post-COVID Syndrome Research Articles

Post-COVID asthenia, sarcopenia and muscle weakness among geriatric patients

Sarcopenia, asthenia, and motor activity restriction are common among geriatric patients in the post-COVID period. The SARS-CoV-2 virus triggers a cytokine storm in the human body and induces a direct viral effect on skeletal muscles. Manifestations of post-acute sequelae of COVID-19 (PASC) can include organ and system dysfunction, asthenia, muscle weakness, dyspnea, chest pain, cognitive impairment, depression, anxiety, and sleep disorders. Hypoxemia, comorbidity, and prolonged inactivity contribute to changes in the structure and functionality of the muscular fibers. One of the recent studies is ALMI-index, which indicates that a decrease in muscle mass of the upper and lower extremities may cause functional limitations in patients with long-COVID conditions. Rehabilitation of patients with post-COVID syndrome involves daily exercise with weights, considering load tolerance; mandatory medication; and nutritional and psychological support.

Cardiovascular diseases as risk factors of post-COVID syndrome: a systematic review

BackgroundA growing proportion of people experience incomplete recovery months after contracting coronavirus disease 2019 (COVID-19). These COVID-19 survivors develop a condition known as post-COVID syndrome (PCS), where COVID-19 symptoms persist for > 12 weeks after acute infection. Limited studies have investigated PCS risk factors that notably include pre-existing cardiovascular diseases (CVD), which should be examined considering the most recent PCS data. This review aims to identify CVD as a risk factor for PCS development in COVID-19 survivors.MethodsFollowing the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist, systematic literature searches were performed in the PubMed, Scopus, and Web of Science databases from the earliest date available to June 2023. Data from observational studies in English that described the association between CVD and PCS in adults (≥ 18 years old) were included. A minimum of two authors independently performed the screening, study selection, data extraction, data synthesis, and quality assessment (Newcastle-Ottawa Scale). The protocol of this review was registered under PROSPERO (ID: CRD42023440834).ResultsIn total, 594 studies were screened after duplicates and non-original articles had been removed. Of the 11 included studies, CVD including hypertension (six studies), heart failure (three studies), and others (two studies) were significantly associated with PCS development with different factors considered. The included studies were of moderate to high methodological quality.ConclusionOur review highlighted that COVID-19 survivors with pre-existing CVD have a significantly greater risk of developing PCS symptomology than survivors without pre-existing CVD. As heart failure, hypertension and other CVD are associated with a higher risk of developing PCS, comprehensive screening and thorough examinations are essential to minimise the impact of PCS and improve patients’ disease progression.

Clinical and immunological characteristics of post-COVID syndrome

Clinical and immunological characteristics of post-COVID syndrome

Factors Affecting COVID-19 Vaccine Confidence and Prevalence of Post-COVID Syndrome

Background/Aims: Determining the attitudes and confidence levels of society towards vaccines is important even after administering vaccinations. The aims of this study are: to determine the prevalence of post-COVID syndrome, the side effects after COVID-19 vaccinations, and the factors affecting COVID-19 vaccine confidence in individuals aged eighteen and over. Methods: The population of this cross-sectional study consisted of people aged eighteen and above living in the city center of Amasya. It was aimed to reach 392 people. Data collection was carried out between August 15 – September 15, 2022, through a questionnaire prepared by the researchers. Results: The number of people having chronic COVID condition was 55 (20.0%). Three hundred nine people (43.2%) developed side effects after at least one dose of the vaccine. The rate of trusting all the vaccines was higher among those who did not develop side effects after vaccination, who did not use social media as a source of information, who were aged 65 and over, who resided in rural areas, who had secondary school education and below, who did not work and who were housewives (p

Clinical spectrum and short-term outcome of post-COVID multisystem inflammatory syndrome in children after the 2019 pandemic: a longitudinal cohort study

