COVID-19 Survivors Research Articles

The long-term effects of different telerehabilitation programs on respiratory, exercise, and activity-related parameters in COVID-19 survivors: a randomized controlled trial in Türkiye.

The long-term outcomes of different telerehabilitation gains for discharged COVID-19 patients are largely uncertain, and this point needs to be explored. This study aimed to research the effectiveness of telerehabilitation and compare the long-term results of videoconferencing-guided synchronous telerehabilitation and mobile application-guided asynchronous telerehabilitation programs, as well as determine the correlation between clinical and hemodynamic parameters. Exercise programs including aerobic exercises, strengthening exercises, and pulmonary exercises were given to COVID-19 patients discharged from the Kartal Dr. L&uuml;tfi Kirdar City Hospital in Istanbul, T&uuml;rkiye between August 2021 and January 2022, by videoconferencing or mobile application telerehabilitation. All patients underwent programs three times per week for 8 weeks. Lower extremity strength and functional status were assessed using a 30-second sit-to-stand test (30 s STS); physical activity level was assessed using the International Physical Activity Questionnaire short form (IPAQ); pulse oximetry was used to determine oxygen saturation and heart rate; and dyspnea and fatigue were assessed using a modified Borg Rating of Perceived Exertion Scale. Baseline, post-treatment, and long-term data were analyzed. A total of 27 patients completed the study. Significant improvement was seen in all parameters in long-term results with telerehabilitation programs (p<0.05). Especially in the between-group effect at rest (p=0.031) and post-exertion oxygen saturation (p=0.004), there were significant differences in favor of videoconferencing. Oxygen saturation was negatively correlated with dyspnea and fatigue (p<0.05). Post-exercise, dyspnea showed a moderate positive correlation with fatigue (r=0.582, p=0.001) and heart rate (r=0.412, p=0.033), while it exhibited a moderate negative correlation with 30 s STS (r=-0.424, p=0.027) and IPAQ (r=-0.401, p=0.038). Both methods generally provide positive gains in clinical and hemodynamic parameters, but the videoconferencing results were slightly better. Saturation at rest and dyspnea after exertion can provide a brief prediction about the cardiopulmonary system. Our findings are important for individuals who have access problems to the clinic and city center, and can be used for follow-up and treatment approaches.

Investigating DNA damage caused by COVID-19 and influenza in post COVID-19.

The SARS-CoV-2 virus (termed COVID-19) was responsible for over 34 million global deaths. Although the COVID-19 pandemic has subsided, infection by emerging mutant variants of SARS-CoV-2 poses a continuing threat to public health. COVID-19 infection has been associated with the development of cytokine storm syndrome, hypercoagulability, immunological dysregulation and direct viral invasion of organs, and the long-term consequences for the health of COVID-19 survivors are currently unknown. Our research focuses on the possible mutagenic aspects of infection by COVID-19 and measures their harmful effects on DNA composition. DNA damage was investigated, using the comet assay method, during two periods: in the epidemic peak of COVID-19 and during the post-COVID-19 period, both in patients infected with COVID-19 and in those with influenza. During the epidemic peak, the levels of DNA damage ranged from the highest to the lowest levels in the following groups, respectively: intubated-ICU, non-intubated-ICU, non-ICU, and influenza, with a discernible increase in DNA damage in ICU-treated patients. The levels of DNA damage in the post-COVID-19 period were significantly lower compared to those in the epidemic peak period but there was still a discernible increase in DNA damage in the ICU group. Our results indicate that levels of DNA damage may be an effective indicator in prognostic decision-making and may therefore help to reduce mortality. Given that DNA damage and impaired repair processes can contribute to chronic diseases like diabetes, cancer, and neurodegenerative conditions, it will be crucial to investigate potential similar effects in patients with COVID-19.

Expression Levels of PF4, ALOX12, ITGA2B, F131A in Pregnant COVID-19 Survivors.

