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1.
Sci Rep ; 14(1): 13396, 2024 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-38862636

RESUMO

Despite its high prevalence, the determinants of smelling impairment in COVID-19 remain not fully understood. In this work, we aimed to examine the association between olfactory bulb volume and the clinical trajectory of COVID-19-related smelling impairment in a large-scale magnetic resonance imaging (MRI) analysis. Data of non-vaccinated COVID-19 convalescents recruited within the framework of the prospective Hamburg City Health Study COVID Program between March and December 2020 were analyzed. At baseline, 233 participants underwent MRI and neuropsychological testing as well as a structured questionnaire for olfactory function. Between March and April 2022, olfactory function was assessed at follow-up including quantitative olfactometric testing with Sniffin' Sticks. This study included 233 individuals recovered from mainly mild to moderate SARS-CoV-2 infections. Longitudinal assessment demonstrated a declining prevalence of self-reported olfactory dysfunction from 67.1% at acute infection, 21.0% at baseline examination and 17.5% at follow-up. Participants with post-acute self-reported olfactory dysfunction had a significantly lower olfactory bulb volume at baseline than normally smelling individuals. Olfactory bulb volume at baseline predicted olfactometric scores at follow-up. Performance in neuropsychological testing was not significantly associated with the olfactory bulb volume. Our work demonstrates an association of long-term self-reported smelling dysfunction and olfactory bulb integrity in a sample of individuals recovered from mainly mild to moderate COVID-19. Collectively, our results highlight olfactory bulb volume as a surrogate marker that may inform diagnosis and guide rehabilitation strategies in COVID-19.


Assuntos
COVID-19 , Imageamento por Ressonância Magnética , Transtornos do Olfato , Bulbo Olfatório , SARS-CoV-2 , Humanos , Bulbo Olfatório/fisiopatologia , Bulbo Olfatório/patologia , Bulbo Olfatório/diagnóstico por imagem , COVID-19/fisiopatologia , COVID-19/complicações , Masculino , Feminino , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Adulto , SARS-CoV-2/isolamento & purificação , Idoso , Estudos Prospectivos , Testes Neuropsicológicos , Olfato/fisiologia
2.
Chron Respir Dis ; 21: 14799731241259749, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38863283

RESUMO

BACKGROUND: The effects of coronavirus disease 2019 (COVID-19) on the cardiorespiratory fitness of hospitalized and obese patients are of utmost relevance. This study aimed to analyze how hospital and intensive care unit (ICU) stay together with body mass index affect cardiorespiratory fitness in patients with COVID-19. METHODS: 251 participants (males, n = 118; females, n = 133) were assigned to four groups: non-hospitalized COVID-19 patients (n = 65, age: 45.3 years), hospitalized COVID-19 patients (n = 63, age: 57.6 years), COVID-19 patients admitted to the ICU (n = 61, age: 56.9 years), and control group (n = 62, age: 49.8 years). An incremental cardiopulmonary exercise test was performed between 3 and 6 weeks after medical discharge from hospital. RESULTS: Higher peak oxygen uptake (VO2peak), ventilatory efficiency and power output were found in ICU patients with normal weight (NW) than in overweight (OW) (Mean difference: 0.1 L·min-1, -5.5, 29.0 W, respectively) and obese (OB) ICU patients (Mean difference: 0.1 L·min-1, -5.0, 26.2 W, respectively) (p < .05). In NW, OW and OB participants, higher VO2peak and power output were observed in control group compared with non-hospitalized (Mean difference: NW: 0.2 L·min-1, 83.3 W; OW: 0.2 L·min-1, 60.0 W; OB: 0.2 L·min-1, 70.9 W, respectively), hospitalized (Mean difference: NW: 0.2 L·min-1, 72.9 W; OW: 0.1 L·min-1, 58.3 W; OB: 0.2 L•min-1, 91.1 W, respectively) and ICU patients (Mean difference: NW: 0.1 L·min-1, 70.9 W; OW: 0.2 L·min-1, 91.1 W; OB: 0.3 L·min-1; 65.0 W, respectively) (p < .05). CONCLUSIONS: The degree of severity of COVID-19, especially identified by hospitalization and ICU stay, together with obesity and overweight were key factors in reducing cardiorespiratory fitness in patients with COVID-19.


Assuntos
Índice de Massa Corporal , COVID-19 , Aptidão Cardiorrespiratória , Unidades de Terapia Intensiva , Tempo de Internação , Obesidade , Humanos , COVID-19/fisiopatologia , COVID-19/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Aptidão Cardiorrespiratória/fisiologia , Obesidade/fisiopatologia , Obesidade/epidemiologia , Tempo de Internação/estatística & dados numéricos , SARS-CoV-2 , Teste de Esforço , Consumo de Oxigênio/fisiologia , Adulto , Hospitalização/estatística & dados numéricos , Idoso , Sobrepeso/fisiopatologia , Sobrepeso/epidemiologia
3.
Nat Commun ; 15(1): 4256, 2024 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-38762609

RESUMO

After contracting COVID-19, a substantial number of individuals develop a Post-COVID-Condition, marked by neurologic symptoms such as cognitive deficits, olfactory dysfunction, and fatigue. Despite this, biomarkers and pathophysiological understandings of this condition remain limited. Employing magnetic resonance imaging, we conduct a comparative analysis of cerebral microstructure among patients with Post-COVID-Condition, healthy controls, and individuals that contracted COVID-19 without long-term symptoms. We reveal widespread alterations in cerebral microstructure, attributed to a shift in volume from neuronal compartments to free fluid, associated with the severity of the initial infection. Correlating these alterations with cognition, olfaction, and fatigue unveils distinct affected networks, which are in close anatomical-functional relationship with the respective symptoms.


