Survivors Of Coronavirus Disease 2019 Research Articles

Sulfated Bile Acids in Serum as Potential Biomarkers of Disease Severity and Mortality in COVID-19.

The fight against coronavirus disease 2019 (COVID-19) continues. Since the pandemic's onset, several biomarkers have been proposed to assess the diagnosis and prognosis of this disease. This research aimed to identify potential disease severity biomarkers in serum samples of patients with COVID-19 during the disease course. Data were collected using untargeted and targeted mass spectrometry methods. The results were interpreted by performing univariate and multivariate analyses. Important metabolite classes were identified by qualitative untargeted metabolomics in 15 serum samples from survivors of COVID-19. Quantitative targeted metabolomics on a larger patient cohort including 15 non-survivors confirmed serum 3-sulfate bile acids (i.e. GLCA-3S) were significantly increased in non-survivors compared to survivors during the early disease stage (p-value < 0.0001). Notably, it was associated with a higher risk of mortality (odds ratio of 26). A principal component analysis showed the ability to discriminate between survivors and non-survivors using the BA concentrations. Furthermore, increased BA-S is highly correlated with known parameters altered in severe clinical conditions.

Reversible central adrenal insufficiency in survivors of COVID-19: results from a 24-month longitudinal study.

We studied the temporal course of hypothalamic-pituitary-adrenal (HPA) dysfunction in patients with coronavirus disease 2019 (COVID-19). Three hundred and two patients (median age 54 years (interquartile range (IQR) 42-64), 76% males) were recruited. The HPA axis was evaluated by morning cortisol and adrenocorticotrophic hormone (ACTH) at admission (n = 232). Adrenal insufficiency (AI) during acute illness was defined using a morning cortisol <83 nmol/L. AI at 12 months follow-up was defined using a peak cortisol <406 nmol/L in the ACTH stimulation test (APST) (n = 90). Those with AI at 12 months were further assessed by APST every 6 months for recovery of hypoadrenalism. The median morning cortisol and ACTH levels during COVID-19 were 295 (IQR 133-460) nmol/L and 3.9 (0.8-6.9) pmol/L, respectively. AI was present in 33 (14%) patients; ACTH was elevated in three and low or inappropriately normal in the rest 30 patients. At 12 months, AI was seen in 13% (12/90) patients, with all cases being hypothalamic-pituitary in origin; five (42%) of them had not met the diagnostic criteria for AI during COVID-19. AI diagnosed at admission persisted at 12 months in seven patients and recovered in seven; the remaining 19 patients were lost to follow-up. The presence of AI at 12 months was independent of severity and steroid use during COVID-19. A morning cortisol <138 nmol/L during COVID-19 predicted the presence of AI at 12 months. All patients showed recovery of the HPA axis in the ensuing 12 months. Central AI was common during acute COVID-19 and at 12 months of follow-up. AI can be late onset, developing after recovery from COVID-19, and was transient in nature.

Coronavirus disease 2019 and its impact on the cognition of older adults: Unraveling the role of inflammation

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic significantly impacted the older adult population globally. This study aimed to investigate cognitive function and its relationship with inflammation in older COVID-19 survivors over a three-month follow-up to address concerns about cognitive impairment and its risk factors. MethodsIn this descriptive-analytical study, 177 hospitalized COVID-19 patients aged >60 were assessed from July 2021 to February 2022. Psychiatric, global cognitive assessments and activities of daily living were conducted at discharge, 1 month, and 3 months post-discharge. Statistical analyses were conducted using SPSS Version 24. The evolution of cognitive status over time was evaluated using the Repeated Measures Test. The study probed into the association between inflammatory markers and cognitive function through the Pearson correlation test and the Mann–Whitney U test. Additionally, the link between anxiety/depression and cognitive performance was examined using the Pearson correlation. ResultsResults indicated that higher levels of C-reactive protein (CRP), D-dimer, and Lactate Dehydrogenase (LDH) were correlated to reduced cognitive performance. Conversely, Erythrocyte Sedimentation Rate (ESR) and Creatine Phosphokinase (CPK) did not exhibit a significant relationship with cognitive scores. A positive correlation was observed between improved cognitive function (reflected by higher GPCOG scores) and lower levels of anxiety and depression (indicated by lower scores on the Hospital Anxiety and Depression Scale). Over the study period, cognitive function and anxiety scores showed an upward trend, whereas symptoms of depression and challenges in daily activities remained consistent. ConclusionsThe study highlights the enduring effects and detrimental role of inflammation on overall cognitive abilities among older survivors of COVID-19. It underscores the urgent need for specialized interventions and rehabilitative strategies to facilitate sustained cognitive recuperation among these individuals.

