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Aim. To determine the prevalence and show the features of the development of newly diagnosed heart failure (HF) in patients with dyspnea after a coronavirus disease 2019 (COVID-19). Material and methods. This clinical prospective observational study was conducted during 2020-2022. The study consecutively included 368 outpatients with shortness of breath, who applied to the clinic. Depending on the presence of prior COVID-19, the patients were divided into 2 groups: the first group consisted of 205 patients with shortness of breath after COVID-19, the second group - 163 patients without prior COVID-19. All patients underwent a clinical examination within 3 days after presentation with an assessment of outpatient records and other medical documents for the differential diagnosis of dyspnea. The severity of dyspnea was determined using the Modified Medical Research Council Dyspnoea Scale (mMRC). The diagnosis of HF was verified in accordance with the 2020 Russian Society of Cardiology guidelines and in some cases reclassified in accordance with the 2021European Society of Cardiology guidelines. For further analysis, 2 subgroups of patients with HF were identified depending on the presence and absence of prior COVID-19. The subgroup analysis excluded patients with acute heart failure, acute illness, and conditions requiring hospitalization and/or intensive care. Results. Among 368 patients who presented to the clinic with dyspnea during 2020-2022, 205 patients (55,7%) had COVID-19. The average period of treatment after COVID-19 was 3,5 [1,5;22,4] months. Patients after COVID-19 applied earlier after the onset of dyspnea, which is associated with higher mMRC score. The prevalence of HF among patients with shortness of breath after COVID-19 was significantly higher than in patients without this pathology in history, and amounted to 19,0% vs 9,8% (p=0,021). Prior COVID-19 increased the relative risk (RR) of HF in patients with shortness of breath by 1,7 times. RR for HF in systolic blood pressure >140 mm Hg increased by 1,9 times, while in diastolic blood pressure >90 mm Hg - by 1,9 times, with the development of a hypertensive crisis - by 28%, with a heart rate >80 bpm at rest - by 1,4 times, with the development of type 2 diabetes - by 31%, in the presence of pulmonary fibrosis - by 2,3 times. Patients with shortness of breath after COVID-19 had more severe HF, both according to clinical tests and according to the blood concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), mainly with the preserved ejection fraction (EF) with a higher prevalence of left atrial (LA) enlargement in combination with a decrease in right ventricular (RV) systolic function and its dilatation. In patients after COVID-19 in the presence of chronic kidney disease, the RR for HF increased by 4,5 times;in the presence of C-reactive protein >4 mg/l - by 1,6 times. Conclusion. Every fifth patient with shortness of breath 3,5 months after COVID-19 had more severe HF, both according to clinical tests and according to blood NT-proBNP concentration, mainly with preserved EF with a higher prevalence of LA increase in combination with a decrease in RV systolic function and its dilatation. The risk of HF is interrelated with the female sex and multiple comorbidities.Copyright © 2023, Silicea-Poligraf. All rights reserved.
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Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome. The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome. Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded. Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea.Copyright © Chuchalin A.G. et al., 2023.
ABSTRACT
Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase®) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome. The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome. Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded. Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea. © Chuchalin A.G. et al., 2023.