Assuntos
COVID-19 , Disfunção Cognitiva , Fadiga , Imageamento por Ressonância Magnética , Transtornos do Olfato , SARS-CoV-2 , Humanos , COVID-19/complicações , COVID-19/diagnóstico por imagem , COVID-19/fisiopatologia , COVID-19/patologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/virologia , Masculino , Fadiga/fisiopatologia , Feminino , Pessoa de Meia-Idade , Transtornos do Olfato/diagnóstico por imagem , Transtornos do Olfato/virologia , Transtornos do Olfato/fisiopatologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/fisiopatologia , Síndrome de COVID-19 Pós-Aguda , Idoso
4.
J Med Virol ; 96(5): e29671, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38747003

RESUMO

The coronavirus disease of 2019 (COVID-19) pandemic has led to more than 700 million confirmed cases and nearly 7 million deaths. Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus mainly infects the respiratory system, neurological complications are widely reported in both acute infection and long-COVID cases. Despite the success of vaccines and antiviral treatments, neuroinvasiveness of SARS-CoV-2 remains an important question, which is also centered on the mystery of whether the virus is capable of breaching the barriers into the central nervous system. By studying the K18-hACE2 infection model, we observed clear evidence of microvascular damage and breakdown of the blood-brain barrier (BBB). Mechanistically, SARS-CoV-2 infection caused pericyte damage, tight junction loss, endothelial activation and vascular inflammation, which together drive microvascular injury and BBB impairment. In addition, the blood-cerebrospinal fluid barrier at the choroid plexus was also impaired after infection. Therefore, cerebrovascular and choroid plexus dysfunctions are important aspects of COVID-19 and may contribute to neurological complications both acutely and in long COVID.


Assuntos
Barreira Hematoencefálica , COVID-19 , Plexo Corióideo , SARS-CoV-2 , Barreira Hematoencefálica/virologia , Animais , Plexo Corióideo/virologia , Plexo Corióideo/patologia , COVID-19/virologia , COVID-19/patologia , COVID-19/complicações , COVID-19/fisiopatologia , Camundongos , Junções Íntimas/virologia , Modelos Animais de Doenças , Enzima de Conversão de Angiotensina 2/metabolismo , Inflamação/virologia , Humanos , Pericitos/virologia , Pericitos/patologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-38747853

RESUMO

Post-acute COVID-19 syndrome, or long COVID, presents with persistent symptoms, including cough, dyspnea, and fatigue, extending beyond one month after SARS-CoV-2 infection. Cardiac complications such as chest pain and arrhythmias have raised concerns, with chronotropic incompetence (CI), an inadequate heart rate increase during exercise, emerging as a significant condition contributing to diminished exercise tolerance and quality of life. This study estimated the prevalence of CI and explored its association with aerobic capacity and physical activity levels in long COVID patients. A cross-sectional study was conducted at a private hospital in Sergipe, Brazil, involving 93 patients over 18 years old with persistent post-COVID-19 symptoms after confirmed SARS-CoV-2 infections. Exclusion criteria included beta-blocker use, inadequate respiratory exchange ratio, and inability to complete cardiopulmonary exercise testing (CPET). Clinical histories, CPET results, and chronotropic index calculation were used to identify CI, with logistic regression analyzing associated factors. Of the participants (mean age 45 years; average duration since COVID-19 diagnosis 120 days), 20.4% were diagnosed with CI. Logistic regression identified a strong association between CI and sedentary behavior (OR 11.80; 95% CI 2.54 to 54.78; p=0.001). Patients with CI showed lower predicted peak heart rates and maximal oxygen uptake. The prevalence of CI among long COVID patients in this study was approximately 20%, associated with decreased aerobic capacity and increased sedentary behavior. These findings highlight the need for timely diagnosis and therapeutic interventions, including cardiopulmonary rehabilitation, to enhance the quality of life in post-COVID patients with CI. The study's cross-sectional design and its specific context have limited causality inference and generalizability, underscoring the importance of further research in diverse settings.


