalent histopathology of both cohorts was chronic cholecystitis (58 vs. 48.28%). Acute on chronic cholecystitis (23 vs. 25.86%) and necrotising/gangranous changes (11 vs. 12.07%) were more prevalent in the ‘during COVID-19’ group. When reviewing costs between the two groups, no statistically significant differences in LoS, nor investigation tariffs was observed. Conclusions Our study shows that the COVID-19 pandemic has had a negative impact on two clinical aspects of emergency LC – an increase in the rate of subtotal cholecystectomy, as well as SDEC reviews. This could be explained by delays in elective surgery encountered during the pandemic, leading to patients experiencing recurrent infections, or other associated complications of gallstone disease and consequently requiring more frequent clinician/SDEC reviews. These complications can also result in unclear anatomy, diffuse scarring, necrosis and abscess formation, all of which can lead to increasingly complex cases encountered intra-operatively. If surgeons are unable to safely achieve a critical view of safety, guidance recommends subtotal cholecystectomy as a bail out procedure, in order to avoid serious damage to the bile duct or blood vessels. This could justify the statistically significant higher rate of subtotal cholecystectomy in the ‘during COVID-19’ group. Currently, there are approximately 6 million patients on NHS surgical waiting lists and this issue must be addressed urgently in the COVID-19 recovery phase, so as to prevent adverse outcomes for both patients and the NHS.

Analysis of the IgG subclass profile and IgG sum-total discrepancy in COVID-19 convalescent plasma donors: A single-centre prospective cohort study

IntroductionAlthough IgG1 and IgG3 have been shown to be the dominant subclasses in the acute phase of SARS-CoV-2 infection, little is known about the distribution of IgG subclasses during the recovery phase of COVID-19. The aim of the study was to analyze the profile of IgG subclasses in COVID-19 convalescent plasma donors. MethodsA total of 36 convalescent plasma donors were included in the analysis. IgG and IgG subclass levels were measured using a nephelometric assay in plasma samples obtained directly from the plasma container. ResultsAlthough there was no significant difference in the concentration of IgG subclasses between the study and control groups, the contribution of IgG1 to the total IgG pool between the study and control groups was statistically significant (p = 0.0478). In addition, there was a discrepancy between the total IgG and IgG sum values in the study group, exceeding 15 % in 19,4 % of samples (n = 7), while in the control group no samples with a sum/ total IgG difference > 15 % were observed. ConclusionsThe selective affinity of the IgG1 subclass for the polyclonal anti-IgG reagent may interfere with the determination of total IgG and should be considered when interpreting the results of enzyme immunoassays Data AvailabilityThe data that support the findings of this study are available on request from the corresponding author.

TU7.4 Service Evaluation Audit of Virtual Outpatient Clinics in the Post-COVID-19 era

IntroductionThe COVID-19 pandemic has significantly changed outpatient clinic services which now involve virtual (telephone/video) rather than face-to-face consultations. For both new clinic patients or follow-up patients after a recent emergency admission, these changes may impact on their perceptions and confidence in the outpatient service. The aim of this service provision audit is to ascertain both patient satisfaction and confidence in virtual consultations in our unit.MethodsA retrospective evaluation of all General Surgery virtual clinic appointments between January and March 2021 was undertaken. Patients were contacted for feedback about their surgical consultation based on questions from the National Health Service Outpatient Department Survey (2011).ResultsIn total, 151 patients were contacted. Overall satisfaction regarding telephone consultations was significantly higher when compared to survey results of face-to-face appointments in the pre-COVID era. The majority of patients were confident (51%) or confident to some extent (27%) of being listed for surgery without further examination. Only 8% of patients were not confident at the way surgery was explained and 10% were not confident of the risks of surgery. Finally, more than a third were not happy to be discharged from clinic following a telephone consultation.ConclusionFollow-up appointments are an integral part of the patient journey following an emergency admission. The COVID-19 recovery phase has necessitated a service reconfiguration towards virtual appointments. We show that patients were satisfied with virtual consultations, although further quality improvement should be undertaken to ensure outpatient discharge is satisfactory for all patients following an emergency admission.