Background As a post-COVID complication in children, multisystem inflammatory syndrome in children (MIS-C) is important because of its varied and life-threatening manifestations. With this background, this study attempts to focus on MIS-C cases in an underprivileged rural setting in north-eastern India, with most patients being treated with methylprednisolone rather than intravenous immunoglobulin due to financial constraints. Methods In this prospective longitudinal cohort study at MGM Medical College, 27 MIS-C cases diagnosed following WHO criteria were included. Laboratory and radiological investigations, including echocardiography, were performed as required for diagnosis and to assess prognosis. Most patients were treated with methylprednisolone. A follow-up assessment was done six weeks after discharge for any residual impairment. Results The most frequently affected age group was 5–10 years (59.28%), while respiratory (48.14%) and cardiac (40.74%) were the most commonly involved systems. Logistic regression studies established a significant association between serum ferritin level and prolonged hospital stay (coefficient 0.0674, p=0.0041), possibly due to greater complications in cases with high ferritin levels. Organ impairment was found to increase the need for inotrope use (coefficient 3.8797, p=0.00584). Most cases were treated with methylprednisolone alone (85.18%) with a favourable response and no death occurred. Conclusion The favourable response in cases treated with methylprednisolone only affirms the effectiveness of the drug as a cheaper alternative in a resource-poor setting. The study highlights that higher ferritin levels in complicated cases leads to prolonged hospitalisation and the increased need for inotropes in cases with organ impairment.

Long-Term Health Impacts of Post-COVID Syndrome: Genetic and Epigenetic Modifications Increasing Cancer Risk and Public Health Challenges

The COVID-19 pandemic has had a profound and lasting impact on global health, extending beyond the immediate effects of the acute respiratory illness it initially caused. Post-COVID syndrome, or long COVID, has emerged as a significant health concern, characterized by a wide range of persistent symptoms and complications affecting multiple organ systems. This syndrome poses substantial challenges to both individuals and healthcare systems, with potential long-term consequences that warrant urgent attention and research. Among the most alarming potential outcomes is the risk of a significant increase in oncological diseases. The chronic inflammation, immune dysregulation, and genetic and epigenetic changes induced by prolonged COVID are factors that have long been associated with cancer development. The possibility that these factors could lead to a substantial rise in cancer incidence over the next 5-7 years is a critical area of investigation. Chronic inflammation, a hallmark of long COVID, is a well-established risk factor for cancer. Persistent inflammatory responses can cause DNA damage, promote the activation of oncogenes, and suppress tumor suppressor genes, thereby creating an environment conducive to cancer development. The oxidative stress associated with chronic inflammation can result in significant genetic alterations, including DNA mutations and chromosomal aberrations, further increasing cancer risk. Additionally, epigenetic changes such as DNA methylation, histone modifications, and alterations in non-coding RNA expression can disrupt normal gene regulation, leading to inappropriate activation or silencing of genes involved in cell growth, apoptosis, and immune responses. These epigenetic disruptions can create a cellular environment that favors malignant transformation and cancer progression. Telomere shortening, another consequence of chronic stress and inflammation observed in long COVID patients, is associated with increased cancer risk. Accelerated telomere shortening due to chronic inflammation and oxidative stress can lead to cellular senescence, genomic instability, and increased susceptibility to cancer. Expert opinions from leading oncologists, geneticists, and epidemiologists underscore the urgency of addressing the potential long-term oncological impacts of postCOVID syndrome. Mathematical models and epidemiological studies support concerns that cancer incidence could potentially double due to long COVID, indicating a significant public health challenge.In addition to oncological diseases, long COVID is associated with an increased risk of several other chronic conditions, including cardiovascular diseases, neurological diseases, metabolic disorders, respiratory diseases, autoimmune diseases, and mental health disorders. Addressing these potential increases requires a comprehensive approach, including continued research, enhanced screening and monitoring, public health initiatives, and targeted therapeutic interventions. This abstract highlights the multifaceted impacts of long COVID, emphasizing the need for ongoing vigilance and a coordinated response to mitigate its long-term health consequences. Understanding and addressing these challenges is crucial for improving the quality of life for individuals affected by long COVID and for protecting global health in the post-pandemic era.