Assuntos
COVID-19 , Exercício Físico , Síndrome de COVID-19 Pós-Aguda , Comportamento Sedentário , Humanos , Masculino , Estudos Transversais , Feminino , COVID-19/fisiopatologia , COVID-19/complicações , Pessoa de Meia-Idade , Exercício Físico/fisiologia , Adulto , SARS-CoV-2 , Tolerância ao Exercício/fisiologia , Brasil/epidemiologia , Frequência Cardíaca/fisiologia , Teste de Esforço , Qualidade de Vida
6.
J Neonatal Perinatal Med ; 17(2): 241-246, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38701165

RESUMO

 Recent studies showed that COVID-19 infection can affect cochleo-vestibular system. The possibility of a vertical transmission is controversial. Some studies suggested that it is possible but unlikely, others find no evidence of vertical transmission. The objective of this study was to investigate whether exposure to COVID-19 during pregnancy or at birth has an impact on the hearing of the offspring. As part of the national hearing screening program, we performed in all newborns between January 2022 and February 2023, TEOAEs (Transient Evoked Otoacoustic Emissions) at birth and at 3 months. For those "REFER" at the third month test, we performed aABR (Automatic Auditory Brainstem Response) at 6 months. We analysed separately result between infants born to COVID-positive mothers during pregnancy and those born to COVID-negative mothers. To statistical verify differences we performed "Chi-square test". We enrolled a total of 157 infants, of whom 16 were born to mothers who had a molecular PCR test positive for COVID-19. In the latter we tested a total of 32 ears and only 1 ear (3,1%) resulted "REFER". On the other hand, in the control group we tested a total of 282 ears and 22 (7,8%) were found to be "REFER". Our study showed no significant differences in audiological assessment between newborns exposed to COVID-19 infection during pregnancy or at birth compared to the unexposed group. However, further studies with a larger patient's sample will be necessary for a more comprehensive evaluation.


Assuntos
COVID-19 , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , SARS-CoV-2 , Humanos , Feminino , COVID-19/diagnóstico , COVID-19/fisiopatologia , COVID-19/transmissão , Gravidez , Recém-Nascido , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/diagnóstico , Emissões Otoacústicas Espontâneas/fisiologia , Potenciais Evocados Auditivos do Tronco Encefálico , Triagem Neonatal/métodos , Masculino , Adulto , Lactente , Testes Auditivos/métodos
7.
J Bras Pneumol ; 50(2): e20230261, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38808823

RESUMO

OBJECTIVE: To evaluate symptoms, lung function, and quality of life of a cohort of patients hospitalized for severe COVID-19 12 months after hospital admission. METHODS: This was a cross-sectional study. We included severe COVID-19 survivors hospitalized in one of three tertiary referral hospitals for COVID-19 in the city of Belo Horizonte, Brazil. Participants were submitted to lung function and six-minute walk tests and completed the EQ-5D-3L questionnaire. RESULTS: The whole sample comprised 189 COVID-19 survivors (mean age = 59.6 ± 13.4 years) who had been admitted to a ward only (n = 96; 50.8%) or to an ICU (n = 93; 49.2%). At 12 months of follow-up, 43% of patients presented with dyspnea, 27% of whom had a restrictive ventilatory disorder and 18% of whom presented with impaired DLCO. There were no significant differences in FVC, FEV1, and TLC between the survivors with or without dyspnea. However, those who still had dyspnea had significantly more impaired DLCO (14.9% vs. 22.4%; p < 0.020) and poorer quality of life. CONCLUSIONS: After one year, survivors of severe COVID-19 in a middle-income country still present with high symptom burden, restrictive ventilatory changes, and loss of quality of life. Ongoing follow-up is needed to characterize long COVID-19 and identify strategies to mitigate its consequences.


Assuntos
COVID-19 , Dispneia , Qualidade de Vida , Testes de Função Respiratória , Humanos , COVID-19/psicologia , COVID-19/fisiopatologia , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Transversais , Brasil/epidemiologia , Idoso , Dispneia/fisiopatologia , Dispneia/psicologia , SARS-CoV-2 , Índice de Gravidade de Doença , Pulmão/fisiopatologia , Inquéritos e Questionários , Teste de Caminhada , Fatores de Tempo , Hospitalização/estatística & dados numéricos
8.
BMC Infect Dis ; 24(1): 527, 2024 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-38796423