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Background: Virtual reality (VR) can offer an innovative approach to providing training in emergency situations, especially in times of COVID-19. There is no risk of infection, and the procedure is scalable and resource-efficient. Nevertheless, the challenges and problems that can arise in the development of VR training are often unclear or underestimated. As an example, we present the evaluation of the feasibility of development of a VR training session for the treatment of dyspnoea. This is based on frameworks for serious games, and provides lessons learned. We evaluate the VR training session with respect to usability, satisfaction, as well as perceived effectiveness and workload of participants. Methods: The VR training was developed using the established framework (Steps 1-4) for serious games of Verschueren et al. and Nicholson's RECIPE elements for meaningful gamification. Primary validation (Step 4) was performed at the University of Bern, Switzerland, in a pilot study without control group, with a convenience sample of medical students (n=16) and established measurement tools. Results: The theoretical frameworks permitted guided development of the VR training session. Validation gave a median System Usability Scale of 80 (IQR 77.5-85); for the User Satisfaction Evaluation Questionnaire, the median score was 27 (IQR 26-28). After the VR training, there was a significant gain in the participants' confidence in treating a dyspnoeic patient (median pre-training 2 (IQR 2-3) vs. post-training 3 (IQR 3-3), p=0.016).Lessons learned include the need for involving medical experts, medical educators and technical experts at an equivalent level during the entire development process. Peer-teaching guidance for VR training was feasible. Conclusion: The proposed frameworks can be valuable tools to guide the development and validation of scientifically founded VR training. The new VR training session is easy and satisfying to use and is effective - and is almost without motion sickness.
Subject(s)
COVID-19 , Virtual Reality , Humans , Pilot Projects , COVID-19/epidemiology , Emergency Treatment , Dyspnea/therapyABSTRACT
Post-COVID syndrome develops after COVID-19 (COronaVIrus Disease 2019) and leads to cumulative effects in the form of shortness of breath and impaired lung function. Notably, patients with airway inflammation and COVID-19 were found to have increased concentrations of hyaluronic acid (HA). Since bovhyaluronidase azoximer (Longidase) catalyzes the hydrolysis of HA, this drug has the potential to reduce HA levels and improve lung function in patients with post-COVID syndrome. The aim of the DISSOLVE trial, which was conducted early in the pandemic, was to investigate the efficacy and safety of bovhyaluronidase azoximer in patients with symptoms associated with post-COVID syndrome. Methods. An open, prospective, controlled, comparative, multicenter clinical trial (NCT04645368) included adult patients (n = 160) who had post-COVID syndrome. Patients in the treatment group (n = 81) received bovhyaluronidase azoximer, and individuals in the control group (n = 79) were followed up without intervention. The study included physical examination, evaluation of forced vital capacity (FVC), assessment of dyspnea with the Modified Medical Research Council Dyspnea Scale (mMRC), 6-minute walking test, and pulse oximetry. These indicators were measured on 3 visits, at days 1 (baseline), 75, and 180. In addition, the number of patients who experienced adverse events and serious adverse events were recorded. Results. Baseline patient characteristics in the treatment group and the control group were similar. In the treatment group, there was a statistically significant reduction in residual pulmonary abnormalities after visit 2 (day 75) and visit 3 (day 180). In addition, FVC, pulse oximetry values, and functional exercise tolerance increased statistically significantly at days 75 and 180 compared to baseline. The mMRC scores for dyspnea decreased statistically significantly in the treatment group over 75 days. The safety profile of the drug was reported to be favorable throughout the study. Conclusion. Treatment with bovhyaluronidase azoximer in patients with post-COVID syndrome showed improvement in FVC, pulse oximetry, functional exercise tolerance, and mMRC dyspnea.Copyright © Chuchalin A.G. et al., 2023.
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Background: Introduction: Coronavirus disease (COVID-19) is a global problem. The COVID-19 pandemic has infected millions of people and the number of patients who have been exposed to postcovid implications are increased. Postcovid changes are more investigated in adults, although information is scarce in pediatric patients. Method(s): The aim of the study was to evaluate the radiological changes of respiratory system in peaditric patients after acute mild and severe covid infections. Research subjects: 259 pediatric patients (age: 10 months -18 years) recovered from Covid-19 and had a negative PCR test were examined. All patients underwent X-ray examinations. Patients were divided into 3 subgroups. Patients (46%) recovered from severe or moderate covid pneumonia and had non-respiratory symptoms upon arrival at the clinic: weakness, mild fatigue, drowsiness. Patients (28%) recovered from covid infection and had respiratory symptoms: cough, shortness of breath during exercise, respiratory failure;Patients (26%) with a fever upon entry to the hospital. The statitical analysis was done using SPSS 12.0 software. Result(s): Patients, whose had (69.9% ) the severe Covid pneumonia and postcovid respiratory symptoms (cough 78.4%), which was the cause of abnormal changes in the cardiovascular system were onserved in 48.6% of patients. Unlike other types of viral infections, the changes continue in the postcovid period. Severe course of the disease does not always mean detection of postcovid syndrome and vice versa. However, in case of mild disease the possibility development of various degrees of polyorgan damage was 26.9%. Conclusion(s): The radiological changes are manifested during 4th week from recovery and may last for a longer period of time, however the radiological changes do not always indicator a severity of the disease.