Post-COVID syndrome prevalence: a systematic review and meta-analysis

BackgroundSince the Coronavirus disease 2019 (COVID-19) pandemic began, the number of individuals recovering from COVID-19 infection have increased. Post-COVID Syndrome, or PCS, which is defined as signs and symptoms that develop during or after infection in line with COVID-19, continue beyond 12 weeks, and are not explained by an alternative diagnosis, has also gained attention. We systematically reviewed and determined the pooled prevalence estimate of PCS worldwide based on published literature.MethodsRelevant articles from the Web of Science, Scopus, PubMed, Cochrane Library, and Ovid MEDLINE databases were screened using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic search process. The included studies were in English, published from January 2020 to April 2024, had overall PCS prevalence as one of the outcomes studied, involved a human population with confirmed COVID-19 diagnosis and undergone assessment at 12 weeks post-COVID infection or beyond. As the primary outcome measured, the pooled prevalence of PCS was estimated from a meta-analysis of the PCS prevalence data extracted from individual studies, which was conducted via the random-effects model. This study has been registered on PROSPERO (CRD42023435280).ResultsForty eight studies met the eligibility criteria and were included in this review. 16 were accepted for meta-analysis to estimate the pooled prevalence for PCS worldwide, which was 41.79% (95% confidence interval [CI] 39.70–43.88%, I2 = 51%, p = 0.03). Based on different assessment or follow-up timepoints after acute COVID-19 infection, PCS prevalence estimated at ≥ 3rd, ≥ 6th, and ≥ 12th months timepoints were each 45.06% (95% CI: 41.25–48.87%), 41.30% (95% CI: 34.37–48.24%), and 41.32% (95% CI: 39.27–43.37%), respectively. Sex-stratified PCS prevalence was estimated at 47.23% (95% CI: 44.03–50.42%) in male and 52.77% (95% CI: 49.58–55.97%) in female. Based on continental regions, pooled PCS prevalence was estimated at 46.28% (95% CI: 39.53%-53.03%) in Europe, 46.29% (95% CI: 35.82%-56.77%) in America, 49.79% (95% CI: 30.05%-69.54%) in Asia, and 42.41% (95% CI: 0.00%-90.06%) in Australia.ConclusionThe prevalence estimates in this meta-analysis could be used in further comprehensive studies on PCS, which might enable the development of better PCS management plans to reduce the effect of PCS on population health and the related economic burden.

Study of Right Ventricular Function in Post COVID Syndrome in Recovered Mild Severity COVID-19 Patients Using Conventional and Speckle Tracking Echocardiography