RESUMO

BACKGROUND: Renal impairment is a predictor of coronavirus disease (COVID-19) severity. No studies have compared COVID-19 outcomes in patients with chronic kidney disease (CKD) and patients with impaired renal function without a prior diagnosis of CKD. This study aimed to identify the impact of pre-existing impaired renal function without CKD on COVID-19 outcomes. METHODS: This retrospective study included 3,637 patients with COVID-19 classified into three groups by CKD history and estimated glomerular filtration rate (eGFR) on referral: Group 1 (n = 2,460), normal renal function without a CKD history; Group 2 (n = 905), impaired renal function without a CKD history; and Group 3 (n = 272), history of CKD. We compared the clinical characteristics of these groups and assessed the effect of CKD and impaired renal function on critical outcomes (requirement for respiratory support with high-flow oxygen devices, invasive mechanical ventilation, or extracorporeal membrane oxygen, and death during hospitalization) using multivariable logistic regression. RESULTS: The prevalence of comorbidities (hypertension, diabetes, and cardiovascular disease) and incidence of inflammatory responses (white blood counts, and C-reactive protein, procalcitonin, and D-dimer levels) and complications (bacterial infection and heart failure) were higher in Groups 2 and 3 than that in Group 1. The incidence of critical outcomes was 10.8%, 17.7%, and 26.8% in Groups 1, 2, and 3, respectively. The mortality rate and the rate of requiring IMV support was lowest in Group 1 and highest in Group 3. Compared with Group 1, the risk of critical outcomes was higher in Group 2 (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.03-1.70, P = 0.030) and Group 3 (aOR: 1.94, 95% CI: 1.36-2.78, P < 0.001). Additionally, the eGFR was significantly associated with critical outcomes in Groups 2 (odds ratio [OR]: 2.89, 95% CI: 1.64-4.98, P < 0.001) and 3 (OR: 1.87, 95% CI: 1.08-3.23, P = 0.025) only. CONCLUSIONS: Clinicians should consider pre-existing CKD and impaired renal function at the time of COVID-19 diagnosis for the management of COVID-19.


Assuntos
COVID-19 , Taxa de Filtração Glomerular , Insuficiência Renal Crônica , Humanos , COVID-19/complicações , COVID-19/mortalidade , COVID-19/fisiopatologia , COVID-19/epidemiologia , Masculino , Feminino , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Idoso , Pessoa de Meia-Idade , Prognóstico , Japão/epidemiologia , SARS-CoV-2 , Comorbidade , Idoso de 80 Anos ou mais , População do Leste Asiático
9.
BMC Pulm Med ; 24(1): 258, 2024 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-38796432

RESUMO

BACKGROUND: SARS-CoV-2 infection has raised concerns about long-term health repercussions. Exercise ventilatory inefficiency (EVin) has emerged as a notable long-term sequela, potentially impacting respiratory and cardiovascular health. This study aims to assess the long-term presence of EVin after 34 months and its association with cardiorespiratory health in post-COVID patients. METHODS: In a longitudinal study on 32 selected post-COVID subjects, we performed two cardiopulmonary exercise tests (CPETs) at 6 months (T0) and 34 months (T1) after hospital discharge. The study sought to explore the long-term persistence of EVin and its correlation with respiratory and cardiovascular responses during exercise. Measurements included also V̇O2peak, end-tidal pressure of CO2 (PETCO2) levels, oxygen uptake efficiency slope (OUES) and other cardiorespiratory parameters, with statistical significance set at p < 0.05. The presence of EVin at both T0 and T1 defines a persisting EVin (pEVin). RESULTS: Out of the cohort, five subjects (16%) have pEVin at 34 months. Subjects with pEVin, compared to those with ventilatory efficiency (Evef) have lower values of PETCO2 throughout exercise, showing hyperventilation. Evef subjects demonstrated selective improvements in DLCO and oxygen pulse, suggesting a recovery in cardiorespiratory function over time. In contrast, those with pEvin did not exhibit these improvements. Notably, significant correlations were found between hyperventilation (measured by PETCO2), oxygen pulse and OUES, indicating the potential prognostic value of OUES and Evin in post-COVID follow-ups. CONCLUSIONS: The study highlights the clinical importance of long-term follow-up for post-COVID patients, as a significant group exhibit persistent EVin, which correlates with altered and potentially unfavorable cardiovascular responses to exercise. These findings advocate for the continued investigation into the long-term health impacts of COVID-19, especially regarding persistent ventilatory inefficiencies and their implications on patient health outcomes.


Assuntos
COVID-19 , Teste de Esforço , Humanos , COVID-19/fisiopatologia , COVID-19/complicações , Masculino , Estudos Longitudinais , Feminino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , SARS-CoV-2 , Exercício Físico/fisiologia , Adulto , Idoso , Alta do Paciente
10.
BMC Cardiovasc Disord ; 24(1): 240, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38714940

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has various sequelae, one of which might be hypertension. We aimed to evaluate COVID-19's impact on blood pressure (BP) in non-hospitalized patients at one-year follow-up. METHOD: A total of 7,950 consecutive COVID-19 patients regularly visiting our cardiology clinic were retrospectively screened. Patients' electronic medical records including demographics, comorbidities, vital signs, treatments, and outcomes, were reviewed by two physicians. Individuals with at least one BP measurement in the three months preceding COVID-19 and one measurement in 12 months or more following recovery were included. BP levels before and after COVID-19 were compared using the paired t-test. RESULTS: 5,355 confirmed COVID-19 patients (mean age 55.51 ± 15.38 years) were included. Hypertension (56.9%) and diabetes mellitus (34%) were the predominant comorbidities, and 44.3% had prior major adverse cardiovascular events. Both systolic (126.90 ± 20.91 vs. 139.99 ± 23.94 mmHg, P < 0.001) and diastolic BP (80.54 ± 13.94 vs. 86.49 ± 14.40 mmHg, P < 0.001) were significantly higher post-COVID-19 vs. pre-COVID-19. Notably, 456 (14%) hypertensive patients experienced exacerbated hypertension, while 408 (17%) patients developed new-onset hypertension, overall 864 (16%) of patients had exacerbation or new hypertension. Linear regression analysis revealed that advanced age, smoking, previous cardiovascular events, hypertension, and diabetes mellitus predict increased BP following COVID-19 (P < 0.001). CONCLUSION: COVID-19 raised systolic and diastolic BP in the long term in non-hospitalized patients, with over one-sixth developing new-onset or exacerbated hypertension. All patients should be evaluated regarding BP, following COVID-19 recovery, particularly those with the mentioned predictive factors. (clinicaltrial.gov: NCT05798208).


