Isolated Trigeminal Mononeuropathy: A Possible COVID-19 Sequelae.

COVID-19 infections have been linked with multiple neurological manifestations. One of the infrequent complications of post-COVID-19 infection is trigeminal neuropathy. Despite its infrequency, few cases of trigeminal neuropathy following COVID-19 infection have been documented in the literature. However, there remains a paucity of evidence regarding isolated trigeminal neuropathy following COVID-19, particularly in cases devoid of pain but characterized by sensory deficits such as loss of sensation and paresthesia only. We describe a clinical case of trigeminal neuropathy that emerged after a COVID-19 infection at our institution. Our case report delves into the clinical presentation of such trigeminal neuropathy that would aid clinicians in including this pathology in their differential diagnosis.

Association of obesity status and the risk of long-COVID: Isfahan COVID cohort study.

People with COVID-19 infection continue to have their symptoms or develop new ones after recovery. This is called long-COVID syndrome. We aimed to examine the association of general and abdominal obesity with long COVID. This study was conducted using Isfahan COVID Cohort (ICC). Totally 4008 including 3213 hospitalized and 795 non-hospitalized patients with positive RT-PCR were included. Body mass index (BMI) and waist circumference (WC) were calculated. BMI >25 kg/m2 and WC >88 cm in women and 102 cm in men were considered generally and abdominally obese, respectively. By using an open-ended questionnaire, subjects were asked whether they had any new or persistent symptom. Reported symptoms were categorized in three different fields including general, cardiac, and respiratory symptoms. Higher BMI and WC tended to increase general symptoms (odds ratio [OR] for BMI = 1.16, 95 % confidence interval (95% CI): 0.97, 1.38, and OR for WC = 1.14, 95% CI: 0.99, 1.32). Higher BMI significantly increased cardiovascular (OR = 1.38, 95% CI: 1.14, 1.67) and respiratory symptoms (OR = 1.43, 95% CI: 1.15, 1.78). Compared with patients with normal WC, the risk of cardiovascular (OR = 1.44, 95% CI: 1.24, 1.69) and respiratory symptoms was significantly higher in subjects with abdominal obesity (OR = 1.31, 95% CI: 1.10, 1.56). We found that general and abdominal obesity were associated with increased risk of cardiovascular and respiratory symptoms in patients with long-COVID symptoms. However, only general obesity was associated with increased risk of general symptoms.

Lexical retrieval difficulties in post-COVID-19 syndrome: Insights from verbal fluency and naming tasks.

BACKGROUND: Although considerable research has been conducted on post-COVID-19 syndrome (PCS), cognitive symptoms, particularly those related to language, are still not well understood. AIMS: To provide a detailed quantitative and qualitative analysis of language performance in PCS patients using a comprehensive set of semantic and verbal production tasks. METHODS & PROCEDURES: The study involved 195 PCS patients aged 26-64 years and 50 healthy controls aged 25-61 years. Participants were assessed using two semantic tasks, three naming tasks and four types of verbal fluency tasks, designed to evaluate different aspects of language processing. OUTCOMES & RESULTS: PCS patients demonstrated significantly poorer performance compared with controls across all verbal fluency tasks. This was evident in both the total number of words generated and their types, with patients tending to choose more easily accessible words. In naming tasks, the pattern of errors was similar in both groups, although patients showed a higher number of non-responses and made more errors, reflecting difficulties in word retrieval. The analysis highlighted the impact of factors such as stimulus availability, educational level and cognitive reserve on performance. Notably, younger patients performed worse than older, a paradoxical trend also observed in previous research. CONCLUSIONS & IMPLICATIONS: These findings reveal significant word retrieval difficulties in PCS patients, suggesting that cognitive impairment related to language may be more pronounced than previously understood. The results underscore the need for a thorough evaluation of language functions in PCS patients and the development of more targeted and individualized language rehabilitation strategies to address these specific challenges. WHAT THIS PAPER ADDS: What is already known on the subject Studies on the cognitive characteristics of CPS have focused mainly on broad-spectrum neuropsychological assessments covering all cognitive functions. However, there are very few studies analysing oral production with specific lexical and semantic system tasks. Furthermore, no work has specifically included tasks assessing semantic processing or conducted qualitative analyses of the psycholinguistic variables affecting performance. Such analyses could undoubtedly help clarify the nature of the language impairments in patients with PCS. What this paper adds to the existing knowledge This study explores in depth the evaluation and analysis of the oral production of patients with PCS using several lexical and semantic tasks. In addition, psycholinguistic variables are analysed that could undoubtedly help clarify the nature of the language impairments in patients with PCS. What are the potential or actual clinical implications of this work? The study allows the identification of specific lexical-semantic deficits in the spoken language in patients with this PCS. A more detailed assessment of the oral language of these patients, keeping in mind the psycholinguistic variables that may affect the performance, will facilitate the design of more efficient and individualized rehabilitation programmes.