Abstract Background Many patients seek medical help for COVID-19’s longer term physical and mental effects. The term post COVID syndrome is used by the World Health Organization (WHO) to identify individuals with a history of probable or confirmed COVID-19 infection, usually 3 months from the onset of infection with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Symptoms may be due to persistent chronic inflammation, sequelae of organ damage, and hospitalization and social isolation. These symptoms may persist from the initial infection, or appear after a period of recovery. RV dimensions (RVD) and RV function (RVF) are closely correlated to symptom occurrence and to exercise capacity in many clinical conditions. Consequently, a comprehensive and accurate evaluation of the RV is essential. Echocardiography is the modality of choice for the assessment of RVD and RVF in clinical practice owing to its numerous advantages. It is widely available, relatively cheaper than other modalities, non-invasive, and doesn’t require radiation or contrast injection. Nevertheless, the RV special anatomy, its retrosternal position and its complex architecture pose a challenge to conventional echocardiographic imaging. Novel modalities of echocardiography, such as myocardial deformation imaging by speckle tracking echocardiography (STE), provide the solution to overcome most of these challenges owing to the fact that it is independent of cardiac translation, angle-independent and load-independent. Aim and Objectives The aim was to study RV function in post COVID syndrome in recovered mild severity COVID-19 patients using 2D RV STE and correlate these findings with the patients’ symptomatology. Patients and Methods This study included 96 subjects divided into 3 age and gender matched groups; the first group consisted of 32 mild severity COVID-19 patients 3-6 months after recovery and not complaining of post COVID-19 syndrome, the second group consisted of 32 mild severity COVID-19 patients 3-6 months after recovery and complaining of post COVID-19 syndrome and the third group consisted of 32 healthy controls who didn’t get COVID-19. This study was conducted at Ain Shams University Hospitals. The patients were recruited from the outpatient ECHO clinic in the cardiology department during the period from March 2022 to August 2022. The entire study population was evaluated via 2D conventional echocardiography and STE imaging. Results Our study assessed RV functions at 3-6 months after recovery from mild severity COVID-19 disease. At the follow-up, TAPSE, RV-FAC, RV S’, RV-GLS and RV-FWLS parameters were significantly lower in patients with mild severity COVID-19 disease than healthy controls. They also showed lower values in patients with post COVID syndrome than those without post COVID syndrome with P-value = 0.032, 0.034, 0.003, 0.010 and 0.029 respectively. In addition, RV diameters (longitudinal, mid and basal RVEDD), RV MPI and sPAP values were significantly higher in patients with mild severity COVID-19 disease than healthy controls. They also showed higher values in patients with post COVID syndrome than those without post COVID syndrome with P-value = 0.043, 0.026, 0.014, 0.000 and 0.025 respectively. LV-GLS showed lower value in patients with post COVID syndrome than control group with P-value = 0.002. It also showed lower value in patients with post COVID syndrome than those without post COVID syndrome with P-value = 0.018. We also found that the most common symptom in post COVID syndrome was fatigue, with a percentage of 65.6%, followed by palpitations (40.6%) and chest pain (31%). These three symptoms showed a significant negative relation with RV 2D STE parameters. Additionally, a negative correlation between inflammatory markers including CRP, TLC, PLT, ferritin and D-dimer levels during active infection and long term echocardiographic parameters such as RV-GLS, RV-FWLS and LV-GLS was detected in our study. Conclusion We concluded that RV-GLS and RV-FWLS decreased at 3-6 month follow-up of patients with history of mild severity COVID-19 disease especially those complaining of post COVID syndrome. Additionally, it is demonstrated that increased CRP, TLC, PLT, ferritin and D-dimer levels during acute infection is related to RV-GLS, RV-FWLS and LV-GLS values. 2D STE may be used for both detection and follow-up for possible long term right ventricular dysfunction after mild severity COVID-19 disease. Key words: Post-COVID Syndrome, Speckle Tracking Echocardiography, RV-GLS, RV-FWLS, LV-GLS Abbreviations. Abbreviations: RV Right Ventricle STE Speckle Tracking Echocardiography 2D 2-Dimensional TAPSE Tricuspid Annular Plane Systolic Excursion RV-FAC Right Ventricular Fractional Area Change RV-GLS Right Ventricular Global Longitudinal Strain RV-FWLS Right Ventricular Free Wall Longitudinal Strain LV-GLS Left Ventricular Global Longitudinal Strain RVEDD Right Ventricular End Diastolic Dimension RV MPI Right Ventricular Myocardial Performance Index sPAP Systolic Pulmonary Artery Pressure CRP C – Reactive Protein TLC Total Leucocytic Count PLT Platelets WHO World Health Organization LVEDD Left Ventricular End Diastolic Dimension LVESD Left Ventricular End Systolic Dimension FS Fractional Shortening EF Ejection Fraction

Clinical cases of vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA vasculitis) induced by COVID-19