Delayed Antibody Response in the Acute Phase of Infection Is Associated with a Lower Mental Component of Quality of Life in Survivors of Severe and Critical COVID-19.

Background: The long-term sequelae of coronavirus disease 2019 (COVID-19) significantly affects quality of life (QoL) in disease survivors. Delayed development of the adaptive immune response is associated with more severe disease and a worse prognosis in COVID-19. The effects of delayed immune response on COVID-19 sequelae and QoL are unknown. Methods: We conducted a prospective study to assess the relationship between the delayed antibody response in the acute phase of infection in naïve unvaccinated patients suffering from severe or critical COVID-19 and their QoL 12 months after hospital discharge. The 12-item Short Form Survey (SF-12) questionnaire was used for assessment of QoL. The SF-12 evaluates both mental and physical components of QoL, incorporating a mental component score (MCS-12) and a physical component score (PCS-12). A delayed antibody response was defined as testing negative for anti-spike SARS-CoV-2 antibodies at the time of hospital admission. Results: The study included 274 patients (154 men and 120 women). Of the enrolled patients, 144 had a delayed immune response. These patients had a significantly lower MCS-12 (p = 0.002), but PCS-12 (p = 0.397) was not significantly different at the 12-month follow-up compared to patients with positive anti-spike SARS-CoV-2 antibodies. The MCS-12 at the time of follow-up was negatively associated with delayed antibody response irrespective of possible confounders (p = 0.006; B = 3.609; ηp2 = 0.035; 95% CI = 1.069-6.150). An MSC-12 below 50 points at the time of follow-up was positively associated with delayed antibody response (p = 0.001; B = 1.092; OR = 2.979; 95% CI = 1.554-5.711). Conclusions: This study confirmed that, in patients with severe and critical COVID-19, a negative result for anti-spike SARS-CoV-2 antibodies at the time of hospital admission is associated with a lower mental component of QoL in unvaccinated patients naïve to COVID-19 one year after hospital discharge.

Prevalence of Exercise-induced Desaturation in Survivors of Severe COVID-19 Pneumonia and the Predictive Value of Lung Ultrasound: A Cross-sectional Study

Introduction: Survivors of severe Coronavirus Disease2019 (COVID-19) pneumonia may experience ExerciseInduced Desaturation (EID), which can remain undiagnosed at discharge, as most exhibit normal resting Arterial Blood Gases (ABGs). This undiagnosed condition may lead to unexpected hospital readmissions, causing additional burden to the health system. However, the prevalence of EID among this population, especially in developing countries, is not well documented. Aim: To estimate the prevalence of EID among survivors of severe COVID-19 pneumonia and to explore the predictive role of Lung Ultrasound Scan (LUS) in detecting EID. Materials and Methods: This hospital-based, observational, cross-sectional study was conducted at the Institute of Chest Diseases in Kozhikode, Kerala, India from October 2021 to September 2022. It involved 153 COVID-19 patients aged 18 years and above who had recovered from severe pneumonia, were otherwise fit for hospital discharge, and had normal resting ABGs. The study examined the prevalence of EID using the 6-Minute Walk Test (6MWT). Additionally, it investigated the predictive ability of a LUS for EID. A LUS was performed on all patients and scoring was conducted according to the established protocol. Results: The mean age of the study subjects was 53.50±14.13 years, with 119 (77.8%) being male. During the 6MWT, 96 patients (62.7%) showed significant desaturation. A total of 83 (95.4%) subjects in the desaturated group required Non-Invasive Ventilation (NIV) compared to 4 (4.6%) in the non-desaturated group (p&lt;0.001). All 24 (100%) subjects in the desaturated group required Invasive Mechanical Ventilation (IMV), while none in the non-desaturated group did. The mean Length Of Stay (LOS) in the hospital was 35.50±13.35 days for the desaturated group, compared to 23.32±16.25 days for the non-desaturated group (p&lt;0.001). The LUS score was significantly higher in the desaturated group (16.61±5.92) than in the non-desaturated group (5.54±4.62). The Receiver Operating Characteristic (ROC) curve for the LUS score indicated a cut-off value of 8.5 for identifying significant EID. Conclusion: Survivors of COVID-19 who recovered from Acute Respiratory Failure (ARF) and have normal resting ABGs may still have significant EID. A protocol-based LUS score can potentially identify individuals at risk for EID.