Effects of cognitive training and group psychotherapy on cognitive performance of post COVID-19 patients: an exploratory and non-randomized clinical trial.

Cognitive complaints are common signs of the Post COVID-19 (PC) condition, but the extent and type of cognitive impairment may be heterogeneous. Little is known about neuropsychological treatment options. Preliminary evidence suggests cognitive symptoms may improve with cognitive training and naturally over time. In this clinical trial, we examined whether participation in a weekly group consisting of cognitive training and group psychotherapy is feasible and would exert beneficial effects on cognitive performance in PC and whether improvements were associated with intervention group participation or represented a temporal improvement effect during syndrome progression. 15 PC patients underwent an 8-week intervention. Cognitive performance was assessed before and after each intervention group participation. A control group of 15 PC patients with subjective neurocognitive or psychiatric complaints underwent two cognitive assessments with comparable time intervals without group participation. To attribute changes to the intervention group participation, interaction effects of group participation and time were checked for significance. This is an exploratory, non-randomized, non-blinded controlled clinical trial. Within the intervention group, significant improvements were found for most cognitive measures. However, significant time x group interactions were only detected in some dimensions of verbal memory and visuo-spatial construction skills. Significant time effects were observed for attention, concentration, memory, executive functions, and processing speed. The intervention setting was feasible and rated as helpful and relevant by the patients. Our results suggest that cognitive symptoms of PC patients may improve over time. Patients affected by both neurocognitive impairments and mental disorders benefit from group psychotherapy and neurocognitive training. The present study provides evidence for a better understanding of the dynamic symptomatology of PC and might help to develop further studies addressing possible therapy designs. The main limitations of this exploratory feasibility trial are the small sample size as well as the non-randomized design due to the clinical setting.

A pilot cross-sectional investigation of symptom clusters and associations with patient-reported outcomes in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post COVID-19 Condition.

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is associated with long-term disability and poor quality of life (QoL). Cardinal ME/CFS symptoms (including post-exertional malaise, cognitive dysfunction and sleep disturbances) have been observed in Post COVID-19 Condition (PCC). To gain further insight into the potential role of ME/CFS as a post-COVID-19 sequela, this study investigates associations between symptoms and patient-reported outcomes, as well as symptom clusters. METHODS: Participants included Australian residents aged between 18 and 65 years formally diagnosed with ME/CFS fulfilling the Canadian or International Consensus Criteria or PCC meeting the World Health Organization case definition. Validated, self-administered questionnaires collected participants' sociodemographic and illness characteristics, symptoms, QoL and functional capacity. Associations between symptoms and patient-reported outcomes were investigated with multivariate linear regression models. Hierarchical cluster analysis was performed to identify symptom clusters. RESULTS: Most people with ME/CFS (pwME/CFS) and people with PCC (pwPCC) were female (n = 48/60, 80.0% and n = 19/30, 63.3%, respectively; p = 0.12). PwME/CFS were significantly younger (x̄=41.75, s = 12.91 years) than pwPCC (x̄=48.13, s =10.05 years; p =0.017). Autonomic symptoms (notably dyspnoea) were associated with poorer scores in most patient-reported outcome domains for both cohorts. None of the four symptom clusters identified were unique to ME/CFS or PCC. Clusters were largely delineated by the presence of gastrointestinal and neurosensory symptoms, illness duration, ME/CFS criteria met and total symptoms. CONCLUSIONS: Illness duration may explain differences in symptom burden between pwME/CFS and pwPCC. PCC diagnostic criteria must be refined to distinguish pwPCC at risk of long-term ME/CFS-like illness and subsequently deliver necessary care and support.