COVID-19 is similar to immunoinflammatory rheumatic diseases in clinical manifestations, immune responses and pathogenetic mechanisms. Specific autoantibodies as markers of autoimmune diseases can be detected in patients with coronavirus infection. Most often, after COVID-19, antinuclear antibodies, antibodies to phospholipids, to cardiolipin, to β2-glycoprotein, to cytoplasmic antigens SS-A and SS/B, and cyclic citrulline-containing peptide are detected. In moderate and severe cases of COVID-19 infection with pulmonary-renal syndrome, cytokine storm, antineutrophil cytoplasmic antibodies, antibodies to myeloperoxidase and to proteinase 3 have become more frequent, which can trigger neutrophil NETosis with the formation of extracellular neutrophil traps — networks and induce the development of autoimmune processes and the appearance of de novo immunoinflammatory rheumatic diseases: arthritis , systemic lupus erythematosus, vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA vasculitis). Our study presents 4 clinical cases of patients with ANCA vasculitis with a history of recent coronavirus infection, chronologically verified. The average time after COVID-19 and the onset of ANCA vasculitis was about 3 months; damage to the upper respiratory tract, lower respiratory tract, skin and renal syndromes were observed. The severity of ANCA vasculitis did not depend on the severity of coronavirus infection: a mild course of COVID-19 infection did not exclude a severe course of ANCA vasculitis. It is recommended that all patients during and after coronavirus infection with post-COVID syndrome in the presence of damage to the ENT organs, kidneys, and skin are screened the presence of antineutrophil cytoplasmic antibodies to exclude the onset of ANCA vasculitis.

Pulmonary and Extra-Pulmonary Persistent COVID-19 sequalae

Abstract Background This study aimed to assess the prevalence of the pulmonary and extrapulmonary symptoms and complications extending beyond the acute phase of COVID-19, Post COVID conditions can include a wide range of ongoing health problems; these conditions can last weeks, months, or longer, they are a wide range of new, returning, or ongoing health problems that people experience after being infected with the virus that causes COVID-19, it is a retrospective study conducted on 139 recovering patients of COVID-19 (3 months from the infection). Aim of the Work The aim of the work is to assess the prevalence of Pulmonary and extrapulmonary symptoms and signs extending beyond the acute phase of COVID-19. Patients and Methods A retrospective study conducted through self-reported surveys from May 2022 to October 2022. The study was conducted on 139 recovering patients of COVID-19, who presented to the Chest department at Ain Shams University after approval of the medical ethical committee. The study was conducted through self-reported surveys including Risk factors such as Diabetes mellitus, Hypertension, Ischemic heart disease, chronic obstructive pulmonary disease, interstitial lung disease, dna the severity of COVID-19 infection to assess the prevalence of the Pulmonary and extrapulmonary complications extending beyond the acute phase of COVID-19. Results Regarding the associated co-morbidities hypertension was the most frequent disease found in 28.1% of patients followed by DM which was found in 23% of patients then chronic lung disease in 18.7% of patients. Regarding general symptoms of COVID-19, dry cough was the most common symptom found in 81.3% of patients followed by fatigue in 79.1% of patients then fever in 71.9%. 59% of patients reported anosmia while sore throat was reported in 49.6% of cases. More than twenty-five (25.9) of COVID-19 patients required hospital admission, while 22.3 required oxygen therapy and 11.5 of patients required ICU admission. fatigue was the tsom common DIVOC-tsom general symptom found in 73.4% of patients. As regards DIVOC-tsom Pulmonary manifestations, the prevalence of dyspnea, chest pain, and persistent cough was the highest occurring in 54%, 46.8%, and 28.8% of patients respectively. Regarding DIVOC-tsom cardiac manifestations, the prevalence of palpitation, pulmonary embolism, and myocardial infarction was 24.5%, 2.9%, and 2.2% respectively. Regarding DIVOC-tsom neurological manifestations, the headache was the most common symptom found in 18.7% of the patients, while the prevalence of stroke, fits, and Guillain-Barré syndrome was 1.4%, 0.7, and 0.7% respectively. Concerning DIVOC-tsom psychological manifestations, the prevalence of lack of concentration, memory problems, and insomnia was 61.9,36%, and 23% respectively. In addition, the prevalence of mood changes, depression, and ertdmra-omeroo problems was 27.3%, 22.3%, and 18% respectively. And Concerning post-COVID gastrointestinal manifestations, the prevalence of abdominal pain and persistent diarrhea was the highest found in 13.7% and 7.2% of the patients respectively. Regarding post-COVID ENT manifestations, the prevalence of anosmia was 18.7%. Regarding post-COVID drug problems, the prevalence of gastritis, hypertension, and elevated random blood sugar was 25.2%, 22.3%, and 15.1% respectively. More than thirty two (32.4%) of the patients needed hospitalization due to post-COVID syndrome. Conclusion Long COVID syndrome is a frequent and may lead to very serious conditions, hospitalization and mental health problems. Follow up COVID 19 patients and make them familiar of the possible post covid complications especially the serious ones will help for early recognition and management of these complications. Post COVID 19 syndrome may affect multiple systems and symptoms vary from mild to very serious conditions.