Long COVID syndrome: psychological and sexual dysfunction among survivors of COVID-19 infection.

To explore the neuropsychiatric symptoms, sleep disturbances, and sexual dysfunction in patients with long COVID syndrome, which can help in building better follow-up strategies for coronavirus disease 2019 (COVID-19) survivors. A cross-sectional research was undertaken at the premises of a psychiatry unit at a tertiary care unit in Karachi, Pakistan, between August 2022 and April 2023. All individuals aged 18 years or older, who had a history of contracting COVID-19 infection in the last 12 months presented to the department of Psychiatry with neuropsychiatric symptoms were recruited. Using a predefined questionnaire, data was collected from the participants. A linear logistic regression was used to find the impact of age, sex, hospitalization, and duration of home isolation on the likelihood of persistent neuropsychiatric symptoms or sexual dysfunction. A total of 457 patients were included. It was found that individuals were less likely to experience neuropsychiatric symptoms as age increased (OR=0.968, 95% CI: 0.949-0.986, P=0.001). Females were 4.8 times more likely to experience neuropsychiatric symptoms than males, and the association was extremely significant (OR=4.851, 95% CI: 3.085-7.626, P<0.0001). An increase in age raised the odds of having sleep disturbances among the survivors by 2.7 times (OR=2.672, 95% CI: 2.654-2.684, P<0.0001). The odds of having sleep disturbances were three times more likely in female participants as compared to male participants (OR=3.00, 95% CI: 1.771-5.094, P<0.0001). The majority of the COVID-19 survivors are presenting with persistent neuropsychiatric and sexual symptoms in our setting. Therefore, it is necessary to maintain proper follow-up with the survivors of COVID-19 and counsel the patients to inform the family physician if these symptoms persist for longer than a month. Increasing such practices of regular follow-ups with COVID-19 survivors can help in detecting early neuropsychiatric and sexual changes.

Can a brief session of the online coronavirus disease 2019 destigmatization program reduce stigma among survivors? A randomized controlled trial.

Stigmatization has taken a heavy toll on the mental health and quality of life of the survivors of coronavirus disease 2019 (COVID-19). To address this issue, we proposed a brief, self-directed, reflective, and practical destigmatization intervention. The current study aimed to investigate the efficacy of the online COVID-19 destigmatization program (OCDP) in mitigating stigma among the survivors of COVID-19. This study was conducted on 142 survivors of COVID-19 before their discharge from Vajra Hospital from July 2022 to November 2022. The participants were randomly assigned between the intervention group (n = 71), who attended the 40-min OCDP, and the control group (n = 71), who received standard mental health care. The primary outcome was the efficacy of OCDP in reducing stigmatization. A COVID-19 stigma questionnaire was administered to assess stigmatization in the intervention and control groups immediately before and after the program during follow-up on days 7, 14, and 28. The secondary outcome was the efficacy of the program in alleviating negative emotions according to the Depression Anxiety Stress Scale 21 questionnaire. Compared with the control group, the intervention group had a more prominent reduction in the overall stigma score on day 7 (p = 0.002) and day 14 (p = 0.028). The intervention group had a more evident reduction in enacted stigma (day 7, p = 0.04), internalized stigma (day 7, p = 0.008; day 14, p < 0.028), and perceived external stigma (day 7, p = 0.002) than the control group. However, there was no significant difference in terms of disclosure concern between the intervention and control groups. Furthermore, the reduction in depression, anxiety, and stress between the two groups did not significantly differ. Online COVID-19 destigmatization program provided prior to hospital discharge is an effective tool in reducing stigmatization, particularly within the first 2 weeks after reintegration into society, among the survivors of COVID-19.

A Review: The Potential Involvement of Growth Arrest-Specific 6 and Its Receptors in the Pathogenesis of Lung Damage and in Coronavirus Disease 2019.