COVID-19 is viral illness caused by SARS-CoV-2. The immediate complications of COVID-19 are well defined and associated with increased mortality. A global effort is required to determine its effects on implantation, fetal growth and labor. Post COVID-19 recovery period presents a further challenge regarding service provision, prevention, and management. To assess the expression of Platelet Factor 4 (PF4), Arachidonate 12-lipoxygenase (ALOX 12), Integrin alpha-IIb (ITGA2B) & Coagulation Factor XIII A Chain F13A1 in post-acute COVID-19 survivors pregnant women. Prospective case control study, conducted on 400 pregnant women. Case group consists of 200 singleton pregnancies who had recovered from COVID-19 since 4-6 weeks before conception. Control group consists of 200 singleton pregnancies with no history for COVID-19. Expression levels of ALOX12, PF4, ITGA2B, and F13A1genes were determined using quantitative reverse transcription polymerase chain reaction method (qRT-PCR). Expression levels of ALOX12, ITGA2B, and F13A1, were significantly higher in the patients group (3.82±9.6, 6.63±8.45, and 8.9±9.1, respectively) (p < 0.05) compared to those in the control group (1.0±6.0, 1.0±8.1, and 0.6±7.6, respectively). No significant difference in PF4 expression between patients and control group (p = 0.3). Results obtained from enrichment analysis have also supported the above findings. Relative expression levels of these candidate genes could be distinguished between post-acute COVID-19 survivors' pregnant women and control group, significant relative gene expression of ALOX12, ITGA2B, and F13A1 may be associated with an increased risk of placenta-mediated adverse pregnancy outcomes.

Perceived Parents’ Stigma and Personal Stigma Toward COVID-19 Survivors: A Study Among Emerging Adults in India

The COVID-19 pandemic introduced widespread stigma toward individuals who contracted the virus, impacting social interactions and perceptions within communities. This study aimed to understand personal and perceived parental stigma toward COVID-19 survivors among Indian college students, examining how this stigma varies based on the relationship closeness to the survivor (peer vs. best friend) and whether gender differences influence personal stigma levels. A sample of 650 Indian college students (mean age = 20.01 years, SD = 1.43; 501 males) participated in the study. We assessed both personal stigma and perceived parental stigma toward COVID-19 survivors, with additional comparisons made based on the survivor’s relationship to the student (peer vs. best friend) and participant gender. Findings indicated that personal and perceived parental stigma were significantly higher toward peers than toward best friends who had recovered from COVID-19. Additionally, among perceived parental stigmas, stigma attributed to mothers was highest, followed by that attributed to fathers, with participants’ personal stigma being lowest. Notably, no significant gender differences were found in personal stigma among participants. The results highlight nuanced perceptions of stigma toward COVID-19 survivors, with stigma levels varying by relational closeness and perceived parental attitudes, particularly mothers. These findings underscore the importance of targeting stigma reduction efforts, considering family influence and relational factors. Policymakers and mental health professionals could develop age-specific interventions to mitigate stigma toward COVID-19 survivors, potentially enhancing social support systems within college communities.

Change in frailty among older COVID-19 survivors.

COVID-19 survivors are at greater risk for new medical conditions. Among older adults, where multimorbidity and functional impairment are common, frailty measurement provides a tool for understanding how infection impacts future health beyond a one-disease-at-a-time approach. We investigated whether COVID-19 was associated with change in frailty among older Veterans. Data were from the Veterans Affairs (VA) COVID-19 Observational Research Collaboratory, which extracted VA medical record data. We included Veterans who had COVID-19 from March 1, 2020, to April 30, 2021 and matched uninfected controls. We excluded those <50 years at index or did not survive 12 months after. Frailty was assessed at the index date and 12 months using the VA Frailty Index (VA-FI). We assessed the number of new VA-FI deficits over 12 months. Analysis was done by negative binomial regression adjusted for age, gender, race, ethnicity, and BMI. Coefficients are given as the ratio of the mean number of new deficits in COVID-19 cases versus controls during follow-up. We identified 91,338 COVID-19-infected Veterans and an equal number of matched controls. Median (IQR) age was 68.9 years (60.3-74.2), 5% were female, 71% were White, and baseline VA-FI was 0.16 (0.10, 0.26). Median (IQR) number of new deficits at 1 year was 1 (0-2) for infected and 0 (0-1) for uninfected controls. After adjustment, those with COVID-19 accrued 1.54 (95% CI 1.52-1.56) times more deficits than those who did not. The five most common new deficits were fatigue (9.7%), anemia (6.8%), muscle atrophy (6.5%), gait abnormality (6.2%), and arthritis (5.8%). We found a greater increase in frailty among older Veterans with COVID-19 compared with matched uninfected controls, suggesting that COVID-19 infection has long-term implications for vulnerability and disability among older adults. Functional impairments such as fatigue, impaired mobility, and joint pain may warrant specific attention in this population.