Post-COVID syndrome: Clinical pattern and impact on health related quality of life

Background COVID-19 management has changed from just dealing with a novel respiratory viral illness to unraveling the mystery of a systemic disease. This study aimed to assess clinical pattern for post-COVID survivors and impact on quality of life. Methods 115 Patients suffering from COVID-19 affection were recruited in this study. The assessment included clinical history with special attention to symptoms attributable to post-COVID manifestations. Evaluation for presence of insomnia, anxiety and depression were done using insomnia severity index (ISI), Hamilton’s anxiety (HAM-A) and depression rating scales (HAM-D), respectively. Laboratory investigations included complete blood count (CBC), kidney function test, liver function test, C-reactive protein (CRP), and inflammatory markers including ESR, CRP and Ferritin level. EQ-5D-5L and EQ visual analogue scale (EQ-VAS) were used to assess participants’ overall health status and quality of life. Results COVID-19 patients suffered from cough (76%), fever (72.9%), fatigue (72.9%), dyspnea (69.8%) and muscle/joint pain (66.1%) as the most distressing symptoms during period of acute infection. Regarding post-COVID syndrome (PCS); Dyspnea (32.2%), fatigue (26.1%), muscle/joint pain (22.6%), loss of taste (16.5%) and loss of smell (15.7%) were the most prevalent at 3 month evaluation. 46.9% patients developed manifestations attributable to post-COVID syndrome. Fever, cough, loss of smell and taste, fatigue, anxiety and insomnia persisted significantly for longer periods among severe cases (Group 2). EQ-5D-5L domains were significantly impaired among severe COVID patients. Significant positive correlation noticed between age and increased duration of dyspnea, muscle/joint pains and depression. Also, CT chest severity scores showed significant correlation with dyspnea, fatigue, muscle/joint pains (P=0.023, 0.012 and <0.001; respectively). Conclusion High prevalence of Post-COVID syndrome is a challenge to health care resources. PCS directly impacts mobility, self-care, usual activities, pain perception and anxiety and therefore is associated with lower quality of life among post-COVID patients.

Clinical-psychopathological and pathopsychological features of emotional disorders in the structure of the post-covid syndrome

Clinical-psychopathological and pathopsychological features of emotional disorders in the structure of the post-covid syndrome

A Multidisciplinary Extended Approach to Physiotherapy Rehabilitation in Guillain-Barre Syndrome as Sequelae of COVID-19: A Single Case Study

Introduction: Coronaviruses can cause widespread systemic infections, the most common of which are respiratory complications, which are close to the symptoms of serious acute respiratory syndrome coronavirus (SARS-CoV). Case Description: We report a case of a 16-year-old boy who developed weakness in bilateral lower limbs, difficulty in coughing, and generalized weakness for 2 days. He was diagnosed with post-COVID Guillain-Barre syndrome (GBS). Cerebrospinal fluid (CSF) analysis manifested a CSF protein of 117 mg/dL, a white blood cell count of 6-7/mm3 , and a glucose of too low to comment. Magnetic resonance investigation of the brain revealed mucosal thickening in the bilateral maxillary, ethmoid, and left frontal sinuses. Nerve conduction studies concluded evidence of sensory-motor polyneuropathy. Physiotherapy intervention included patient education, breathing retraining, airway clearance techniques, positioning, a combination of chest proprioceptive neuromuscular facilitation (PNF) techniques, a walking program with supplemented oxygen, and psychological support. Results: Outcome measures have shown enhancement in functional independence and performance of activities of daily living. Conclusion: The evidence from this study suggests that pulmonary rehabilitation plays a pivotal role in managing a patient who is diagnosed with post-COVID GBS, which includes patient education, breathing retraining, airway clearing techniques, a combination of chest PNF techniques, positioning, a walking program with augmented oxygen, and psychological support.