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Background: Early in the pandemic, we established COVID-19 Recovery and Engagement (CORE) Clinics in the Bronx and implemented a detailed evaluation protocol to assess physical, emotional, and cognitive function, pulmonary function tests, and imaging for COVID-19 survivors. Here, we report our findings up to five months post-acute COVID-19. Methods: Main outcomes and measures included pulmonary function tests, imaging tests, and a battery of symptom, physical, emotional, and cognitive assessments 5 months post-acute COVID-19. Findings: Dyspnea, fatigue, decreased exercise tolerance, brain fog, and shortness of breath were the most common symptoms but there were generally no significant differences between hospitalized and non-hospitalized cohorts (p > 0.05). Many patients had abnormal physical, emotional, and cognitive scores, but most functioned independently; there were no significant differences between hospitalized and non-hospitalized cohorts (p > 0.05). Six-minute walk tests, lung ultrasound, and diaphragm excursion were abnormal but only in the hospitalized cohort. Pulmonary function tests showed moderately restrictive pulmonary function only in the hospitalized cohort but no obstructive pulmonary function. Newly detected major neurological events, microvascular disease, atrophy, and white-matter changes were rare, but lung opacity and fibrosis-like findings were common after acute COVID-19. Interpretation: Many COVID-19 survivors experienced moderately restrictive pulmonary function, and significant symptoms across the physical, emotional, and cognitive health domains. Newly detected brain imaging abnormalities were rare, but lung imaging abnormalities were common. This study provides insights into post-acute sequelae following SARS-CoV-2 infection in neurological and pulmonary systems which may be used to support at-risk patients and develop effective screening methods and interventions.
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Background: The aim of the study was to investigate the impact of COVID-19 on the pulmonary function tests (PFT) in COVID-19 convalescents six months after recovery. Additionally, the research question was whether PFT should be performed routinely in post-COVID-19 patients. Methods: A total of 39 patients with a history of COVID-19 6 months prior to the study were included in the study (Group I). Individuals were hospitalized or treated in the outpatients department. The control group (Group II) consisted of 39 healthy patients without a COVID-19 history. Each subject completed a questionnaire interview and underwent laboratory and pulmonary function examinations. Results: Six months after COVID-19 recovery, patients mainly complained about cough (46%, n = 18), shortness of breath (23%, n = 9), weakness (13%, n = 5), and memory/concentration disorders (8%, n = 3). In the group of patients complaining of persistent cough present 6 months after COVID-19, the following PFT parameters were decreased: FEV1, FVC, FRC, TLC, and DLCO (p < 0.05) in comparison with patients without this symptom. Conclusions: Persistent shortness of breath is not necessarily associated with pulmonary function impairment in patients 6 months after SARS-CoV-2 infection, and hence it requires appropriate differential diagnosis. Patients with a cough persisting 6 months after the acute phase of COVID-19 may benefit from PFT.