The tyrosine kinase receptors of the TAM family-Tyro3, Axl and Mer-and their main ligand Gas6 (growth arrest-specific 6) have been implicated in several human diseases, having a particularly important role in the regulation of innate immunity and inflammatory response. The Gas6/TAM system is involved in the recognition of apoptotic debris by immune cells and this mechanism has been exploited by viruses for cell entry and infection. Coronavirus disease 2019 (COVID-19) is a multi-systemic disease, but the lungs are particularly affected during the acute phase and some patients may suffer persistent lung damage. Among the manifestations of the disease, fibrotic abnormalities have been observed among the survivors of COVID-19. The mechanisms of COVID-related fibrosis remain elusive, even though some parallels may be drawn with other fibrotic diseases, such as idiopathic pulmonary fibrosis. Due to the still limited number of scientific studies addressing this question, in this review we aimed to integrate the current knowledge of the Gas6/TAM axis with the pathophysiological mechanisms underlying COVID-19, with emphasis on the development of a fibrotic phenotype.

Assessment of Cognitive and Mood Changes in Older Survivors of COVID-19: A Year's Follow-up.

The long-term effects of coronavirus disease 2019 (COVID-19) infection are not fully known. In this study, we aimed to evaluate cognitive function and mood changes with 1-year follow-up in the elderly after COVID-19 disease. Ninety COVID-19 survivors and 90 healthy controls were included in the study between April 2022 and 2023. The patients were evaluated at the 1st, 6th, and 12th months for cognition, depression, and sleep quality. Cognitive function is assessed by the Montreal Cognitive Assessment (MoCA), sleep quality by the Pittsburgh Sleep Quality Index, and depression by the Yesavage Geriatric Depression Scale. COVID-19 survivors secured lower scores in certain domains of the MoCA in comparison with the controls at the first and sixth months. However, at the 12th month, no difference was observed in total MoCA ( p = 0.100), Yesavage Geriatric Depression Scale ( p = 0.503), and Pittsburgh Sleep Quality Index ( p = 0.907) between survivors and controls. Older patients who recovered from COVID-19 have lower cognitive function compared with controls up to 12 months. However, cognitive function scores were similar at the end of the first year except for memory scores.

US and Dutch Perspectives on the Use of COVID-19 Clinical Prediction Models: Findings from a Qualitative Analysis.

Clinical prediction models (CPMs) for coronavirus disease 2019 (COVID-19) may support clinical decision making, treatment, and communication. However, attitudes about using CPMs for COVID-19 decision making are unknown. Online focus groups and interviews were conducted among health care providers, survivors of COVID-19, and surrogates (i.e., loved ones/surrogate decision makers) in the United States and the Netherlands. Semistructured questions explored experiences about clinical decision making in COVID-19 care and facilitators and barriers for implementing CPMs. In the United States, we conducted 4 online focus groups with 1) providers and 2) surrogates and survivors of COVID-19 between January 2021 and July 2021. In the Netherlands, we conducted 3 focus groups and 4 individual interviews with 1) providers and 2) surrogates and survivors of COVID-19 between May 2021 and July 2021. Providers expressed concern about CPM validity and the belief that patients may interpret CPM predictions as absolute. They described CPMs as potentially useful for resource allocation, triaging, education, and research. Several surrogates and people who had COVID-19 were not given prognostic estimates but believed this information would have supported and influenced their decision making. A limited number of participants felt the data would not have applied to them and that they or their loved ones may not have survived, as poor prognosis may have suggested withdrawal of treatment. Many providers had reservations about using CPMs for people with COVID-19 due to concerns about CPM validity and patient-level interpretation of the outcome predictions. However, several people who survived COVID-19 and their surrogates indicated that they would have found this information useful for decision making. Therefore, information provision may be needed to improve provider-level comfort and patient and surrogate understanding of CPMs. While clinical prediction models (CPMs) may provide an objective means of assessing COVID-19 prognosis, provider concerns about CPM validity and the interpretation of CPM predictions may limit their clinical use.Providers felt that CPMs may be most useful for resource allocation, triage, research, or educational purposes for COVID-19.Several survivors of COVID-19 and their surrogates felt that CPMs would have been informative and may have aided them in making COVID-19 treatment decisions, while others felt the data would not have applied to them.