Post COVID-19 Condition (PCC), or Long COVID, refers to the ongoing symptoms experienced after acute COVID-19 illness. The symptoms reported by people with PCC (pwPCC) resemble Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). However, existing diagnostic criteria for PCC are broad and cannot discern PCC subtypes (such as pwPCC experiencing ME/CFS-like illness), which may require different approaches to care. This study contributes to improving PCC case criteria and approaches to care for both ME/CFS and PCC by investigating the relationships between symptoms and patient-reported outcomes among pwPCC and people with ME/CFS (pwME/CFS).For both cohorts, symptoms had a negative relationship with all aspects of health. Autonomic symptoms, notably breathing issues, returned the most negative associations. Pain, flu-like symptoms and lack of temperature control appeared more burdensome among pwPCC. These symptoms may signify the early stages of ME/CFS. Symptom clusters were also identified for the first time among a combined cohort of pwME/CFS and pwPCC in this study. Importantly, none of the symptom clusters were specific to ME/CFS or PCC. Instead, symptom clusters were defined by the prevalence of gastrointestinal and neurosensory symptoms, illness duration, ME/CFS criteria met and the total number of symptoms.This study suggests that the few differences between ME/CFS and PCC may be explained by illness duration. These findings further implicate ME/CFS as a potential post-COVID-19 outcome. As ME/CFS is associated with profound reductions in quality of life and functioning, identifying pwPCC experiencing ME/CFS-like illness through refined diagnostic criteria must be prioritised to ensure the delivery of necessary care.

Glucocorticoid treatment during COVID-19 infection: does it affect the incidence of long COVID?

BACKGROUND: Long COVID (LC) is a frequent complication of COVID infection. It usually results in cognitive impairment, myalgia, headache and fatigue. No effective treatment has been found yet. We aimed to explore the effect of glucocorticoid (GC) treatment during COVID-19 infection on the later development of LC. METHODS: We examined electronic health records from Clalit Health Services for documentation of COVID-19, GC treatment, and LC frequency. Background diagnoses, demographic data, hospitalization rates, and the use of anti-COVID drugs were recorded. RESULTS: 1,322,599 cases of COVID-19 infection met the inclusion criteria; 13,530 patients (1.02%) received GC treatment. 149,272 patients, 11.29% of COVID-19 patients were diagnosed with LC. Age and female gender were prognostic risk factors for LC (OR 1.06 for age, OR 1.4 for female gender; p value < 0.0001). Background psychiatric diagnoses, migraine, backache and irritable bowel syndrome were predisposing conditions for LC (OR 2.7, p value < .0001). Higher BMI was associated with a greater probability of LC (OR of 1.25 for obese population). COVID patients who received GC were diagnosed with LC more frequently: 2294 cases (16.95%) compared to 146,978 cases (11.23%) in the non-GC group; (adjusted OR of 1.28 ± 0.07, 95% CI, p < 0.0001). CONCLUSIONS: GC treatment during COVID-19 is correlated with the development of LC. In vivo and animal models may be used to explore the mechanism of this correlation. Future directions include prospective studies as well.

COVID-19 associated lung cavitary lesions: A case series.

Background: Our study discusses the probable etiologies and characteristics of pulmonary cavities in post-COVID-19 patients. A pulmonary cavity is a late complication of the disease, yet it has led to multiple referrals to our tertiary hospital in Tehran, Iran. Methods: We conducted a retrospective case-series study on 20 patients who were admitted to our center between April 2020 and September 2021. They were all diagnosed with COVID-19 and concomitantly developed pulmonary cavities. We assessed their electronic medical records in 2021 and compared their characteristics with other studies based on the available literature. Result: Of the 20 patients with cavities, 12 (60%) had been diagnosed with prior COVID-19, and 9 (45%) had type 2 diabetes mellitus. 9 patients (45%) had bacterial superinfections while 4 (44%) had fungal infections. All patients received corticosteroids, but only 4 (20%) were additionally administered Tocilizumab. Conclusion: COVID-19 patients can develop pulmonary cavities during recovery; however, this infrequent radiologic finding depends on specific risk factors.

Immune response and cognitive impairment in Post-COVID Syndrome: A systematic review.