Comparison of clinical characteristics and outcomes between COVID-19 survivors and non-survivors: a retrospective observational study

Background To compare the clinical characteristics of COVID-19 survivors and non-survivors who were transferred from general wards to the critical care units in four tertiary hospitals of Nepal. Methods This study utilized electronic data from the National Intensive Care Unit (ICU) registry managed by the Nepal Intensive Care Research Foundation (NICRF). A retrospective observational study was conducted among 78 eligible COVID-19 patients admitted to the intensive care units of four different hospitals between 2020 and 2022. The Mann-Whitney U test was used to compare each continuous variable between the survivors and non survivors, while Pearson's chi-squared test was used to examine the association between each categorical variable and outcome. Results Among 78 cases of COVID-19 studied, 29 (37.1%) had died, and 49 (62.8%) had recovered. The median age of the patient was 57.5 years, with a higher percentage of males (66.6%). Hypertension (41%) and diabetes (26.9%) were common comorbidities, whereas pneumonia (41%) and acute respiratory distress syndrome (19.2%) were common complications. Most patients required oxygen therapy (96.2%). Corticosteroids (76.9%) and anticoagulants (83.3%) were commonly administered medications. Median of mean arterial pressure was 85 mm Hg [ IQR- 79.2 - 99.5] in non-survivors and 93.3 mm Hg [IQR- 86.6 - 102.6 ] in survivors which was significantly different between the two groups (p=0.04). Nine of the patients had cardiac dysfunction on ICU admission, of which none survived (p=0.001). Out of ten patients requiring inotropes or vasopressors, only two survived (p=0.001). Conclusions Non-survivor COVID patients had lower mean arterial pressure on admission to intensive care units. A higher proportion of patients with cardiac dysfunction and requiring inotropes or vasopressors could not survive.

Long COVID: A risk factor for anxiety, depression, and suicidality?

In many COVID-19 survivors, symptoms continue for a long time. This study aims to examine the relationship between the long-term effects of COVID-19, levels of anxiety and depression, and suicidal ideation with sociodemographic factors and symptoms. A cross-sectional study was conducted on patients who came for control at least 3 months after having COVID-19 disease, in the stable period, and still have symptoms after COVID-19. Demographic characteristics, symptoms, The Beck Depression Scale (BDS), The Beck Anxiety Scale (BAS), and suicidal ideation were assessed with face-to-face questionnaires. A total of 490 patients participated in the study. Thirty percent of patients scored positive on the BDS and 46% scored high on the BAS. Female sex was found to be a risk factor. Anxiety and depression were found to be significantly associated with long COVID symptoms. Both BAS and BDS scores were significantly higher in people with suicidality compared to others, and long-term symptoms were found to be statistically associated with this situation. Depression and anxiety are common in cases of long COVID. It is important for healthcare professionals to be aware of these potential mental health consequences, especially suicidality, and to provide appropriate support and interventions for individuals with long COVID.

The Impact of Vaccination Status on Post-acute Sequelae in Hospitalized COVID-19 Survivors using a multi-disciplinary approach: an observational single center study.

The Impact of Vaccination Status on Post-acute Sequelae in Hospitalized COVID-19 Survivors using a multi-disciplinary approach: an observational single center study.