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

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

Long COVID-19 Syndrome and its Effects on Various Systems: A Narrative Review

Since December 2019, the Coronavirus Disease-2019 (COVID-19) outbreak has led to a pandemic, causing suffering worldwide. Among the survivors of COVID-19, a second type of pandemic is observed in individuals experiencing long-term effects, known as long COVID-19 or post COVID-19 syndrome. This condition occurs when people who have recovered from COVID-19 continue to experience symptoms or develop new ones after a month or more. The exacerbation of symptoms can be attributed to various factors, including psychological, social, or biological causes, all of which contribute to the development of this condition. Although COVID-19 was first discovered a few years ago, its impact on a large population is still not fully understood. As the disease affects multiple organ systems, its effects persist even after the virus is cleared from the body, resulting in a significant number of individuals who continue to suffer from it. Therefore, this review focuses on the long-term effects of COVID-19 as post COVID-19 syndrome.

THE INVESTIGATION OF THE COGNITIVE COMMUNICATION FUNCTIONS OF SURVIVORS OF CORONAVIRUS DISEASE 2019 (COVID-19): A SURVEY STUDY

Objective: Coronavirus Disease-2019 (COVID-19) can cause problems in cognitive-communication functions such as attention, executive function, and short-term memory. The aim of the study is to investigate the cognitive-communication functions of survivors of COVID-19.&#x0D; Method: A total of 484 adult individuals (Age: 18-73, M=27.2, SD=6.2) participated in the study. A 40-item survey that includes attention, memory, executive functions, language, and orientation domains was used.&#x0D; Results: The common problems were related to memory function (61.4%), attention (56.2%) and executive functions (50.4%), respectively. The mainly problematic area in executive functions was found to be controlling emotions (38.9%). Participants reported that 37.6% of them had problems with their naming skills during a conversation.&#x0D; Conclusion: While there may be fewer problems with orientation skills, which is one of the cognitive communication functions, in individuals with COVID-19, problems in short-term memory, maintaining attention, and organizing emotions can be seen more.

Association of COVID-19 with diabetes: a systematic review and meta-analysis

Emerging evidence suggests that coronavirus disease-2019 (COVID-19) may lead to a wide range of post-acute sequelae outcomes, including new onset of diabetes. The aim of this meta-analysis was to estimate the incidence of newly diagnosed diabetes in survivors of COVID-19. We searched MEDLINE, Scopus, Cochrane Central Register of Controlled Trials and the World Health Organization Global Literature on Coronavirus Disease and clinical trial registries for studies reporting the association of COVID-19 and diabetes. Search dates were December 2019–October 16, 2022. Two investigators independently assessed studies for inclusion. Risk of bias was assessed using the Newcastle–Ottawa Scale. We estimated the effect of COVID-19 on incident diabetes by random-effects meta-analyses using the generic inverse variance method. We identified 8 eligible studies consisting of 4,270,747 COVID-19 patients and 43,203,759 controls. Median age was 43 years (interquartile range, IQR 35–49), and 50% were female. COVID-19 was associated with a 66% higher risk of incident diabetes (risk ratio, 1.66; 95% CI 1.38; 2.00). The risk was not modified by age, sex, or study quality. The median risk of bias assessment was 7. In this systematic review and meta-analysis, COVID-19 was associated with higher risk for developing new onset diabetes among survivors. Active monitoring of glucose dysregulation after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is warranted.

A Physiotherapy Treatment Plan for Post-COVID-19 Patients That Improves the FEV1, FVC, and 6-Min Walk Values, and Reduces the Sequelae in 12 Sessions.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causal agent of Coronavirus disease 2019 (COVID-19), a pandemic disease declared in 2020. The clinical manifestations of this pathology are heterogeneous including fever, cough, dyspnea, anosmia, headache, fatigue, taste dysfunction, among others. Survivors of COVID-19 have demonstrated several persistent symptoms derived from its multisystemic physiopathology. These symptoms can be fatigue, dyspnea, chest pain, dry and productive cough, respiratory insufficiency, and psychoemotional disturbance. To reduce and recover from the post-COVID-19 sequelae is fundamental an early and multifactorial medical treatment. Integral post-COVID-19 physiotherapy is a tool to reduce dyspnea, improve lung capacity, decrease psychoemotional alterations, as well as increase the muscle strength affected by this disease. Thus, the aim of this study was to establish a novel physiotherapeutic plan for post-COVID-19 patients, evaluating the effect of this treatment in the reduction of the sequelae in terms of lung capacity, cardio-respiratory, and muscular strength improvements. This was a cross-sectional study in which a protocol of 12 sessions in 4 weeks of physiotherapy was implemented in the patients enrolled. We conducted a medical assessment, an interview, a DASS-21 test, a spirometry, a 6-min walk test, and a hand dynamometer test to evaluate the post-COVID condition of patients before and after the sessions. A total of 42 patients participated in the program. Results of this work showed a decrease of around 50% of post-COVID-19 sequelae and an improvement in the psychoemotional status of patients. Also, we observed an increase of 7.16% in the FEV1 value and 7.56% for FVC. In addition, the maximal functional capacity increased by 0.577 METs, the 6-min walk test performance increased by 13%, and the SpO2 improved by 1.40%. Finally, the handgrip strength test showed an improvement in the left hand and right hand of 2.90 and 2.24 Kg, respectively. We developed this study to propose a novel methodology to provide information for a better treatment and management of post-COVID-19 patients.