BACKGROUND: Altered immune response and cognitive difficulties have been demonstrated in studies of post-COVID syndrome, including differences in immune status and cognitive functioning in the months following infection. This review aimed to examine immune status and cognitive differences in post-COVID Syndrome twelve or more weeks after COVID-19 infection. A further aim of this review was to explore a link between immune response and the cognitive deficits observed in this group. METHODS: A systematic review was carried out of PubMed, PsychInfo, EMBASE and Web of Science electronic databases of observational studies 12+ weeks after COVID-19 infection, with assessment of immune status and cognitive function in post-COVID Syndrome samples. This review protocol was recorded on PROSPERO with registration number CRD42022366920. RESULTS: Following eligibility screening, eleven studies met inclusion criteria and were selected for our review. Six of eight studies which examined between group differences in specific domains suggested impaired cognition in the Post COVID Syndrome population, with the domains of executive function particularly affected. Of the eleven studies with immune data, nine studies reported increased markers of inflammation in the Post COVID Syndrome group, when compared to an age and gender matched "healthy control" sample, or population norms. Finally, when immune function and cognition are examined together, six studies presented results indicating a significant association between elevated immune response and cognitive function. CONCLUSION: This review highlights the frequency of cognitive difficulties months after COVID-19 infection and explores heighted immune response as a predictor of this change. Six studies suggest that immune status is a predictor of cognitive function, examining a marker of immune function and objective cognitive performance at 12 or more weeks following infection. Future studies of cognitive function in Post COVID Syndrome are needed to explore this relationship, and underlying mechanisms leading to changes in cognitive performance.

Use of strain imaging to detect subtle myocardial involvement in post COVID-19 patients: An Indian perspective.

BACKGROUND: The study assessed Global longitudinal strain imaging (GLS) to detect subtle myocardial dysfunction among patients clinically recovered from COVID-19. METHODS: All patients (n = 101 76 % males, mean age 55.45 ± 11.14 years), and controls (n = 30), underwent clinical assessment and echocardiography, including GLS assessment. RESULTS: The prevalence of diabetes mellitus, hypertension and dyslipidemia was comparable amongst patients and controls. The average GLS was significantly lesser in post COVID patients (-16.21 ± 1.96 vs -18.49 ± 1.64 respectively, p = 0.004) and significantly higher proportion of post COVID patients had GLS > -18 % (43 % vs 22.58 % respectively, p = 0.001) as compared to controls. The RV free wall longitudinal strain (RVFLS) was also lower in the patient group (22.35 ± 4.69 vs 24.19 ± 4.11, p = 0.004) and 21.7 % post COVID-19 patients had pathological RV FWLS (> -20 %) vs controls (6.6 %). Average GLS was significantly lesser in severe post COVID patients (viz -14.25 ± 1.92 vs -16.63 ± 1.61 vs -17.63 ± 1.91, p < 0.0001, respectively among severe, moderate and mild COVID-19 patients. On performing regression analysis, severity of COVID-19 (OR 7.762) was a significant predictor of impaired GLS. CONCLUSION: Despite normal global LVEF, post COVID-19 recovered patients had significantly lower LV GLS and RV FWLS with severe COVID-19 infection, regardless of having a clinical recovery. This study reiterates the importance of speckle tracking echocardiography as an important imaging modality for detection of subclinical myocardial dysfunction in the post COVID-19 recovered patients.

Prevalence, Risk Factors and Pain Subtypes of Post-COVID Pain in Nonhospitalized Older Adults: A Cross-Sectional Study.