The long-term impact of the COVID-19 pandemic on mental health and quality of life: a retrospective cohort study in northern Vietnam

The objective of this study was to investigate the mental disturbances among COVID-19 survivors while also examining their quality of life. A retrospective cohort study was conducted among COVID-19 survivors in northern Vietnam. Anxiety, depression, insomnia, cognitive impairment, and quality of life were assessed using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Pittsburgh Sleep Quality Index, Mini-Cog, and Short Form-8 (SF-8), respectively. Information regarding COVID and post-COVID conditions was retrospectively collected through direct interviews. Ordinal logistic regression was employed to identify factors associated with the severity of depression and anxiety; binary logistic regression was used to identify factors associated with the presence of sleep disturbance and cognitive impairment, and linear regression was utilized to identify factors associated with the mental and physical components of the SF-8. A total of 1596 participants were included in this study, with the prevalence of depression, anxiety, sleep disturbance, and cognitive impairment being 8.7%, 16.9%, 23.4%, and 5.6%, respectively. Experiencing discrimination during COVID-19 infection and post-COVID syndrome were both linked to long-term outcomes of depression, anxiety, and insomnia and were also related to a decline in the quality of life. Our study provided initial insights into the mental outcomes and quality of life among COVID-19 survivors over an extended period, with stigmatization and post-COVID syndrome identified as the primary associated factors. A longitudinal study with random sampling, a control group, and measures to better control recall bias is recommended.

Anxiety, depression, and poor sleep quality in COVID-19 survivors of the first year of the pandemic

Abstract Background Psychological outcomes after SARS-CoV-2 infection have been reported primarily among patients with post-COVID-19 condition followed at COVID-specific clinics who may not represent the population of COVID-19 survivors. This study compares the frequency, 2 years after infection, of symptoms of anxiety and depression and poor sleep quality between COVID-19 survivors from the first year of the pandemic and comparison groups matched for sex, age, and level of care. Methods Participants are users of the Local Health Unit of Matosinhos (comprising almost all citizens of this municipality) classified according to hospitalization and SARS-CoV-2 infection between March, 2020 and February, 2021 in 4 groups: group#1, hospitalized due to COVID-19 (n = 101); group#2, hospitalized, uninfected (n = 87); group#3, infected, non-hospitalized (n = 252); group#4, uninfected, non-hospitalized (n = 258). They were evaluated between July, 2022 and October, 2023, with the Hospital Anxiety and Depression Scale (HADS-A, anxiety, and HADS-D, depression) and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was used to compute OR and 95%CI adjusted for sex, age, education, marital status, employment, smoking, and level of care of the associations between the study group and clinically significant symptoms of anxiety (HADS-A scores&amp;gt;10), depression (HADS-D scores&amp;gt;10) and poor sleep (PSQI scores&amp;gt;5). Results No significant differences (p &amp;lt; 0.05) were observed for the prevalence of clinically significant symptoms of depression (overall 9.2%) and poor sleep quality (overall 59.8%) between SARS-COV-2 infected participants and comparison groups, but HADS-A scores&amp;gt;10 were more frequent in infected individuals (19.3% vs. 13.6%; OR = 1.92; 95%CI:1.21,3.05). Conclusions Healthcare services should pay special attention to COVID-19 survivors from the first year of the pandemic to identify and treat anxiety symptoms. Funding: FCT UIDB/ 04750/2020 LA/P/0064/2020 PTDC/SAU-EPI/6275/2020 Key messages • COVID-19 survivors from the 1st year of the pandemic present more frequently high levels of anxiety than the general population 2 years after COVID-19. • Specific care for anxiety symptoms are needed for COVID-19 survivors from the 1st year of the pandemic

Long COVID in the UAE: symptomatology, gender gaps, and health implications among COVID-19 survivors