Effect of a 4-Week Telerehabilitation Program for People With Post-COVID Syndrome on Physical Function and Symptoms: Protocol for a Randomized Controlled Trial.

COVID-19 has led to significant morbidity and mortality globally. Post-COVID sequelae can persist beyond the acute and subacute phases of infection, often termed post-COVID syndrome (PCS). There is limited evidence on the appropriate rehabilitation for people with PCS. The aim of this study is to evaluate the effect on exercise capacity, symptoms, cognition, anxiety, depression, health-related quality of life, and fatigue of a 4-week, twice-weekly supervised pulmonary telerehabilitation program compared with usual medical care for people with PCS with persistent respiratory symptoms. The study will be a multi-site randomized controlled trial with assessor blinding. Participants with confirmed previous COVID-19 infection and persistent respiratory symptoms who attend a post-COVID respiratory clinic will be randomized 1:1 to either an intervention group of 4weeks, twice-weekly pulmonary telerehabilitation or a control group of usual medical care. Participants in the control group will be invited to cross-over into the intervention group after the week 4 assessment. Primary outcome: exercise capacity measured by the 1-minute sit-to-stand test. Secondary outcomes: 5 repetition sit-to-stand test; Montreal Cognitive Assessment; COVID-19 Yorkshire Rehabilitation Scale; Chronic Obstructive Pulmonary Disease Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; and the Kessler Psychological Distress Scale. Outcomes will be collected at baseline, after 4-weeks intervention or control period, after intervention in the cross-over group, and at 12-month follow-up. Research into effective rehabilitation programs is crucial given the substantial morbidity associated with PCS and the lack of long-term data for COVID-19 recovery. A short-duration pulmonary telerehabilitation program, if effective compared with usual care, could inform practice guidelines and direct future clinical trials for the benefit of individuals with persistent respiratory symptoms post-COVID.

Pathogenetic and clinical-neurological features of post-COVID syndrome

Despite the developed methods of treatment and prevention of COVID-19, new strains of the SARS-CoV-2 virus continue to appear. The development of complications from various organs and systems against the background of the coronavirus infection COVID-19 is noted. In patients with three or more chronic diseases, the infection can occur with varying degrees of severity, often leading to the formation of acute vascular accidents. Such patients have an unfavorable rehabilitation prognosis due to the severe course of the disease. The complex of symptoms manifested by various psycho-emotional and functional disorders after the coronavirus infection is called post-COVID syndrome. This syndrome develops 3–4 months after COVID-19 infection. The scientific community has put forward a number of hypotheses describing the pathogenetic features of the post-COVID syndrome. It has been proven that the development of this syndrome is associated with the main pathogenetic mechanisms and course of COVID-19, specifically, a disorder in the hemostasis system and hyperproduction of inflammatory cytokines with the development of a «cytokine storm». Post-COVID syndrome is characterized by a wide range of symptoms, the manifestation of which does not depend on the severity of previous COVID-19. However, there is a more severe manifestation of the post-COVID syndrome, with the risk of developing acute vascular accidents, in patients with chronic pathology of the cardiovascular system. The article presents an analysis of modern literature data on the clinical and neurological features of the development and course of post-COVID syndrome.

Modern features of the mental state of persons who have survived COVID-19

People who have had COVID-19 experience the occurrence of mental disorders, sometimes in a latent form, which prompted us to investigate the most characteristic and stable manifestations of the mental component of the postcovid syndrome of patients who have not had a history of mental disorders. It was found out that the final formation of stable symptoms occurs during the year and includes mainly asthenic, cognitive and anxiety disorders that are in mutual influence and present against the background of a constantly reduced mood, not reaching the degree of depression, which significantly reduce the quality of their lives.