BACKGROUND: Post-COVID pain (PCP) is a condition that ensues from an infection of coronavirus disease 2019 (COVID-19). Some researchers have explored the prevalence of PCP and its characteristics in the individuals who experience it. However, most individuals involved in the previous studies were middle-aged, and those studies focused mainly on hospital patients and musculoskeletal PCP. Existing data on PCP and its subtypes among older adults and outpatients are scanty. OBJECTIVE: Our study aims to identify PCP's prevalence and associated risk factors and to compare the quality of life (QoL), sleep quality, and anxiety and depression levels in nonhospitalized elderly COVID-19 survivors with different PCP subtypes. STUDY DESIGN: A cross-sectional study. SETTING: The study was conducted from April 2023 to June 2023 after the first outbreak of the Omicron variant of SARS-CoV-2 in the Taikang Yanyuan Continuing Care Retirement Community (CCRC) in China. METHODS: Eligible participants were surveyed using the Numeric Rating Scale (NRS), Douleur Neuropathique-4 questionnaire (DN4), EuroQol 5D-5L questionnaire (EQ-5D-5L), Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale. COVID-19 symptoms and laboratory parameters were obtained through an electronic healthcare system. Descriptive analysis was performed based on the presence of PCP and PCP subtypes. Multivariable logistic regression analysis and multiple linear regression were used for risk-factor analysis and adjustment of confounding factors. RESULTS: A total of 668 individuals (female: 59.3%, median age: 84 years) who had been infected with COVID-19 for a median duration of 145 (126-168) days were enrolled in our study. PCP was observed in 9.4% (63/668) of elderly COVID-19 survivors. Number of COVID-19 symptoms (aOR 1.31, 95%CI 1.05-1.64, P = 0.018) and previous chronic pain (aOR 4.24, 95%CI 1.59-11.27, P = 0.004) were risk factors associated with PCP. Individuals with neuropathic PCP exhibited higher NRS scores (5 [5-6] vs. 3 [3-4], P < 0.001) and more use of analgesic drugs (70.0%, 7/10 vs. 20.8%, 11/53, P = 0.005) for pain management. Neuropathic PCP was associated with lower scores on the EQ-5D index (B = -0.210, 95% CI -0.369 to -0.051, P = 0.011) and EQ-VAS (B = -10.808, 95% CI -21.149 to -0.468, P = 0.041) and higher PHQ-9 scores (B = 3.154, 95% CI 0.674-5.634, P = 0.014). LIMITATIONS: It is difficult to establish a strong causality between PCP and SARS-CoV-2 infection due to the study's cross-sectional nature. Selection bias could not be eliminated, since our study relied on volunteer participation. Due to neuropathic PCP's lower prevalence than nonneuropathic PCP, larger sample sizes and multicenter studies are crucial for a comprehensive understanding of the neuropathic PCP condition. CONCLUSION: Our study found a PCP prevalence of 9.4% in nonhospitalized older adults who had survived COVID-19. Number of COVID-19 symptoms and history of previous chronic pain seemed to be potential risk factors for PCP. Neuropathic PCP was associated with lower QoL and a more severe depression level.

FOLLOW-UP OF PATIENTS WITH POST COVID-19 CONDITION AFTER A MULTIDISCIPLINARY TEAM ASSESSMENT: A PILOT STUDY.

Objective: To follow up patients with post-COVID-19 condition (PCC) 6 months after a multidisciplinary team assessment in specialist care regarding symptoms of pain, anxiety, depression, fatigue and cognition, level of activity, physical activity and sick leave. Methods: A prospective pilot study conducted in a clinical setting of patients (n = 22) with PCC referred from primary healthcare to a specialist clinic for a 2 day-multidisciplinary team assessment followed by a subsequent rehabilitation plan. Data were collected through questionnaires filled in prior to the team assessment and 6 months later. Results: Fifteen of the initial 22 patients participated in the follow-up. No statistically significant improvements were seen in any of the questionnaires after 6 months. However, 76.9% of the participants perceived the intervention as being helpful. This differed between the genders, where all the women 100% (n = 8) perceived it as being helpful, compared with 40% (n = 2) of the men (p = 0.012). Conclusions: Based on these findings, the benefit of a multidisciplinary team assessment of PCC is not fully convincing. However, since the participants themselves perceived the intervention as being helpful, the team assessment seems to be of some value. Further studies with larger populations would be of interest.

Most people who become ill with COVID-19 experience mild symptoms and recover within days or weeks. However, minor symptoms last from weeks to months and include fatigue, attention disorder, headache, dyspnea, anxiety, pain, anosmia, etc. This clinical state has been denoted as "post-COVID-19 condition" (PCC). It has been recommended that complex cases of PCC are to be assessed by a multidisciplinary team regarding treatment and rehabilitation. The efficiency of this recommendation has not yet been proven. This pilot study aimed to follow up patients with PCC six months after a multidisciplinary team assessment in specialist care regarding symptoms of pain, anxiety, depression, fatigue and cognition, level of activity, physical activity and sick leave through questionnaires. The results showed no statistically significant improvements in any of the questionnaires after six months. The majority of the participants perceived the team assessment as being helpful. Since the assessment seemed to be of some value, there is a need for further studies with larger populations.

Occupational and industry prevalence of new long-term symptoms within American Red Cross blood donors with and without history of SARS-CoV-2 infection.