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Background The entire world is combating COVID-19;however, a significant proportion of patients demonstrate the persistence of some COVID-19 symptoms, new symptom development, or exaggeration of pre-existing disease after a negative viral load. They are referred to as a post-COVID-19 syndrome. According to various researches, COVID-19 has a wide range of long-term effects on virtually all systems, including the respiratory, cardiovascular, gastrointestinal, neurological, mental, and dermatological systems. Finding the various symptoms of post-acute and chronic is critical since they might have a significant impact on the patients' everyday functioning. As a result, we aimed to distinguish the symptoms immediately after the initial phase in which the symptoms affected them for more than three weeks.The symptoms prolonged for a few weeks in post covid time are referred to as acute COVID-19 and the symptoms that persist with the affected individuals for more than three months are referred to as chronic COVID - 19. This paper was written as a review report to provide an overview of the nature and frequency of symptoms observed by patients with mild COVID-19 after the first three weeks. We also envisionedlooking at the various incidences and factors that contribute to the development of post-COVID-19 syndrome in different patient groups, as well as the chances of overcoming it. Objective The objective of this review paper is as follows: To establish the prevalence and characteristics of the post-COVID 19 syndrome in COVID-19 survivors, as well as the factors associated with persistent symptoms. To increase community knowledge about the type and frequency of persistent symptoms experienced by patients post serious and moderate COVID-19 infection. Methods The three-session questionnaire, which includes patient demographic data, vaccination status, and patient status during COVID-19, and post-COVID-19 syndrome, was provided to the public who recovered from COVID-19 and received their responses as primary data. The responses were evaluated to show the relationship between numerous factors that induce post-COVID-19 syndrome. Results A total of 136 responses were obtained and evaluated. This literature review comprised ten publications. As a result, the frequency of persistent symptoms in individuals following mild COVID-19 infection ranged from 15% to 45%. Symptoms reported in mild COVID-19 infected people can be classified as physical, mental, or social. Weakness was the most frequently mentioned consistent symptom. Dyspnea, cough, chest pain, headache, poor mental and cognitive state, and olfactory impairment were also reported as persistent symptoms. There was a significant impact seen in their employment and the daily functioning of the patients. Copyright © 2022, Anka Publishers. All rights reserved.
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The aim. The presented material reflects the results of studies by Russian specialists conducted under the auspices of the Russian Respiratory Society over the past 15 years. The article also includes the main provisions set out in the III Guidelines for dyspnea. A significant part of the manual is devoted to the recent achievements in studying neurophysiological processes in the brain structures during the development of dyspnea. These achievements were driven by image-diagnosis methods. An important aspect of this series of works for the clinical practice was identifying dyspnea domains and developing the instruments to assess severity. Results. Analysis of the data on dyspnea from the clinical practice showed a highly heterogenic clinical picture, which must be taken into account in the management of individual patients. A diagnostic algorithm for long-term follow-up of patients with dyspnea syndrome is also discussed. The attention of doctors is drawn to the features of dyspnea during COVID-19;the disproportion between the sensory perception of respiratory discomfort and the degree of oxygen desaturation is emphasized. Conclusion. It was concluded that in the Russian-speaking environment of patients, doctors should actively use a verbal characteristic of dyspnea – the “language of dyspnea”. © 2021 Medical Education. All rights reserved.
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OBJECTIVES: Dyspnea is one of the most predominant symptom in clinical practice. There is a lack of data about incidents of dyspnea among Polish adults therefore it would be important to establish prevalence of this symptom before COVID-19 pandemic to assess the impact of this infection on the functioning of the adult Polish population in the future. The aim of the study was to establish prevalence of dyspnea in adult Polish population. MATERIAL AND METHODS: It was an observational-cross-sectional study, with representative sample of adult Poles aged 18-79 years. The 2413 participants were surveyed. Responders were asked if and when dyspnea occurs and what is its severity in relation to one of four categories (A, B, C, and D) describing the impact of dyspnea on reduced exercise tolerance and daily activities. RESULTS: The 67.1% of the respondents answered negatively to all question about experiencing dyspnea (females (F) 61% vs. males (M) 74%, p < 0.05). Dyspnea only during intense physical exertion (A), was reported by 22.8% (F 26.2% vs. M 19.2%, p = 0.07). Dyspnea limiting daily activities (B, C and D) was reported by 10.1% (F 13.1% vs. M 7%, p < 0.05). Significant differences in the severity of dyspnea were found between the age groups. People diagnosed with chronic heart failure or lung diseases significantly more often reported dyspnea than people without these conditions. CONCLUSIONS: Every tenth Pole reported dyspnea limiting performing activities of daily living. Additionally, about 20% of Poles experienced dyspnea considered as "gray area," only during intense physical exertion, that requires deepening and clarifying the medical history.