Assuntos
Pressão Sanguínea , COVID-19 , Hipertensão , Humanos , COVID-19/diagnóstico , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/fisiopatologia , Pessoa de Meia-Idade , Masculino , Feminino , Estudos Retrospectivos , Hipertensão/fisiopatologia , Hipertensão/epidemiologia , Hipertensão/diagnóstico , Idoso , Adulto , Fatores de Risco , Comorbidade , Fatores de Tempo , Seguimentos , SARS-CoV-2
11.
Clin EEG Neurosci ; 55(4): 518-525, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38715353

RESUMO

Introduction. Nonlinear EEG provides information about dynamic properties of the brain. This study aimed to compare nonlinear EEG parameters estimated from patients with Long COVID in different cognitive and motor tasks. Materials and Methods. This 12-month prospective cohort study included 83 patients with Long COVID: 53 symptomatic and 30 asymptomatic. Brain electrical activity was evaluated by EEG in 4 situations: (1) at rest, (2) during the Trail Making Test Part A (TMT-A), (3) during the TMT Part B (TMT-B), and (4) during a coordination task: the Box and Blocks Test (BBT). Nonlinear EEG parameters were estimated in the time domain (activity and complexity). Assessments were made at 0 to 3, 3 to 6, and 6 to 12 months after inclusion. Results. There was a decrease in activity and complexity during the TMT-A and TMT-B, and an increase of these parameters during the BBT in both groups. There was an increase in activity at rest and during the TMT-A in the COVID-19 group at 0 to 3 months compared to the control, an increase in activity in the TMT-B in the COVID-19 group at 3 to 6 months compared to the control, and reduced activity and complexity at rest and during the TMT-A at 6 to 12 months compared to the control. Conclusion. The tasks followed a pattern of increased activity and complexity in cognitive tasks, which decreased during the coordination task. It was also observed that an increase in activity at rest and during cognitive tasks in the early stages, and reduced activity and complexity at rest and during cognitive tasks in the late phases of Long COVID.


Assuntos
COVID-19 , Cognição , Eletroencefalografia , Humanos , COVID-19/fisiopatologia , Masculino , Eletroencefalografia/métodos , Feminino , Pessoa de Meia-Idade , Cognição/fisiologia , Idoso , Estudos Prospectivos , Encéfalo/fisiopatologia , SARS-CoV-2 , Dinâmica não Linear , Adulto
12.
Sci Rep ; 14(1): 11835, 2024 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-38782998

RESUMO

Long-COVID19 has been recently associated with long-sick leave and unemployment. The autonomic nervous system functioning may be also affected by SARS-CoV-2, leading to a chronic autonomic syndrome. This latter remains widely unrecognized in clinical practice. In the present study, we assessed the occurrence of Long-COVID19 Autonomic Syndrome in a group of active workers as well as the relationships between their autonomic dysfunction and work ability. This prospective observational study was conducted during the 2nd wave of the pandemic in Italy. Forty-five patients (53.6 ± 8.4 years; 32 M) hospitalized for COVID19, were consecutively enrolled at the time of their hospital discharge (T0) and followed-up for 6 months. Autonomic symptoms and work ability were assessed by COMPASS31 and Work Ability Index questionnaires at T0, one (T1), three and six (T6) months after hospital discharge and compared to those retrospectively collected for a period preceding SARS-CoV-2 infection. Clinical examination and standing test were also performed at T1 and T6. One in three working-age people developed a new autonomic syndrome that was still evident 6 months after the acute infection resolution. This was associated with a significant reduction in the work ability. Recognition of Long-COVID19 Autonomic Syndrome may promote early intervention to facilitate return to work and prevent unemployment.