PURPOSE: Limited information is known about the burden of Long COVID by occupation and industry. This study compares the occurrence of self-reported new long-term symptoms lasting 4 weeks or longer among blood donors with and without prior SARS-CoV-2 infection by occupation and industry. METHODS: The American Red Cross invited blood donors 18 years and older who donated during May 4-December 31, 2021 to participate in online surveys. New long-term symptoms lasting 4 weeks or longer were assessed by self-reported occurrence of any of 35 symptoms since March 2020. SARS-CoV-2 infection status was determined by serological testing and self-report. We describe the prevalence of new long-term symptoms by SARS-CoV-2 infection status. We calculate the difference in reported new long-term symptoms by SARS-CoV-2 infection status within occupation and industry categories. RESULTS: Data were collected from 27,907 employed adults - 9763 were previously infected and 18,234 were never infected with SARS-CoV-2. New long-term symptoms were more prevalent among those previously infected compared to the never-infected respondents (45% vs 24%, p < 0.05). Among all respondents, new long-term symptoms by occupation ranged from 26% (installation, maintenance, and repair) to 41% (healthcare support) and by industry ranged from 26% (mining) to 55% (accommodation and food services). New long-term neurological and other symptoms were commonly reported by those previously infected with SARS-CoV-2. DISCUSSION: New long-term symptoms are more prevalent among certain occupation and industry groups, which likely reflects differential exposure to SARS-CoV-2. These findings highlight potential need for workplace accommodations in a variety of occupational settings to address new long-term symptoms.

Exploring the characteristics and antecedents of clinically significant long COVID: A longitudinal cohort study.

BACKGROUND: A significant number of coronavirus disease 2019 (COVID-19) survivors are experiencing long COVID, with symptoms lasting beyond three months. While diverse long COVID symptoms are established, there are gaps in understanding its long-term trends, intensity, and risk factors, requiring further investigation. AIMS: This study aimed to investigate the long COVID characteristics and associated factors by following COVID-19 survivors for one year post-infection and comparing them with healthy counterparts. MAIN METHODS: In this longitudinal, correlational study, COVID-19 survivors diagnosed between November 2021 and February 2023 were monitored every three months for a year. Participants aged ≥18 years who had reported a positive COVID-19 test were recruited via social media and healthcare provider referrals. KEY FINDINGS: Out of 182 survivors who initially agreed to participate, 176 completed the study. The mean age was 47.56 years (SD = 16.2), and 51.1 % were female. There was a clinically significant decline in cognitive function and health-related quality of life over time, with symptoms like shortness of breath, reduced physical fitness, and increased health concerns. Those with severe acute COVID-19 symptoms experienced greater cognitive and physical declines and more shortness of breath a year later. Lower financial status was linked to poorer health-related quality of life and increased health concerns. SIGNIFICANCE: A year post-infection, COVID-19's impact on cognitive function and health-related quality of life remains significant, affecting individuals and communities. Survivors with severe initial symptoms and economic disadvantages need more attention. Future research should identify additional predictors of severe long COVID.

Gastrointestinal manifestations of long COVID.

Long COVID is estimated to have affected 6.9 % of US adults, 17.8 million people in the US alone, as of early 2023. While SARS-CoV-2 is primarily considered a respiratory virus, gastrointestinal (GI) symptoms are also frequent in patients with coronavirus disease 2019 (COVID-19) and in patients with Long COVID. The risk of developing GI symptoms is increased with increasing severity of COVID-19, the presence of GI symptoms in the acute infection, and psychological distress both before and after COVID-19. Persistence of the virus in the GI tract, ensuing inflammation, and alteration of the microbiome are all likely mediators of the effects of SARS Co-V-2 virus on the gut. These factors may all increase intestinal permeability and systemic inflammation. GI inflammation and dysbiosis can change the absorption and metabolism of tryptophan, an important neurotransmitter. Long COVID GI symptoms resemble a Disorder of Gut Brain Interaction such as post infection Irritable Bowel Syndrome (IBS). Current standards of treatment for IBS can guide our treatment of Long COVID patients. Dysautonomia, a frequent Long COVID condition affecting the autonomic nervous system, can also affect the GI tract, and must be considered in Long COVID patients with GI symptoms. Long COVID symptoms fall within the broader category of Infection Associated Chronic Conditions. Research into the GI symptoms of Long COVID may further our understanding of other post infection chronic GI conditions, and elucidate the roles of therapeutic options including antivirals, probiotics, neuromodulators, and treatments of dysautonomia.

Functioning of post-COVID-19 patients: a cross-sectional study at the outpatient clinic for long-term effects.