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Aim. To evaluate the efficacy and safety of the use of KARMOLIS® DROPS in the rehabilitation of patients after COVID-19 infection. Material and methods. The study included and completed observation of 40 medical staff aged 20 to 60 years who had suffered from COVID-19 in a moderate to severe form. The follow-up period was 21 days. The study participants were divided into two groups. The main group (20 people) received KARMOLIS® DROPS. The control group (20 people) treatment was carried out without the use of KARMOLIS® DROPS. The effectiveness was evaluated according to a set of clinical and functional indicators. Results and discussion. Against the background of taking KARMOLIS® DROPS, reliable positive dynamics of the subjective assessment of shortness of breath (MRC scale) and the subjective assessment of sleep quality (Vane A.M. scale) were recorded in the main group. Subjective efficacy of the studied KARMOLIS ® DROPS was noted by almost all patients who underwent treatment, which is probably due to improved sleep and well-being by reducing autonomic reactions. Taking into account the data obtained during the study, KARMOLIS® DROPS can be used in the recovery process after COVID-19 as a component of comprehensive rehabilitation. Conclusion. The safety of using the herbal medicine KARMOLIS® DROPS was confirmed by the absence of adverse events and cases of decompensation of concomitant diseases during the study. Patients' emotionally positive perception of the drug ensured its high compliance. © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.
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Post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (PASC) infection is particularly concerning to athletes who place a high premium on cardiovascular performance and competition. This initial case series shows the overlap between PASC and orthostatic intolerance in athletes, reveals the diagnostic challenges, and highlights the role of graded exercise training in this population. (Level of Difficulty: Advanced.).
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BACKGROUND: Noninvasive ventilation (NIV) is one of the most important therapeutic tools in patients with acute respiratory failure. However, in case of incorrect patient selection it can delay necessary intubation and is associated with complications and even mortality. Patient selection, therefore, plays a key role in therapeutic success. The purpose of this study was to determine the value of the rapid shallow breathing index (RSBI) in predicting the failure of NIV. METHODS: This prospective observational study was conducted in the emergency department (ED) of a tertiary hospital. Adults presenting to the ED with acute respiratory failure were included in the study. The success of RSBI values measured initially (RSBI 1) and at 30 min (RSBI 2) and the difference between these 2 values (Δ RSBI) in predicting subjects' intubation requirement and survival was tested using multivariate logistic regression analysis. RESULTS: Two hundred sixty-seven subjects were included in the study. RSBI 1, RSBI 2, and Δ RSBI values differed significantly between the intubated and non-intubated subjects. According to the multivariate model, RSBI 1 and RSBI 2 > 105, Δ RSBI < 19, heart rate > 100 beats/min, and SpO2 < 92% were significantly associated with intubation requirement. RSBI 1, RSBI 2, and Δ RSBI values also differed significantly between subjects with a fatal course and surviving individuals. According to the multivariate model, RSBI 2 > 105, Δ RSBI < 19, heart rate > 100, and increasing age were associated with in-hospital mortality. CONCLUSIONS: RSBI can be a successful marker in predicting the failure of NIV and predicting in-hospital mortality in patients admitted to the ED with acute respiratory failure.