Assuntos
COVID-19 , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , COVID-19/complicações , COVID-19/fisiopatologia , COVID-19/epidemiologia , COVID-19/virologia , Estudos Prospectivos , Itália/epidemiologia , Adulto , SARS-CoV-2/isolamento & purificação , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/epidemiologia , Síndrome de COVID-19 Pós-Aguda , Retorno ao Trabalho , Sistema Nervoso Autônomo/fisiopatologia , Inquéritos e Questionários
13.
Medicina (Kaunas) ; 60(5)2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38792933

RESUMO

Background and Objectives. COVID-19 infection has a significant burden on global morbidity and mortality, especially in elderly people and in patients with chronic respiratory and cardiovascular diseases, such as pulmonary hypertension (PH). We aimed to evaluate the impact of COVID-19 infection on patients diagnosed with severe chronic PH. Materials and Methods. A single-center prospective cohort study was performed. Patients were enrolled from 1 November 2020 to 31 December 2022. Follow-up was until 31 December 2023. Data were collected on PH diagnosis, clinical presentation, outcomes, brain natriuretic peptide (BNP) levels, pulmonary function test with lung diffusion capacity for carbon monoxide (DLCO), and computed tomography pulmonary angiography (CTPA) analysis. Results. During the 26 months of our study, 51 PH patients were diagnosed with COVID-19 infection. The majority, 44 (86.3%) of all COVID-19 infected patients, were treated on an outpatient basis, and 7 (13.7%) required hospitalization. During the follow-up period, 8 (15.7%) patients died: 4 (7.8%) due to complications of COVID-19 infection, and the other 4 (7.8%) died in the later stages of the follow-up period after recovery from acute COVID-19 infection. Therefore, the in-hospital mortality in our study was 43% (n = 3). As mentioned above, the overall mortality was 7.8% (n = 4). Higher BNP levels in the third month after COVID-19 were associated with higher mortality rates (p = 0.028). Lung function, including DLCO, did not significantly worsen with COVID-19. In our study, 24 patients (47.1%) were referred for a follow-up CTPA scan and one of them developed typical fibrotic lung changes after COVID-19. Conclusions. The incidence of COVID-19 infection in patients diagnosed with PH was 34%. In our patients with severe chronic PH, the overall mortality rate due to COVID-19 infection was low. Pulmonary fibrosis was a rare complication in our cohort. COVID-19 infection in severe PH may increase the risk of worsening chronic heart failure.


Assuntos
COVID-19 , Hipertensão Pulmonar , Humanos , COVID-19/complicações , COVID-19/mortalidade , COVID-19/fisiopatologia , Feminino , Masculino , Estudos Prospectivos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Idoso , Pessoa de Meia-Idade , Doença Crônica , SARS-CoV-2 , Testes de Função Respiratória , Idoso de 80 Anos ou mais
14.
Medicina (Kaunas) ; 60(5)2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38792969

RESUMO

Background and Objectives: The aim of the study was to evaluate the health status of professional athletes after recovering from COVID-19 and the impact that SARS-CoV-2 had on their overall cardiorespiratory fitness, which was done by conducting cardiopulmonary exercise testing (CPET). Materials and Methods: A total of twenty-seven professional basketball players (Euroleague Basketball and the ABA League) participated in the study. CPET was performed before (as part of their regular preparticipation exam, during the pre-season period), as well as after SARS-CoV-2 infection (after two weeks of home isolation, during the competitive part of the season). CPET was performed on a treadmill, while cardiovascular, respiratory, and metabolic functions were evaluated by using a breath-by-breath analysis technique (Quark CPET system manufactured by Cosmed, Rome, Italy). Results: Maximal oxygen consumption and aerobic efficiency were significantly reduced after SARS-CoV-2 infection (p = 0.000). An obvious decrease in oxygen pulse was observed during CPET after recovering from COVID-19 (p = 0.001), as was deterioration of ventilatory efficiency. Internal respiration was the most negatively affected. An early transition from aerobic to anaerobic mechanisms of creating energy for work and intensive metabolic fatigue were obvious after SARS-CoV-2 infection. Conclusions: Although it was believed that SARS-CoV-2 only affects the cardiopulmonary status of the elderly population and people with associated comorbidities, it is clear from this research that professional athletes can also be at certain risk. Even though no pathological cardiovascular and respiratory changes were found in athletes after COVID-19, results showed significantly decreased cardiorespiratory fitness, with an emphasis on internal respiration.


Assuntos
Atletas , COVID-19 , Aptidão Cardiorrespiratória , Teste de Esforço , Consumo de Oxigênio , Humanos , COVID-19/fisiopatologia , COVID-19/complicações , Aptidão Cardiorrespiratória/fisiologia , Masculino , Atletas/estatística & dados numéricos , Teste de Esforço/métodos , Adulto , Consumo de Oxigênio/fisiologia , SARS-CoV-2 , Basquetebol/fisiologia , Adulto Jovem , Infecções Assintomáticas
15.
Biomed Res Int ; 2024: 3325321, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38726292

RESUMO

Introduction: Many COVID-19 patients display adverse symptoms, such as reduced physical ability, poor quality of life, and impaired pulmonary function. Therefore, this systematic review is aimed at evaluating the effectiveness of physical exercise on various psychophysiological indicators among COVID-19 patients who may be at any stage of their illness (i.e., critically ill, hospitalized, postdischarge, and recovering). Methods: A systematic search was conducted in PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar from 2019 to 2021. Twenty-seven studies, which assessed a total of 1525 patients, were included and analysed. Results: Overall, data revealed significant improvements in the following parameters: physical function, dyspnoea, pulmonary function, quality of life (QOL), lower limb endurance and strength, anxiety, depression, physical activity level, muscle strength, oxygen saturation, fatigue, C-reactive protein (CRP), interleukin 6 (IL-6), tumour necrosis factor-alpha (TNF-α), lymphocyte, leukocytes, and a fibrin degradation product (D-dimer). Conclusions: Physical training turns out to be an effective therapy that minimises the severity of COVID-19 in the intervention group compared to the standard treatment. Therefore, physical training could be incorporated into conventional treatment of COVID-19 patients. More randomized controlled studies with follow-up evaluations are required to evaluate the long-term advantages of physical training. Future research is essential to establish the optimal exercise intensity level and assess the musculoskeletal fitness of recovered COVID-19 patients. This trial is registered with CRD42021283087.