Abstract Background A growing number of COVID-19 survivors are experiencing symptoms post-SARS-CoV-2 infection, known as long COVID. It is a new multisystem condition and understanding its associated factors and its impact on individuals is crucial. This study aims to characterize long COVID in previously hospitalized patients in the UAE, identifying associated factors and assessing its impact on patients’ daily lives. Methods A multicenter retrospective cohort study was conducted in hospitals in Dubai and Sharjah from January 29, 2020 to October 14, 2021, involving RT-PCR confirmed cases. Clinical, epidemiologic, and long COVID data were collected via hospital records and phone interviews. Results Long COVID affected 48.7% of 533 patients, with 46.6% prevalence persisting over a year. A total of 43 symptoms across 11 organ systems were reported. Females had 1.83 times higher odds of long COVID (95% CI [1.22, 2.74], p = 0.003). Each additional initial symptom (AOR = 1.22, 95% CI [1.05, 1.40], p = 0.008), ICU admission (AOR = 1.77, 95% CI [1.06, 2.98], p = 0.030), and ≥ 2 comorbidities (AOR = 2.19, 95% CI [1.09, 4.40], p = 0.027) increased the odds of long COVID. Long COVID significantly impacted daily life, with poorer health ratings (AOR = 5.576, 95% CI [3.029, 10.265], p &amp;lt; .001), worse health status (AOR = 7.842, 95% CI [4.954, 12.415], p &amp;lt; .001), and work limitations due to physical (AOR = 4.808, 95% CI [3.229, 7.158], p &amp;lt; .001) and emotional issues (AOR = 3.149, 95% CI [2.01, 4.933], p &amp;lt; .001). This impact persisted beyond 12 months post-infection. Conclusions Long COVID presents prolonged multisystem involvement and substantial disability among survivors, necessitating further research to understand its lasting effects and intervention development to mitigate its impact Key messages • Long COVID poses a substantial challenge to public health in the UAE, affecting almost half of hospitalized survivors and extending its impact beyond 12 months post-infection. • Risk factors like gender initial symptoms, ICU stay, and comorbidities increase the risk of long COVID, warranting the need for tailored interventions and support strategies for vulnerable populations.

Memory complaints after COVID-19: a potential indicator of primary cognitive impairment or a correlate of psychiatric symptoms?

Cognitive impairment and symptoms of psychiatric disorders have been reported frequently as features of post-acute sequelae of SARS-CoV-2 infection. This study aims to investigate subjective memory complaints in COVID-19 survivors and determine if these are more strongly associated with objective cognitive impairment related to sequelae of SARS-CoV-2 infection or with symptoms of psychiatric conditions. A total of 608 COVID-19 survivors were evaluated in-person 6–11 months after hospitalization, with 377 patients assigned to a “no subjective memory complaint (SMC)” group and 231 patients assigned to an SMC group based on their Memory Complaint Scale scores. Follow-up evaluations included an objective cognitive battery and scale-based assessments of anxiety, depression, and post-traumatic stress symptoms. We found the perception of memory impairment in COVID-19 survivors to be more strongly associated to core symptoms of psychiatric conditions rather than to primary objective cognitive impairment. Univariate analysis indicated significant differences between the “no SMC” and SMC groups, both for the psychiatric symptom evaluations and for the cognitive evaluations (p < 0.05); however, the psychiatric symptoms all had large partial eta-squared values (ranging from 0.181 to 0.213), whereas the cognitive variables had small/medium partial eta-squared values (ranging from 0.002 to 0.024). Additionally, multiple regression analysis indicated that only female sex and depressive and post-traumatic stress symptoms were predictors of subjective memory complaints. These findings may help guide clinical evaluations for COVID-19 survivors presenting with memory complaints while also serving to expand our growing understanding of the relationship between COVID-19, subjective memory complaints, and the risk of cognitive decline.

A systematic analysis of neurologic manifestations of Long COVID in Nigeria.

Long COVID, also called post-acute sequelae of SARS-CoV-2 infection (PASC) affects millions of people in the world. The neurologic manifestations of PASC (Neuro-PASC) are among the most debilitating but they are largely unreported in Africa. We sought to compare the demographics, symptoms and cognitive profile of post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients in Nigeria. In this cross-sectional study performed at the Lagos University Teaching Hospital, 106/2319 (4.6%) SARS-CoV-2 positive individuals contacted via telephone reported Neuro-PASC symptoms with a higher frequency in PNP than in NNP individuals ((23/200 (11.5%) vs. 83/2119 (3.9%), p = < 0.0001). The predominant neurologic symptoms at any time during the disease course were difficulty remembering / brain fog (63/106; 59.4%), fatigue (59/106; 55.7%), sleep problems (34/106; 32%), headache (33/106; 31%), paresthesia (12/106; 11.3%), and myalgia (10/106; 9.4%). Of 66 participants with Neuro-PASC who underwent in-person neurological evaluation and cognitive screening, all had normal scores on the Intervention for Dementia in Elderly Africans cognition screen, while 11/65 (16.9%) that completed the Montreal Cognitive Assessment had results consistent with mild cognitive impairment (3/16 PNP (18.8%) and 8/49 NNP (16.3%); p = 1.0). Finally, 47/66 (71.2%) had digit span test scores consistent with mild cognitive dysfunction (12/16 PNP (75%) and 35/50 (70%) NNP; p = 1.0). Our findings reveal the previously unrecognized occurrence of Neuro-PASC among COVID-19 survivors in Nigeria and highlight the need for improved screening and diagnosis of Neuro-PASC in our population. Development of cognitive support services for persons suffering from Neuro-PASC in Nigeria is warranted.