BACKGROUND: After COVID-19 infection, long-term impacts on functioning may occur. We studied the functioning of patients with post-COVID-19 condition (PCC) and compared them to controls without PCC. METHODS: This cross-sectional study consisted of 442 patients with PCC referred to rehabilitation at the Helsinki University Hospital (HUS) Outpatient Clinic for the Long-Term Effects of COVID-19, and 198 controls without PCC. Functioning was assessed with a questionnaire including WHODAS 2.0. Patients underwent physical testing including a hand grip strength test (HGST) and a 6-minute walking test (6MWT). Lifestyle was assessed by questionnaire and comorbidities were collected as ICD-10 codes from the HUS Data Lake on the HUS Acamedic platform. RESULTS: The WHODAS 2.0 average total score was 34 (SD 18) (moderate functional limitation) for patients with PCC and 6 (SD 8) (normal or mild limitation) for the controls. The disability was higher in all aspects of WHODAS 2.0 in patients with PCC. Bivariate binomial and multivariable regression analyses showed that the presence of comorbidities, anxiety, depression, and smoking predicted a WHODAS 2.0 score of 24 (moderate functional limitation) or above in the PCC group. The average 6MWT distance was 435 m (SD 98 m) in patients with PCC and 627 m (SD 70 m) in controls. HGST measurements showed no significant differences from controls. CONCLUSIONS: In conclusion, patients with PCC had significantly reduced functioning based on WHODAS 2.0 scores and the 6MWT results. Comorbidities, anxiety, depression, and smoking were associated with moderate or severe limitations in functioning. Findings support that PCC is multifactorial and requires a holistic approach to rehabilitation.

The post-COVID-19 condition (PCC) has been shown to negatively impact functioning, quality of life, and mental health, with cognitive and physical impairments being prevalent.This study found that patients with PCC had significantly reduced functioning compared to controls.Key factors predicting severe disability included comorbidities, smoking, and mental health issues like anxiety and depression.The reduced functioning in patients with PCC appears to be multifactorial and not only related to COVID-19 infection.

Symptoms, Course, and Factors Related to Long-Term Morbidity, Including Differences between Infection Strains, in Patients with Long COVID in a Primary Care Clinic in Japan: An Observational Study.

Objectives: The objectives were to investigate the clinical characteristics and course of long COVID, defined as the persistence of symptoms at least one month after the onset of COVID-19, in outpatients and to clarify differences in symptoms between SARS CoV-2 mutant strains. Methods: Our observational study in a primary care institution in Japan included 1053 patients with long COVID who visited our outpatient clinic between April 2021 and March 2023. Symptom distribution, performance status, and patient background at the time of the first outpatient visit were compared between infectious strains (Delta and before group and Omicron group). Background factors and symptoms related to time to remission were also analyzed. Results: The severity of COVID-19 in the acute phase was mild, moderate, and severe in 82.2%, 14.9%, and 2.9% in the Delta and before group; and in 97.6%, 1.7%, and 0.4% in the Omicron group, respectively. Vaccination coverage was significantly different between the Delta and before (37.1%) and Omicron groups (73.1%) (p < 0.001), probably due to the period of vaccine unavailability in the former group. Symptoms of fatigue and headache occurred most frequently, irrespective of infectious strain. The mean number of symptoms per patient was significantly higher in the Delta and before group than the Omicron group (3.4 vs. 2.7, p < 0.0001). The median time overall to remission of long COVID was 169 days. Cox hazard model analysis identified female sex, high body mass index, and dyspnea (but not infectious strain) as significant factors prolonging the time to remission (p < 0.05). Conclusions: Differences in the number of symptoms between infectious strains may be related to differences in viral virulence and/or vaccination coverage. However, the clinical course was found to be minimally influenced by the infectious strain. The present results should improve the understanding of prognosis in patients with long COVID from both the clinical and social perspectives.

Impact of Spa Therapy on Symptoms and Quality of Life in Post-COVID-19 Patients with Chronic Conditions.