Assuntos
COVID-19 , Qualidade de Vida , Humanos , Adaptação Fisiológica , Ansiedade/terapia , Ansiedade/fisiopatologia , COVID-19/psicologia , COVID-19/terapia , COVID-19/fisiopatologia , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Força Muscular/fisiologia , SARS-CoV-2
16.
J Integr Neurosci ; 23(5): 105, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38812399

RESUMO

BACKGROUND: Long-Covid, characterized by persistent symptoms following acute Covid-19 infection, represents a complex challenge for the scientific community. Among the most common and debilitating manifestations, cognitive fog is a neurological disorder characterized by mental confusion and cognitive difficulties. In this study, we investigated the long-term effects of previous Covid-19 infection on cortical brain activity in patients experiencing cognitive fog symptoms in the medium and long term. METHODS: A total of 40 subjects (20 females and 20 males) aged between 45 and 70 years (mean age (M) = 59.78, standard deviation (SD) = 12.93) participated in this study. This sample included individuals with symptoms of cognitive fog, both with and without anosmia, and a control group comprised of healthy subjects. All electroencephalography (EEG) data were collected in two sessions, 1 month and 8 months after recovery from Covid-19, to measure the neurophysiological parameters of P300 and beta band rhythms. RESULTS: The results revealed significant differences in the neurophysiological parameters of P300 and beta band rhythms in subjects affected by cognitive fog, and these alterations persist even 8 months after recovery from Covid-19. Interestingly, no significant differences were observed between the participants with anosmia and without anosmia associated with cognitive fog. CONCLUSIONS: These findings provide a significant contribution to understanding the long-term effects of Covid-19 on the brain and have important implications for future interventions aimed at managing and treating brain fog symptoms. The longitudinal assessment of cortical brain activity helps highlight the persistent impact of the virus on the neurological health of Long-Covid patients.


Assuntos
Anosmia , COVID-19 , Córtex Cerebral , Disfunção Cognitiva , Eletroencefalografia , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , COVID-19/complicações , COVID-19/fisiopatologia , Idoso , Anosmia/fisiopatologia , Anosmia/etiologia , Estudos Longitudinais , Córtex Cerebral/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/etiologia , Potenciais Evocados P300/fisiologia , Ritmo beta/fisiologia
17.
Clin Neurophysiol ; 163: 209-222, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38772083

RESUMO

Fibromyalgia Syndrome (FMS), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID (LC) are similar multisymptom clinical syndromes but with difference in dominant symptoms in each individual. There is existing and emerging literature on possible functional alterations of the central nervous system in these conditions. This review aims to synthesise and appraise the literature on resting-state quantitative EEG (qEEG) in FMS, ME/CFS and LC, drawing on previous research on FMS and ME/CFS to help understand neuropathophysiology of the new condition LC. A systematic search of MEDLINE, Embase, CINHAL, PsycINFO and Web of Science databases for articles published between December 1994 and September 2023 was performed. Out of the initial 2510 studies identified, 17 articles were retrieved that met all the predetermined selection criteria, particularly of assessing qEEG changes in one of the three conditions compared to healthy controls. All studies scored moderate to high quality on the Newcastle-Ottawa scale. There was a general trend for decreased low-frequency EEG band activity (delta, theta, and alpha) and increased high-frequency EEG beta activity in FMS, differing to that found in ME/CFS. The limited LC studies included in this review focused mainly on cognitive impairments and showed mixed findings not consistent with patterns observed in FMS and ME/CFS. Our findings suggest different patterns of qEEG brainwave activity in FMS and ME/CFS. Further research is required to explore whether there are phenotypes within LC that have EEG signatures similar to FMS or ME/CFS. This could inform identification of reliable diagnostic markers and possible targets for neuromodulation therapies tailored to each clinical syndrome.