COVID- 19 Following Acute Psychosis: Case series report

IntroductionCoronavirus disease (COVID-19) could result in various medical consequences. Clinical manifestations are diverse and range from asymptomatic or mild, fever-like symptoms, to more severe and life-threatening complications. Although the clinical presentation was initially dominated by respiratory symptoms, psychiatric symptoms and sequelae have been reported in COVID- 19 patients and convalescents.ObjectivesTo describe four clinical case reports of patients admitted to the inpatient unit of Psychiatric Hospital Sarajevo (PHS) with acute onset of psychosis in the recovery stage of COVID-19.Methods In this case series we report cases of 4 patients, all female, mean age 53.25 years, hospitalized in PHS during the third wave of the COVID-19 pandemic. All developed psychotic symptoms in the recovery phase of COVID-19. None had a previous history of psychiatric disturbances of any kind. All patients were diagnosed with brief psychotic disorder (BPD), according to DSM 5 criteria for BPD.ResultsCOVID-19 affects various organ systems, including the brain, with variable symptoms based on disease severity. Psychotic features have been observed as well. The pathophysiology and direct biological effects of the disease are not fully understood. COVID-19 patients and convalescents can develop psychotic symptoms as a consequence of multiple concurrent factors. Several proposed mechanisms include direct central nervous system infiltration, cytokine network dysregulation, peripheral immune cell transmigration, and post-infectious autoimmunity [1], treatments used to manage the infection, and psychosocial stress.ConclusionsClinicians need to be aware of possible psychotic manifestations in COVID-19 patients and survivors. Long-term follow-up is warranted to provide efficient patient care.DisclosureNo significant relationships.

The expression patterns of MALAT-1, NEAT-1, THRIL, and miR-155-5p in the acute to the post-acute phase of COVID-19 disease

IntroductionOne of the hallmarks of COVID-19 is overwhelming inflammation, which plays a very important role in the pathogenesis of COVID-19. Thus, identification of inflammatory factors that interact with the SARS-CoV-2 can be very important to control and diagnose the severity of COVID-19. The aim of this study was to investigate the expression patterns of inflammation-related non-coding RNAs (ncRNAs) including MALAT-1, NEAT-1, THRIL, and miR-155-5p from the acute phase to the recovery phase of COVID-19. MethodsTotal RNA was extracted from Peripheral Blood Mononuclear Cell (PBMC) samples of 20 patients with acute COVID-19 infection and 20 healthy individuals and the expression levels of MALAT-1, NEAT-1, THRIL, and miR-155-5p were evaluated by real-time PCR assay. Besides, in order to monitor the expression pattern of selected ncRNAs from the acute phase to the recovery phase of COVID-19 disease, the levels of ncRNAs were re-measured 6‒7 weeks after the acute phase. ResultThe mean expression levels of MALAT-1, THRIL, and miR-155-5p were significantly increased in the acute phase of COVID-19 compared with a healthy control group. In addition, the expression levels of MALAT-1 and THRIL in the post-acute phase of COVID-19 were significantly lower than in the acute phase of COVID-19. According to the ROC curve analysis, these ncRNAs could be considered useful biomarkers for COVID-19 diagnosis and for discriminating between acute and post-acute phase of COVID-19. DiscussionInflammation-related ncRNAs (MALAT-1, THRIL, and miR-150-5p) can act as hopeful biomarkers for the monitoring and diagnosis of COVID-19 disease.

NEW ONSET HYPERTENSION IN POST COVID-19 RECOVERED PATIENTS: A CASE SERIES FROM A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on healthcare demographics worldwide. Post Covid Syndrome is a new clinical entity that has emerged as a concern in recent times. It is dened as the presence of some persistent symptoms like fatigue, cognitive impairment and sleep disturbances in patients even after four weeks of recovery from Covid-19. Recent medical literature has hinted on Post-Covid vascular complications and our study has supplemented it by reporting new-onset hypertension in a series of eight patients within four weeks of recovery from laboratory proven Covid-19. None of the patients had pre-existing hypertension, cardiac disease, renal abnormalities or any history of long term steroid intake. These patients presented to the fever clinic with initial symptoms of fever, sore throat, mild cough and fatigue. `They were managed conservatively at home but one of the patients required hospital admission due to hypoxia.All the patients recovered within ten days of presentation and weekly follow-up visits were scheduled for six weeks at Post-Covid Recovery clinic. At the clinic, some of them complained of persistent headaches, occasional palpitations or prolonged fatigue. Examination incidentally revealed consistently elevated blood pressure in all the eight patients, even those who did not have any post covid symptoms. They were advised on antihypertensive drug therapy and lifestyle modications after six week of routine follow-up and home monitoring. It is proposed that the close binding of the virus with Angiotensin Converting Enzyme-2 (ACE2) can lead to decrease in the serum enzyme levels, which in turn inhibit the protective pathway of the Renin-Angiotensin-Aldosterone (RAAS) axis. It might lead to imprudent rise in Angiotensin-2 and thereby blood pressure. Hypertension and its concomitant effect on target organ damage is a well known risk factor for increased mortality and morbidity among hospitalized Covid-19 patients. The development of hypertension and other cardiovascular manifestations in the post covid-19 recovery phase warrants further research to understand the molecular mechanisms, early identication and timely intervention to reduce incidence of adverse cardiovascular events in such patient cohorts.