Subject(s)
Respiratory Insufficiency , Ventilator Weaning , Adult , Hospital Mortality , Humans , Intubation, Intratracheal , Respiration, Artificial , Respiratory Insufficiency/therapyABSTRACT
We are now observing a constantly growing number of patients after SARS-CoV-2 infection who have active complains for more than 12 weeks. Long-term consequences of the disease significantly impair the quality of life and lead to an overburdened healthcare system, which, in the absence of effective therapeutic strategies, has a significant impact on the quality of medical care. This article discusses the main aspects of pathogenesis and clinical characteristics of post-COVID syndrome, as well as the experience of pharmacological correction of this condition. Objective. To evaluate the effect of azoximer bromide on the resolution of post-COVID syndrome by assessing the duration and severity of the main symptoms within 10 days since treatment initiation, as well as the level of chronic fatigue. Patients and methods. This study included 90 patients (both males and females). The experimental group comprised 55 individuals who received azoximer bromide for 10 days according to the package insert. The control group included 35 individuals who received no therapy. Treatment efficacy was evaluated using special questionnaires;Student's t-test and Pearson's chi-squared test were used for statistical analysis. Results. We found that significantly fewer patients from the experimental group had joint and muscle pain and headache on day 10 of the experiment than patients in the control group. Hyposmia was also less common in the experimental group then in controls by day 10. There was a significant decrease in the severity of headache, joint and muscle pain, attention impairment, dizziness, anosmia among patients receiving azoximer bromide by day 10 compared to those receiving no therapy. Patients in the experimental group also demonstrated significantly less severe fatigue compared to controls as early as day 5 of the experiment. No adverse events were registered during the study. Conclusion. Azoximer bromide demonstrated its clinical efficacy and safety in the treatment of post-COVID syndrome. © 2021, Dynasty Publishing House. All rights reserved.
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An analysis of the results of studies carried out by specialists of the Russian Respiratory Society over the past 15 years is given. The article also includes the main provisions set out in the III Guidelines for dyspnea. A significant part of the manual is devoted to the recent achievements in studying neurophysiological processes in the brain structures during the development of dyspnea. These achievements were driven by image-diagnosis methods. An important aspect of this series of works for the clinical practice was identifying dyspnea domains and developing the instruments to assess severity. Analysis of the data on dyspnea from the clinical practice showed a highly heterogenic clinical picture, which must be taken into account in the management of individual patients. A diagnostic algorithm for long-term follow-up of patients with dyspnea syndrome is also discussed. The attention of doctors is drawn to the features of dyspnea during COVID-19; the disproportion between the sensory perception of respiratory discomfort and the degree of oxygen desaturation is emphasized. It was concluded that in the Russian-speaking environment of patients, doctors should actively use a verbal characteristic of dyspnea the language of dyspnea.
Subject(s)
COVID-19 , Humans , COVID-19/complications , Dyspnea/diagnosis , Dyspnea/etiology , Syndrome , Oxygen , RussiaABSTRACT
Objective: To explore the clinical presentation of mild to moderate COVID-19 disease. Study Design: Cross-sectional analytical study Place and Duration of Study: Tertiary Care Hospital, Rawalpindi from Mar 2020 to Aug 2020. Methodology: Three hundred and ninety-two patients with mild to moderate illness, PCR positive for COVID 19 were included. Frequency of typical symptoms of COVID-19 disease cough, fever, sore throat and shortness of breath and trends in laboratory assays were recorded. Discharge Criteria was two consecutive negative PCR performed upon 7th and 8th day of admission, subsequently on the 11th and 12th day if found positive previously. Results: A total of 392 patients were enrolled in the study with age range of 9-45 years. Out of 96 (24.5%) patients presented with cough and fever. Out of 112 (28.6%) patients complained of fatigue and myalgias. Chest x-ray had a bilateral patch in 96 (24.5%) patients and serum ferritin was raised in 96 (24.5%) patients. The coagulation profile was deranged in 64 (16.3%) patients. PCR results remained positive till 12th day in 80 (20.4%) patients. Conclusion: Fever, Cough and sore throat and deranged biochemical, radiological and haematological markers prove multisystem implications of mild to moderate COVID-19 disease. PCR can remain positive till the 12th day and beyond in modest disease.