A Qualitative Study to Explore Survivors' Experiences in the Implementation of Covid-19 Primary Prevention Efforts in Aceh Province

Background: Primary prevention plays an important role in preventing the occurrence of a disease or other health problems including Covid-19. The purpose of this study was to explore the experiences of Covid-19 survivors in implementing primary prevention efforts for Covid-19. Research Method: This Qualitative study used a phenomenological descriptive design. The Study participants comprised Covid-19 survivors in the capital of Aceh Province, Indonesia. Data were collected using demographic data sheets, Covid-19 primary precaution questionnaires, interview guidelines, field notes, and voice recording devices. Data analysis employed a qualitative data analysis technique. Results: The study shows two main themes regarding Covid-19 survivors’ experiences in implementing primary prevention efforts for Covid-19: knowledge about primary prevention efforts for Covid-19, and; obstacles in implementing Covid-19 primary prevention (e.g., use of masks, washing hands, physical distancing, etc) Conclusion: Covid-19 primary prevention implementation can have both positive and negative experiences for survivors (people). Health professionals should consider these in their intervention programs.

One-year mortality and associated factors in older hospitalized COVID-19 survivors: a Nationwide Cohort Study in Korea

This study aimed to evaluate the 1-year mortality rate among older patients with COVID-19 discharged from hospital and to identify risk factors associated with this outcome. Using a COVID-19 dataset from the Korean National Health Insurance System, this study’s evaluation period spanned from October 8, 2020, through December 31, 2021. The primary outcome was the 1-year mortality rate following hospital discharge. A logistic regression model was employed for multivariable analysis to estimate the odds ratios for the outcomes, and the Kaplan-Meier method was used to analyze differences in 1-year survival rates. Among the 66,810 COVID-19 patients aged 60 years or older who were hospitalized during the study period, the in-hospital mortality rate was 4.8% (n = 3219). Among the survivors (n = 63,369), the 1-year mortality rate was 4.9% (n = 3093). Non-survivors, compared to survivors, were significantly older (79.2 ± 9.5 vs. 68.9 ± 7.8, P < 0.001) and exhibited a lower rate of COVID-19 vaccination (63.0% vs. 91.7%, P < 0.001). Additionally, non-survivors experienced a higher incidence of organ dysfunction, along with a greater proportion of required mechanical ventilation (14.6% vs. 1.0%, P < 0.001) and extracorporeal membrane oxygenation (4.0% vs. 0.1%, P < 0.001). Multivariable logistic regression analysis identified older age, male sex, cardiovascular disease, immunosuppression, organ dysfunction, illness severity, and corticosteroid use during hospitalization as factors associated with death within 1 year after hospital discharge. However, vaccination was found to have a long-term protective effect against death among COVID-19 survivors. The 1-year mortality rate after hospital discharge for older COVID-19 patients was comparable to the in-hospital mortality rate for these patients in Korea. The long-term mortality rate among hospitalized older COVID-19 patients was influenced by demographic factors and the severity of illness experienced during hospitalization.

Long-Term Disabilities in ICU Survivors of COVID-19.