\u201cLike before, but not exactly\u201d: the Qualy-REACT qualitative inquiry into the lived experience of long COVID

BackgroundPost-acute sequelae of SARS-CoV-2 infection (PASC) affect millions of individuals worldwide. Rehabilitation interventions could support individuals during the recovery phase of COVID-19, but a comprehensive understanding of this new disease and its associated needs is crucial. This qualitative study investigated the experience of individuals who had been hospitalized for COVID-19, focusing on those needs and difficulties they perceived as most urgent.MethodsThis naturalistic qualitative study was part of a single-center mix-method cross-sectional study (REACT) conducted in Italy during the first peak of the SARS-CoV-2 pandemic. The qualitative data collection took place through a telephone interview conducted 3 months after hospital discharge. The experience of individuals discharged after hospitalization for COVID-19 was investigated through the main research question – “Tell me, how has it been going since you were discharged?”. Two secondary questions investigated symptoms, activities, and participation. Data were recorded and transcribed verbatim within 48 h. An empirical phenomenological approach was used by the researchers, who independently analyzed the data and, through consensus, developed an interpretative model to answer the research question. Translation occurred after data was analyzed.ResultsDuring the first peak of the COVID-19 pandemic, 784 individuals with COVID-19 were discharged from the hospitals of the Local Health Authority of the Province of Reggio Emilia (Italy); 446 were excluded due to the presence of acute or chronic conditions causing disability other than COVID-19 (n. 339), inability to participate in the study procedures (n. 56), insufficient medical documentation to allow for screening (n. 21), discharge to residential facilities (n. 25), and pregnancy (n. 5). Overall, 150 individuals consented to participate in the REACT study, and 56 individuals (60.7% male, average age 62.8 years ±11.8) were interviewed in June–July 2020, up to data saturation.Persistent symptoms, feelings of isolation, fear and stigma, emotional distress, a fatalistic attitude, and return to (adapted) life course were the key themes that characterized the participants’ experience after hospital discharge.ConclusionsThe experience as narrated by the participants in this study confirms the persistence of symptoms described in PASC and highlights the sense of isolation and psychological distress. These phenomena may trigger a vicious circle, but the participants also reported adaptation processes that allowed them to gradually return to their life course. Whether all individuals are able to rapidly activate these mechanisms and whether rehabilitation can help to break this vicious circle by improving residual symptoms remain to be seen.Trial registrationClinicalTrials.com NCT04438239.

Eyelid Myokymia-a Presumed Manifestation of Coronavirus Disease 2019 (COVID-19).

The purpose of this study is to report eyelid myokymia in patients recently recovered from COVID-19 disease. A cohort of 15 patients who developed eyelid myokymia during or immediate post-recovery of systemic disease were evaluated. Demographic, clinical characteristics, effect of age, and hospitalization on the disease course were studied. The disease course was evaluated every month for 3 months period. All, except 2, patients had complete resolution of lid myokymia within 3 months of onset. Median [IQR] myokymia recovery time was 42 [31,60] days. Age and duration of hospitalization had a significant linear relationship with myokymia recovery time. Recovery was delayed by 2.64 days with every 1-year increment in age and by 6.19 days with every additional day of hospital stay. Recovery time was independent of severity of systemic disease (P = .055) and gender (P = 0.2). Eyelid myokymia can be a possible manifestation of COVID-19 recovery phase. While myokymia recovers gradually in all these patients, older age and a longer duration of hospitalization are associated with slower recovery.