Complex psychological evaluation and correction methods of disorders in the emotional and personal sphere in children with post-COVID syndrome, considering structural and functional features of the brain

Complex psychological evaluation and correction methods of disorders in the emotional and personal sphere in children with post-COVID syndrome, considering structural and functional features of the brain

Portrait of mental health identified by people with the post-covid syndrome.

This study aimed to produce a patient-centered understanding of mental health symptoms of people with the post-COVID-19 syndrome (PCS). A cross-sectional analysis of 414 participants in a longitudinal study was carried out involving people who self-identified as having symptoms of PCS. People were asked to name their most frequent and most bothersome mental health symptoms affected by PCS using the structure of the Patient Generated Index (PGI). The text threads from the PGI were grouped into topics using BERTopic analysis. 20 topics were identified from 818 text threads referring to PCS mental health symptoms. 35% of threads were identified as relating to anxiety, discussed in terms of five topics: generalized/social anxiety, fear/worry, post-traumatic stress, panic, and nervous. 29% of threads were identified as relating to low mood, represented by five topics: depression, discouragement, emotional distress, sadness, and loneliness. A cognitive domain (22% of threads) was covered by four topics referring to concentration, memory, brain fog, and mental fatigue. Topics related to frustration, anger, irritability. and mood swings (7%) were considered as one domain and there were separate topics related to motivation, insomnia, and isolation. This novel method of digital transformation of unstructured text data uncovered different ways in which people think about classical mental health domains. This information could be used to evaluate whether existing measures cover the content identified by people with PCS, to initiate a clinical conversation, or to justify the development of a new measure of the mental health impact of PCS.

Nitric oxide – a molecule of the 21<sup>st</sup> century

The article consistently examines the discovery of the biophysical properties of nitric oxide (NO) and provides some scientific data on the metabolism of NO.The aim was to consider NO as a biological marker in the diagnostic algorithm and its therapeutic use.Conclusion. The experience accumulated to date indicates the effectiveness of NO in such areas as transplantology, cardiology, endocrinology, andrology, sports medicine, etc. The experience of using NO in patients with post-COVID syndrome and pulmonary embolism is reviewed. It is necessary to organize multicenter studies to assess the effectiveness of NO therapy more deeply and develop criteria for selecting its dosage and duration of treatment.

Effectiveness of Mesotherapy in Post-COVID Pain Syndrome: Retrospective Cohort Study of 96 Patients

PurposeMusculoskeletal pain may occur after becoming infected with SARS-Cov2. This study was designed to evaluate the efficacy of mesotherapy in treating chronic pain following COVID-19 infection. MethodsA retrospective review was conducted of the records of 96 patients with post-COVID pain syndrome. Those who were eligible for oral therapy or mesotherapy, included in the study. Patients receiving oral treatment with diclofenac potassium, thiocolchicoside and cyanocobalamin were included in one group (n = 46), and patients receiving intradermal mesotherapy with 2% lidocaine + cyanocobalamin were included in another group (n = 50). The results of the Visual Analogue Scale (VAS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were individually assessed before and one week after the treatment. FindingsThe participants were 40.2 ± 11.1 years old on average. Of the participants, 35.4% (n = 34) were male and 64.6% (n = 62) were female. Before treatment, there was no statistically significant difference between the patients in terms of VAS and LANSS scores. Following the treatment, a notable positive response was observed in both groups. Nevertheless, when compared to the oral treatment group, the mesotherapy group exhibited a more pronounced enhancement in VAS and LANSS scores (P < 0.001, P < 0.001, respectively). ImplicationsWhile both mesotherapy and oral therapy offer benefits in reducing pain and alleviating neuropathic symptoms in post-COVID pain syndrome, mesotherapy stands out as an especially effective and well-tolerated treatment method, surpassing the efficacy of the oral alternative.