COVID-19 is associated with prolonged disability, particularly after critical illness. This study aimed to assess and compare disability post-hospital discharge of subjects who were invasively ventilated versus those who were not, following ICU admission due to COVID-19. This study also explored variables associated with long-term disability. In this prospective cohort study, subjects with COVID-19 who received invasive ventilation, noninvasive ventilation, or high-flow nasal cannula during ICU stay were assessed with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at 3 and 6 months post-hospital discharge. Data were analyzed collectively and stratified as subjects with and without invasive mechanical ventilation. Analysis of variance and multiple regression analyses were applied. The subjects (N = 43) were mainly male, middle age, and overweight. Subjects who were invasively ventilated (n = 21) had decreased physical function compared to those who were not during hospital assessments. From 3-6 months after discharge, all WHODAS domains and the overall score decreased in both groups (P < .001), indicating disability recovery. The participation domain, which assesses joining in society, was the only domain that remained worse in the ventilation group compared to the no ventilation group (P = .01). No interaction was found between time and the study groups, suggesting that the recovery trajectory was similar. At 6 months, considering the entire cohort, 70% and 56% had no disability in self-care and getting along domains, respectively, while 42% exhibited moderate to severe disability in the participation domain. According to the overall WHODAS score, 86% of subjects still had some level of disability at 6 months. In multivariate analyses, the overall WHODAS score along with the household and participation domains showed significant positive correlations, indicating higher disability, with corticosteroid use. Disability persisted at 6 month post-hospital discharge for ICU survivors of COVID-19, regardless of the need for invasive mechanical ventilation. Participation was the only domain that showed higher disability among those who received invasive ventilation.

Cardiovascular complications in COVID-19: acute management, long-term sequelae, and post-acute care strategies: a brief review

Background: The COVID-19 pandemic, driven by the SARS-CoV-2 virus, has significantly impacted individuals with pre-existing cardiovascular disease (CVD), elevating their risk of severe complications and mortality. Cardiovascular complications, such as myocarditis, acute coronary syndrome (ACS), arrhythmias, and venous thromboembolism (VTE), have been widely observed in COVID-19 patients, with mechanisms including viral myocardial injury, systemic inflammation, and a hypercoagulable state. These complications not only contribute to acute morbidity but also increase the risk of long-term cardiovascular sequelae, highlighting the need for optimized post-acute care in this population. Methods and Materials: A review was conducted based on a comprehensive search strategy using the PICO framework. Studies published from December 2019 onwards, focusing on COVID-19 patients with cardiovascular complications, were identified from databases including PubMed and Google Scholar. Objectives: This review aims to evaluate the cardiovascular complications of COVID-19, with particular attention to the acute and long-term management strategies. It seeks to assess whether comprehensive post-acute care programs tailored to cardiovascular health can reduce the incidence of long-term cardiovascular events and improve outcomes compared to standard care in COVID-19 survivors with pre-existing CVD. Discussion: The findings from this review underscore the significant cardiovascular burden faced by COVID-19 patients, particularly those with pre-existing conditions. Acute complications such as myocarditis, ACS, and VTE are common, with direct myocardial injury and systemic inflammation playing critical roles. Long-term sequelae, including persistent myocardial injury, heart failure, and arrhythmias, are increasingly being recognized, necessitating specialized post-acute care interventions. Evidence suggests that comprehensive cardiovascular rehabilitation programs incorporating lifestyle modification, pharmacotherapy optimisation, and regular monitoring may improve long-term outcomes. However, further research is required to establish the most effective management strategies, particularly for high-risk groups, such as patients with pre-existing CVD and pediatric populations.

One-year trajectories of physical and mental health-related quality of life, fatigue and dyspnoea in COVID-19 survivors.

A substantial number of people experience a persisting impact on health-related quality of life (HRQoL) after COVID-19. The current study aims to identify different trajectories of physical and mental HRQoL, fatigue severity, and dyspnoea severity following hospitalisation with COVID-19, and associated factors of these trajectories. 500 patients with COVID-19 were followed for one year in a longitudinal cohort study. Self-reported outcomes were measured at 3, 6, 9, and 12 months after hospitalisation. Distinct trajectories were characterised using Growth Mixture Modelling. Sociodemographic and clinical correlates of trajectories were investigated using multivariable (multinomial) logistic regression analyses. Three trajectories ('stable high' (16%), 'improving' (40%), and 'stable low' (44%)) were found for physical HRQoL, and four ('stable high' (43%), 'improving' (14%), 'middle declining' (17%), and 'low' (26%)) for mental HRQoL. Older age, overweight and obesity, lower education, and comorbidities were associated with 'low' physical HRQoL. Younger age was associated with 'low' mental HRQoL. Four fatigue trajectories ('no fatigue' (15%), 'improving' (40%), 'low-severe' (27%), and 'high-severe' (18%)) were found. Participants either experienced almost never ('no dyspnoea', 75%) or almost always ('severe', 25%) dyspnoea. High co-occurrences between low HRQoL and severe fatigue and dyspnoea symptom trajectories were found. A substantial number of COVID-19 survivors continue to struggle with reduced HRQoL over time. However, large variations in these physical and mental HRQoL trajectories exist, and trajectories are associated with persisting COVID-19-related symptoms or pre-hospitalised health status. Regular measurement of HRQoL and post-COVID symptoms may help identify those that may benefit from timely interventions.