Cardiopulmonary Rehabilitation for Patients with Coronavirus Disease 2019 (COVID-19): A Narrative Review

: The novel coronavirus-2019 (COVID-19), which spread rapidly and became a global pandemic, can cause respiratory failure, possibly requiring hospital stay or intensive care unit treatment. While COVID-19 primarily affects the respiratory system, evidence has shown that it may also affect other body organs such as the heart. Survivors of COVID-19 may develop physical, respiratory, cardiac, and psychological impairments as well as reduced quality of life. Also, the long-term consequences of COVID-19 remain unclear. Hence, cardiopulmonary rehabilitation should be started as soon as possible to alleviate dyspnea, preserve function, minimize disability, reduce complications, relieve anxiety, and improve quality of life. In this study, we summarized the current cardiopulmonary rehabilitation guidelines and protocols for patients with COVID-19.

Neuropsychological Outcomes in Adult Patients and Survivors of COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to affect central nervous system functions through various indirect, and possibly direct, mechanisms. We are only now beginning to understand the possible effects of the virus on human cognition. This review summarizes extant yet limited literature on clinical neuropsychological findings in adult coronavirus disease 2019 (COVID-19) patients and survivors. Neuropsychological outcomes were often in the form of cognitive screen results, although various studies administered comprehensive batteries. With respect to screens, the Montreal Cognitive Assessment appeared relatively sensitive to cognitive dysfunction associated with COVID-19. Patients and survivors presented with weaknesses on screens and comprehensive batteries, although the pattern of these weaknesses was not specific to etiology. Broadly, weaknesses were suggestive of executive dysfunction, although more than one study did not detect significant impairment. Weaknesses should be interpreted cautiously due to potential confounds/contributing factors (weaknesses may partly reflect psychiatric sequelae; weaknesses may be over-interpreted due to inadequate assessment of premorbid functioning). Studies reported different approaches in defining impairment, likely contributing to variable findings. The current review discusses ongoing efforts to harmonize approaches to evaluating neuropsychological functioning globally, as well as emphasizes taking a comprehensive approach towards understanding how the disease affects cognition.

IDF21-0663 Health-Related Quality of Life in Moroccan patients with diabetes after hospitalization for COVID-19