Background: With limited pharmacological interventions, post-COVID-19 condition is a clinical challenge, and supplementary therapies are essential for symptom relief and enhancing quality of life (QoL). In our prospective observational study, we aimed to evaluate the impact of Salus per aquam (Spa) therapy on post-COVID-19 symptoms and QoL in individuals who suffer from chronic joint, musculoskeletal, skin, and/or respiratory conditions. Methods: A total of 159 individuals undergoing Spa therapy were enrolled, and 78 of them had post-COVID-19 symptoms, assessed using Visual Analogue Scale (VAS) and modified British Medical Research Council Questionnaire (mMRC-DS scales), as well as the Short Form 36 Health Status Survey (SF-36) questionnaire for QoL. Results: Spa therapy significantly reduced most post-COVID-19 symptoms, especially chronic fatigue, pain, brain fog, and persistent cough (all p < 0.05), as well as physical (+72%) and emotional (+66%) limitations. When stratified by sex, males showed a greater improvement from baseline, while females consistently displayed a higher amelioration in all QoL dimensions. Moreover, full vaccination with 3-4 doses significantly protected against SARS-CoV-2 re-infections and post-COVID-19 development (p < 0.05). Conclusions: Spa therapy demonstrated effectiveness in mitigating post-COVID-19 symptoms and enhancing QoL in patients suffering from chronic diseases.

Symptom Persistence Following COVID-19 Infection among an Indigenous Community Residing in the Isthmus of Tehuantepec, Oaxaca, Mexico.

Introduction/Objectives: Several studies have documented the development and persistence of symptoms related to COVID-19 and its secondary complications up to 12 months after the infection. We aimed to identify the medical complications following COVID-19 infection in the Indigenous Zapotec population of the Isthmus of Tehuantepec region in Oaxaca, Mexico. Methods: This is a cross-sectional analytical study that included 90 Indigenous Zapotec participants (30 males and 60 females) from the Tehuantepec region, Oaxaca, Mexico, who had an infectious process due to SARS-CoV-2. Sociodemographic and clinical data were identified through questionnaires. Results: Among the 201 participants, 90 individuals (66.7% women, 33.3% men) had contracted COVID-19. Out of these, 61 individuals reported persistent symptoms post-infection, with a mean symptom duration of 13.87 months. The results show significant variations in symptom duration based on age, marital status, educational attainment, vaccination status, and blood group. The most commonly reported symptoms included a dry cough, fever, myalgia, fatigue, headache, and depressive symptoms. Conclusions: This study highlights the post-COVID-19 symptoms and their prevalence within a specific sample of the Indigenous Zapotec population in Oaxaca, along with the sociodemographic and clinical factors influencing the duration of these symptoms. It underscores the necessity of personalized recovery strategies and highlights the critical role of vaccination in mitigating the long-term impacts of SARS-CoV-2.

Prevalence of symptoms of post-COVID-19 condition (long COVID) in children hospitalized with COVID-19: A systematic review of observational studies.

This systematic review aimed to investigate the prevalence of symptoms of post-COVID-19 condition (long COVID), in children hospitalized with COVID-19. We searched PUBMED and EMBASE on 15 March, 2023, using search strategy: "long COVID" OR "post-COVID-19" OR "postacute COVID-19" OR "long-term COVID" OR "COVID-19 sequelae" OR "persistent COVID-19" OR "chronic COVID-19". We included observational studies (case-control, cross-sectional, cohort, or case series) that investigated symptoms of post-COVID-19 condition (long COVID) in children (<18 years) admitted with COVID-19. We used the WHO case definition of post-COVID-19 condition. Long COVID was defined as persistence of otherwise unexplained symptoms for at least three months after SARS-CoV-2 infection. We used the command "metaprop" to perform random-effects meta-analysis. Eleven studies involving 2279 patients were included. In the period between ≥3 months and <12 months after acute COVID-19, the most frequent symptom was exercise intolerance with a pooled prevalence of 29% (95% CI: 7%-57%, I2 = 95%), followed by nonspecific respiratory symptoms (12%, 95% CI: 0%-48%, I2 = 0%), psychological disorders (10%, 95% CI: 1%-25%, I2 = 97%), and nonspecific gastrointestinal symptoms (10%, 95% CI: 0%-37%, I2 = 99%). In the period ≥12 months after the initial infection, the pooled prevalence of post COVID symptoms was lower, with 6% (95% CI: 2%-10%, I2 = 83%) for exercise intolerance and 3% (95% CI: 0%-8%, I2 = 89%) for fatigue. In conclusion, symptoms of post-COVID condition (long COVID) in hospitalized children affect multiple organ systems, with higher prevalence in the period up to 12 months after the acute phase of COVID-19.