Persistent Fatigue, Weakness, and Aberrant Muscle Mitochondria in Survivors of Critical COVID-19.

Persistent skeletal muscle dysfunction in survivors of critical illness due to acute respiratory failure is common, but biological data elucidating underlying mechanisms are limited. The objective of this study was to elucidate the prevalence of skeletal muscle weakness and fatigue in survivors of critical illness due to COVID-19 and determine if cellular changes associate with persistent skeletal muscle dysfunction. A prospective observational study in two phases: 1) survivors of critical COVID-19 participating in physical outcome measures while attending an ICU Recovery Clinic at short-term follow-up and 2) a nested cohort of patients performed comprehensive muscle and physical function assessments with a muscle biopsy; data were compared with non-COVID controls. ICU Recovery Clinic and clinical laboratory. Survivors of critical COVID-19 and non-COVID controls. None. One hundred twenty patients with a median of 56 years old (interquartile range [IQR], 42-65 yr old), 43% female, and 33% individuals of underrepresented race attended follow-up 44 ± 17 days after discharge. Patients had a median Acute Physiology and Chronic Health Evaluation-II score of 24.0 (IQR, 16-29) and 98 patients (82%) required mechanical ventilation with a median duration of 14 days (IQR, 9-21 d). At short-term follow-up significant physical dysfunction was observed with 93% of patients reporting generalized fatigue and performing mean 218 ± 151 meters on 6-minute walk test (45% ± 30% of predicted). Eleven patients from this group agreed to participate in long-term assessment and muscle biopsy occurring a mean 267 ± 98 days after discharge. Muscle tissue from COVID exhibited a greater abundance of M2-like macrophages and satellite cells and lower activity of mitochondrial complex II and complex IV compared with controls. Our findings suggest that aberrant repair and altered mitochondrial activity in skeletal muscle associates with long-term impairments in patients surviving an ICU admission for COVID-19.

Impact of Multi-Professional Intervention on Health-Related Physical Fitness and Biomarkers in Overweight COVID-19 Survivors for 8 and 16 Weeks: A Non-Randomized Clinical Trial.

Considering the diverse symptomatology of COVID-19-ranging from mild to severe cases-multi-professional interventions are crucial for enhancing physical recovery, nutritional status, and mental health outcomes in affected patients. Thus, this study aimed to investigate the effects of such an intervention on health-related physical fitness and biomarkers in overweight COVID-19 survivors with varying degrees of symptom severity after 8 weeks and 16 weeks. This non-randomized clinical trial included 59 overweight COVID-19 survivors (32 males and 27 females) divided into three groups: mild (n = 31), moderate (n = 13), and severe/critical (n = 15). The participants underwent a multi-professional program and were assessed for anthropometric and body composition (primary outcome), as well as physical fitness and biochemical markers (secondary outcome) 8 and 16 weeks before the intervention. After 8 weeks, time effects were observed for the maximum isometric handgrip strength (p < 0.001), maximum isometric lumbar-traction strength (p = 0.01), flexibility (p < 0.001), abdominal strength-endurance (p < 0.001), the sit-and-stand test (p < 0.001), maximum oxygen consumption (p < 0.001), and distance covered in the 6 min walk test (p < 0.001). Additionally, time effects were also observed for fat mass (p = 0.03), body fat percentage (p = 0.02), abdominal circumference (p = 0.01), total cholesterol (p < 0.001), low-density lipoproteins (p < 0.001), and glycated hemoglobin (p < 0.001), with lower values after multi-professional interventions. After 16 weeks, the systolic and diastolic blood pressure showed significant reductions independently of the intervention group (p < 0.001). These findings suggest that multi-professional interventions can provide substantial benefits for post-COVID-19 patients, regardless of the severity of their initial symptoms.