Assuntos
COVID-19 , Eletroencefalografia , Síndrome de Fadiga Crônica , Fibromialgia , Humanos , Síndrome de Fadiga Crônica/fisiopatologia , Síndrome de Fadiga Crônica/diagnóstico , Fibromialgia/fisiopatologia , Fibromialgia/diagnóstico , COVID-19/fisiopatologia , COVID-19/complicações , Eletroencefalografia/métodos , Encéfalo/fisiopatologia
18.
Eur Rev Med Pharmacol Sci ; 28(9): 3420-3429, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38766799

RESUMO

OBJECTIVE: Coronavirus disease (COVID-19) is a respiratory disease caused by SARS-CoV-2, which complicates the functioning of multiple systems, including the autonomic nervous system (ANS), causing dysautonomia. Investigation of dysautonomia and its association with exposure to COVID-19 is limited in healthy people. Therefore, the study aimed to investigate the relationship between ANS dysautonomia and coronavirus exposure and compare the ANS function between exposed and non-exposed to COVID-19. SUBJECTS AND METHODS: The study involved 141 participants, with a mean age of 18-24.5 years, 83% male (49.6% exposed to COVID-19). The ANS was measured using a composite autonomic symptom scale (COMPASS-31) questionnaire and heart rate variability (HRV) using photoplethysmography. Exposure to COVID-19 was investigated using two national health-status tracking and COVID-19 exposure applications, "Sehhaty" and "Twakkalna". RESULTS: A significantly inverse weak correlation between COMPASS-31 scores and COVID-19 exposure (r=-0.2, p=0.04). No significant association was found between HRV and COVID-19 exposure. COMPASS-31 scores for the exposed group (median=15, n=70) were significantly higher than those for the non-exposed group (median=12, n=71), U=1,913.5, p=0.03. Height (r=-0.4, p=0.002) and gender (r=0.3, p=0.001) were moderately correlated with COMPASS-31 among the exposed group. CONCLUSIONS: These findings indicated that exposure to COVID-19 was associated with poorer ANS scores measured via COMPASS-31. Additionally, exposure to COVID-19 resulted in higher dysautonomia symptoms than non-exposed. Height and gender differences contribute to the severity of dysautonomia among exposed people.


Assuntos
Sistema Nervoso Autônomo , COVID-19 , Frequência Cardíaca , Humanos , COVID-19/fisiopatologia , Masculino , Feminino , Adolescente , Adulto Jovem , Sistema Nervoso Autônomo/fisiopatologia , SARS-CoV-2 , Adulto , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/diagnóstico , Disautonomias Primárias/fisiopatologia , Disautonomias Primárias/etiologia , Inquéritos e Questionários
19.
Crit Care Sci ; 36: e20240208en, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38747818

RESUMO

OBJECTIVE: To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19. METHODS: This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality. RESULTS: We included 231 patients. The mean age was 64 (53 - 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 - 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 - 1.41 for each cm H2O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure. CONCLUSION: In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.


Assuntos
Peso Corporal , COVID-19 , Mortalidade Hospitalar , Respiração Artificial , Síndrome do Desconforto Respiratório , Volume de Ventilação Pulmonar , Humanos , COVID-19/mortalidade , COVID-19/complicações , COVID-19/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Estudos Prospectivos , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Síndrome do Desconforto Respiratório/mortalidade , Síndrome do Desconforto Respiratório/fisiopatologia , Unidades de Terapia Intensiva , SARS-CoV-2
20.
Respir Res ; 25(1): 209, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38750527

RESUMO

BACKGROUND: Limited research has investigated the relationship between small airway dysfunction (SAD) and static lung hyperinflation (SLH) in patients with post-acute sequelae of COVID-19 (PASC) especially dyspnea and fatigue. METHODS: 64 patients with PASC were enrolled between July 2020 and December 2022 in a prospective observational cohort. Pulmonary function tests, impulse oscillometry (IOS), and symptom questionnaires were performed two, five and eight months after acute infection. Multivariable logistic regression models were used to test the association between SLH and patient-reported outcomes. RESULTS: SLH prevalence was 53.1% (34/64), irrespective of COVID-19 severity. IOS parameters and circulating CD4/CD8 T-cell ratio were significantly correlated with residual volume to total lung capacity ratio (RV/TLC). Serum CD8 + T cell count was negatively correlated with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) with statistical significance. Of the patients who had SLH at baseline, 57% continued to have persistent SLH after eight months of recovery, with these patients tending to be older and having dyspnea and fatigue. Post-COVID dyspnea was significantly associated with SLH and IOS parameters R5-R20, and AX with adjusted odds ratios 12.4, 12.8 and 7.6 respectively. SLH was also significantly associated with fatigue. CONCLUSION: SAD and a decreased serum CD4/CD8 ratio were associated with SLH in patients with PASC. SLH may persist after recovery from infection in a substantial proportion of patients. SAD and dysregulated T-cell immune response correlated with SLH may contribute to the development of dyspnea and fatigue in patients with PASC.


Assuntos
COVID-19 , Pulmão , Síndrome de COVID-19 Pós-Aguda , Testes de Função Respiratória , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , COVID-19/fisiopatologia , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/diagnóstico , COVID-19/imunologia , Estudos Prospectivos , Pulmão/fisiopatologia , Testes de Função Respiratória/métodos , Idoso , Adulto , Recuperação de Função Fisiológica , Fatores de Tempo , Dispneia/fisiopatologia , Dispneia/epidemiologia , Dispneia/diagnóstico , Volume Expiratório Forçado/fisiologia
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