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INTRODUCTION: Enhancement of mucociliary clearance (MCC) might be a potential target in treating COVID-19. The phytomedicine ELOM-080 is an MCC enhancer that is used to treat inflammatory respiratory diseases. PATIENTS/METHODS: This randomised, double-blind exploratory study (EudraCT number 2020-003779-17) evaluated 14 days' add-on therapy with ELOM-080 versus placebo in patients with COVID-19 hospitalised with acute respiratory insufficiency. RESULTS: The trial was terminated early after enrolment of 47 patients as a result of poor recruitment. Twelve patients discontinued prematurely, leaving 35 in the per-protocol set (PPS). Treatment with ELOM-080 had no significant effect on overall clinical status versus placebo (p = 0.49). However, compared with the placebo group, patients treated with ELOM-080 had less dyspnoea in the second week of hospitalisation (p = 0.0035), required less supplemental oxygen (p = 0.0229), and were more often without dyspnoea when climbing stairs at home (p < 0.0001). CONCLUSION: These exploratory data suggest the potential for ELOM-080 to improve respiratory status during and after hospitalisation in patients with COVID-19.
Subject(s)
COVID-19 , Respiratory Insufficiency , COVID-19/complications , Double-Blind Method , Dyspnea/drug therapy , Dyspnea/etiology , Humans , Prospective Studies , Respiratory Insufficiency/drug therapy , SARS-CoV-2 , Treatment OutcomeABSTRACT
A novel coronavirus disease is considered the most dangerous epidemic spread in the world recently. The world health organization (WHO) has named this epidemic a novel COVID-19. According to the literature review, the most important symptoms that confirm the infection with this epidemic are high temperature, coughing, shortness of breath, and chest pain. In general, these symptoms have become the actual cause of most deaths for people who have the novel COVID-19 epidemic. These symptoms adopted in this study as essential criteria. The conflict between criteria formatted a challenge in this study. This paper aims to propose a framework for diagnosing the disease symptoms based on multiple criteria using an analytical hierarchy process (AHP) method. Therefore, decision support methods most suitable to solve various criteria problems. The results reported the most important criterion at the mean (0.407) and ±SD (0.166) for the fever. The least important criterion of the chest pain at the mean (0.116) and ±SD (0.070). While the cough criterion at the mean (0.254) and ±SD (0.099) and the shortness of breath criterion at the mean (0.223) and ±SD (0.127), respectively. This study presented an optimal framework for physicians to immediately diagnose coronavirus symptoms for the person with this disease. © 2022, Springer Nature Switzerland AG.
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Comprehensive data on early prognostic indicators in patients with mild COVID-19 remains sparse. In this single center case series, we characterized the initial clinical presentation in 180 patients with mild COVID-19 and defined the earliest predictors of subsequent deterioration and need for hospitalization. Three broad patient phenotypes and four symptom clusters were characterized, differentiated by varying risk for adverse outcomes. Among 14 symptoms assessed, subjective shortness of breath (SOB) most strongly associated with adverse outcomes (odds ratio (OR) 21.3, 95% confidence interval (CI): 2.7-166.4; p < 0.0001). In combination, SOB and number of comorbidities were highly predictive of subsequent hospitalization (area under the curve (AUC) 92%). Additionally, initial lymphopenia (OR 21.0, 95% CI: 2.1-210.1; p = 0.002) and male sex (OR 3.5, 95% CI: 0.9-13.0; p = 0.05) were associated with increased risk of poor outcomes. Patients with known comorbidities, especially multiple, and those presenting with subjective SOB or lymphopenia should receive close monitoring and consideration for preemptive treatment, even when presenting with mild symptoms.