Physical and cognitive impact following SARS-CoV-2 infection in a large population-based case-control study.

BACKGROUND: Persistent symptoms are common after SARS-CoV-2 infection but correlation with objective measures is unclear. METHODS: We invited all 3098 adults who tested SARS-CoV-2 positive in Iceland before October 2020 to the deCODE Health Study. We compared multiple symptoms and physical measures between 1706 Icelanders with confirmed prior infection (cases) who participated, and 619 contemporary and 13,779 historical controls. Cases participated in the study 5-18 months after infection. RESULTS: Here we report that 41 of 88 symptoms are associated with prior infection, most significantly disturbed smell and taste, memory disturbance, and dyspnea. Measured objectively, cases had poorer smell and taste results, less grip strength, and poorer memory recall. Differences in grip strength and memory recall were small. No other objective measure associated with prior infection including heart rate, blood pressure, postural orthostatic tachycardia, oxygen saturation, exercise tolerance, hearing, and traditional inflammatory, cardiac, liver, and kidney blood biomarkers. There was no evidence of more anxiety or depression among cases. We estimate the prevalence of long Covid to be 7% at a median of 8 months after infection. CONCLUSIONS: We confirm that diverse symptoms are common months after SARS-CoV-2 infection but find few differences between cases and controls in objective parameters measured. These discrepancies between symptoms and physical measures suggest a more complicated contribution to symptoms related to prior infection than is captured with conventional tests. Traditional clinical assessment is not expected to be particularly informative in relating symptoms to a past SARS-CoV-2 infection.

Persistent symptoms are commonly reported after SARS-CoV-2 infection, and this is often described as long Covid. We compared different symptoms reported following SARS-CoV- 2 infection with the results obtained during various medical evaluations that are often used to assess health, such as blood tests, smell tests, taste tests, hearing tests, etc. We compared symptoms and test results between 1,706 Icelanders who had been infected previously with SARS-CoV-2 infection (cases) and 14,398 individuals who had not been infected (controls). Out of 88 assessed symptoms, 41 were more common in cases than controls. However, relatively few differences were seen in the results obtained from the various medical evaluations (cases had poorer smell and taste test results, slightly less grip strength, and slightly poorer memory recall than controls). The differences seen between symptoms and results of medical evaluations suggests that conventional clinical tests may not be informative in relating symptoms to a past SARS-CoV-2 infection.

[Professional moral character of physicians and clinical working environment].

INTRODUCTION: A survey of the experience of Icelandic medical candidates, general physicians, and specialty physicians of clinical work, aimed to show how the working environment affects doctors' moral character and experience of support, well-being and expectations. For comparison, results of a British survey with the same questions for specialty physicians were used. MATERIAL AND METHODS: A total of 89 physicians answered 15 questions. Statistical comparison was made between results from topical clusters of questions. RESULTS: The results show a significant problem in work conditions of Icelandic doctors. Their experience is rated low in the second quarter (2,1 - 3,0) on a numerical scale of how the environment thwarts professional character and of lack of support. In comparison with British specialists, their experience is similar but slighly better regarding supportiveness. Icelandic candidates and general physicians experience significantly more stress, less support and autonomy in their work than specialists. Compared to the British, the experience of Icelandic specialists was more positive about professional autonomy and emotional attachment to the work. Our survey shows for the first time the effect of the working environment on professional virtues of Icelandic doctors. DISCUSSION: These findings resonate with the literature that the moral character of doctors contributes to satisfaction, flourishing and experience of meaningfulness. They substantiate views raised by Icelandic physicians about tremendous work stress and scarcity of staff. The survey demonstrates the doctors' experience of work-related challenges and provides reasons for society to improve their working conditions to enable them to live up to their ideals.

[Beriberi 10 years after gastric bypass surgery - case report].

Beriberi is primarily related to malnutrition, but also known as a complication following abdominal surgical procedures. A 41 year old woman, who underwent gastric bypass surgery 10 years earlier, presented at the emergency department of Landspitali with general weakness and paresthesia. Physical examination revealed muscle atrophy and attenuated deep tendon reflexes in her lower limbs; presenting as polyneuropathy due to beriberi. The diagnosis was confirmed with serum thiamine levels measuring well below reference levels. She was treated with 300 mg of thiamine intravenously and her condition started to improve. Thiamine deficiency in this case is most likely related to malnutrition secondary to the gastric bypass surgery. This rare complication must be considered in patients that present with polyneuropathy following bariatric surgery. Key words: Beriberi, gastric bypass, thiamine, polyneuropathy, surgery, case report. Correspondence: Tomas Gudbjartsson, tomasgud@landspitali.is.