Headache severity in patients with post COVID-19 condition: a case-control study.

Post COVID-19 conditions (PCC) present with a wide range of symptoms. Headache is one of the most frequently reported neurological symptoms by patients with PCC. We aimed to assess the prevalence of headache in patients with PCC who attended the Post-COVIDLMU outpatient department at LMU University Hospital in Munich. We hypothesized that headaches occur more frequently in patients with PCC than in the control group. Patients answered a questionnaire containing sociodemographic characteristics, their current symptoms, and prior psychiatric and somatic diagnoses, the WHO Quality of Life assessment (WHOQOL-BREF), 9-item Patient Health Questionnaire (PHQ-9), and the Fatigue Severity Scale (FSS). 188 PCC patients were included in this study and compared to a control group of patients with a history of COVID-19 or a different infectious disease - but no consecutive post-infectious condition (nc=27). 115 (61%) of our PCC patients were female. The median age was 41 years. 60 (32%, p = 0.001) had a pre-existing psychiatric diagnosis. PCC was associated with worse outcomes in all four domains of the WHOQOL-BREF (p < 0.001), high levels of fatigue (FSS; p < 0.001), and a higher likeliness for symptoms of depression (PHQ-9; p < 0.001). We were able to confirm that psychiatric disorders are more frequently associated with headaches in PCC patients. Headache should be assessed and treated in the context of PCC not only by neurologists but by multi-professional teams and regarding all PCC symptoms.

Characterization of cognitive symptoms in post COVID-19 patients.

Cognitive symptoms (CS) belong to the most common manifestations of the Post COVID-19 (PC) condition. We sought to objectify CS in PC patients using routine diagnostic assessments: neurocognitive testing (NCT) and brain imaging (BI). Further, we investigated possible associations of CS with patient reported outcomes (PROs), and risk factors for developing CS. Clinical data and PROs of 315 PC patients were assessed at a mean of 6 months after SARS-CoV-2 infection. 231 (73.3%) patients reported any sort of CS. Among them, 78 underwent NCT and 55 received BI. In NCT, the cognitive domains most affected were the working memory, attention, and concentration. Nonetheless, pathological thresholds were exceeded only in few cases. Neurocognitive performance did not differ significantly between patients complaining of severe (n = 26) versus non-severe (n = 52) CS. BI findings were abnormal in 8 (14.5%) cases with CS but were most likely not related to PC. Patients reporting high severity of CS scored worse in the PHQ-9, FSS, WHOQOL-BREF, were more likely to report impaired sleep, and had a higher prevalence of psychiatric diagnoses. Overall, NCT could confirm mild impairment in some but not all PC patients with CS, while BI studies were abnormal in only few cases. CS severity did not affect NCT results, but severe CS were associated with symptoms of depression (PHQ-9), fatigue (FSS), reduced quality of life (WHOQOL-BREF) and higher prevalence of psychiatric illnesses. These findings support the importance of NCT, BI, and neuro-psychological assessment in the work-up of PC patients reporting CS. TRIAL REGISTRATION: Trial registration number and date of registration: DRKS00030974, 22 Dec 2022, retrospectively registered.

Substantial differences in perception of disease severity between post COVID-19 patients, internists, and psychiatrists or psychologists: the Health Perception Gap and its clinical implications.

Patient-reported outcome measures (PROMs) such as the Numeric Pain Rating Scale (NPRS) or Likert scales addressing various domains of health are important tools to assess disease severity in Post COVID-19 (PC) patients. By design, they are subjective in nature and prone to bias. Our findings reveal substantial differences in the perception of disease severity between patients (PAT), their attending internists (INT) and psychiatrists/psychologists (PSY). Patients rated almost all aspects of their health worse than INT or PSY. Most of the differences were statistically highly significant. The presence of fatigue and mood disorders correlated negatively with health perception. The physical health section of the WHO Quality of Life Assessment (WHOQoL-BREF) and Karnofsky index correlated positively with overall and mental health ratings by PAT and INT. Health ratings by neither PAT, PSY nor INT were associated with the number of abnormal findings in diagnostic procedures. This study highlights how strongly perceptions of disease severity diverge between PC patients and attending medical staff. Imprecise communication, different experiences regarding health and disease, and confounding psychological factors may explain these observations. Discrepancies in disease perception threaten patient-physician relationships and pose strong confounders in clinical studies. Established scores (e.g., WHOQoL-BREF, Karnofsky index) may represent an approach to overcome these discrepancies. Physicians and psychologists noting harsh differences between a patient's and their own perception of the patient's health should apply screening tools for mood disorders (i.e., PHQ-9, WHOQoL-BREF), psychosomatic symptom burden (SSD-12, FCV-19) and consider further psychological evaluation. An interdisciplinary approach to PC patients remains imperative. Trial Registration Number & Date of Registration: DRKS00030974, 22 Dec 2022, retrospectively registered.

Evaluation of Inulin Replacing Chitosan in a Polyurethane/Polysaccharide Material for Pb2+ Removal.

Downstream waste from industry and other industrial processes could increase concentration of heavy metals in water. These pollutants are commonly removed by adsorption because it is an effective and economical method. Previously, we reported adsorption capacity of a chitosan/polyurethane/titanium dioxide (TiO2) composite for three ions in a dynamic wastewater system. There, increasing the chitosan concentration in composite increased the cation removal as well; however, for ratios higher than 50% of chitosan/TiO2, the manufacturing cost increased significantly. In this work, we address the manufacturing cost problem by proposing a new formulation of the composite. Our hypothesis is that inulin could replace chitosan in the composite formulation, either wholly or in part. In this exploratory research, three blends were prepared with a polyurethane matrix using inulin or/and chitosan. Adsorption was evaluated using a colorimetric method and the Langmuir and Freundlich models. Fourier-transform infrared spectroscopy (FTIR) spectra, scanning electron microscopy (SEM) micrographs, differential scanning calorimetry and thermogravimetric analysis curves were obtained to characterize blends. Results indicate that blends are suitable for toxic materials removal (specifically lead II, Pb2+). Material characterization indicates that polysaccharides were distributed in polyurethane's external part, thus improving adsorption. Thermal degradation of materials was found above 200 °C. Comparing the blends data, inulin could replace chitosan in part and thereby improve the cost efficiency and scalability of the production process of the polyurethane based-adsorbent. Further research with different inulin/chitosan ratios in the adsorbent and experiments with a dynamic system are justified.

Synthesis and Characterization of Inulin-Based Responsive Polyurethanes for Breast Cancer Applications.

In this study, new polyurethanes (PUs) were prepared by using inulin and polycaprolactone as polyols. Their structure and morphology were determined by Fourier transform infrared spectroscopy (FTIR), Raman dispersive spectroscopy, Nuclear magnetic resonance spectroscopy (1H NMR and 13C NMR), and scanning electron microscopy (SEM), whereas their mechanical properties were evaluated by a universal testing machine. Additionally, their water uptake, swelling behavior, and degradation were evaluated to be used as drug delivery carriers. Therefore, an anti-cancer drug was loaded to these PUs with 25% of loading efficiency and its release behavior was studied using different theoretical models to unveil its mechanism. Finally, the ability of the new PUs to be used as a clip marker in breast biopsy was evaluated. The results clearly demonstrate that these PUs are safe and can be used as intelligent drug release matrices for targeted drug delivery and exhibits positive results to be used for clip marker and in general for breast cancer applications.