Background: Coronavirus disease 2019 (COVID-19) is a world health issue. Chronic diseases such as diabetes stand as among the established potential risk factor for COVID-19. Indeed, mortality and morbidity rate for COVID-19 was higher in this category. COVID-19 and their complications are an unpleasant experience that can cause unprecedented disruption in the well-being of patients with diabetes. Aim: The aim of this study was to evaluate the impact of the COVID-19 on the Health Related Quality of Life (HRQoL) and mental health among Moroccan diabetic patients survivors of COVID-19, and also to determine the demographic and clinical risk factors associated to COVID-19 among patients with diabetes. Method: The study population consisted of 416 diabetic patients. Out of these patients, 158 patients had been discharged from hospital after recovered from COVID-19 and 258 patients had no previous COVID-19 infection (control group). To assess the HRQoL and symptoms of depression and anxiety, the following questionnaires were used: EQ-5D-5L and Hospital Anxiety and Depression Scale (HADS). Results: Data analysis has shown that COVID-19 infection has a negative impact on the HRQoL among diabetic patients. Indeed, patients with diabetes who had recovered from COVID-19 had lower scores of HRQoL (P<0.0001) on both utility (0.18) and VAS (46.42) compared to control group (Utility=0.42; VAS=62.44). The comparison of each EQ-5D-5L dimensions between diabetic patients survivors of COVID-19 versus control group showed that mobility, self-care, usual activities, pain/discomfort, and anxiety/depression dimensions were negatively impacted by COVID-19 (P<0.0001). The results of HADS instrument revealed high level of anxiety and depression symptoms (P<0.05) for diabetic patients recovered of COVID-19 (anxiety = 13.89; depression= 11.79) compared to control group (anxiety = 12.70; depression= 10.85). Concerning the association between socio-demographic/clinical characteristics of patients with diabetes and COVID-19, the results of the binary logistic regression analysis suggested that there was no significant association between gender and COVID-19 (P=0.407). In contrast, patients with diabetes who were older, who were widowed, who had no children, with a primary, secondary or university level education, who were employed, living in urban area, and who had a medium socioeconomic level had higher risk to have COVID-19 (P<0.05). Regarding clinical characteristics, the statistical analysis revealed that patients with diabetes who had other comorbidities especially kidney disease and cardiovascular disease (P<0.0001) had higher risk to have COVID-19 infection compared to those without comorbidities. Discussion: Our survey reported that the COVID-19 infection has a negative impact on diabetic patients’ HRQoL. This result is confirmed also by previous studies. COVID-19 is highly infectious, therefore in order to limit their spread infected patients are isolated that lead to reduce their social interaction. This can affect negatively patients' psychological well-being. The present study shows a high level of anxiety and depression for diabetic patients recovered from COVID-19 compared to control group. The present investigation support policy makers understand the consequences of COVID-19 infection on the diabetic patients’ HRQoL and therefore geared towards post-COVID-19 care and create supportive interventions to restore a good QoL for patients with diabetes.

Long-term cardiovascular outcomes of COVID-19

The cardiovascular complications of acute coronavirus disease 2019 (COVID-19) are well described, but the post-acute cardiovascular manifestations of COVID-19 have not yet been comprehensively characterized. Here we used national healthcare databases from the US Department of Veterans Affairs to build a cohort of 153,760 individuals with COVID-19, as well as two sets of control cohorts with 5,637,647 (contemporary controls) and 5,859,411 (historical controls) individuals, to estimate risks and 1-year burdens of a set of pre-specified incident cardiovascular outcomes. We show that, beyond the first 30 d after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care). Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of those surviving the acute episode of COVID-19 should include attention to cardiovascular health and disease.

Dynamic changes of pulmonary diffusion capacity in survivors of non-critical COVID-19 during the first six months.

SummaryBackgroundThe dynamic trends of pulmonary function in coronavirus disease 2019 (COVID-19) survivors since discharge have been rarely described. We aimed to describe the changes of lung function and identify risk factors for impaired diffusion capacity.MethodsNon-critical COVID-19 patients admitted to the Guangzhou Eighth People's Hospital, China, were enrolled from March to June 2020. Subjects were prospectively followed up with pulmonary function tests at discharge, three and six months after discharge.FindingsEighty-six patients completed diffusion capacity tests at three timepoints. The mean diffusion capacity for carbon monoxide (DLCO)% pred was 79.8% at discharge and significantly improved to 84.9% at Month-3. The transfer coefficient of the lung for carbon monoxide (KCO)% pred significantly increased from 91.7% at discharge to 95.7% at Month-3. Both of them showed no further improvement at Month-6. The change rates of DLCO% pred and KCO% pred were significantly higher in 0–3 months than in 3–6 months. The alveolar ventilation (VA) improved continuously during the follow-ups. At Month-6, impaired DLCO% pred was associated with being female (OR 5.2 [1.7–15.8]; p = 0.004) and peak total lesion score (TLS) of chest CT > 8.5 (OR 6.6 [1.7–26.5]; p = 0.007). DLCO% pred and KCO% pred were worse in females at discharge. And in patients with impaired diffusion capacity, females’ DLCO% pred recovered slower than males.InterpretationThe first three months is the critical recovery period for diffusion capacity. The impaired diffusion capacity was more severe and recovered slower in females than in males. Early pulmonary rehabilitation and individualized interventions for recovery are worthy of further investigations.