Search Results (727)

The difference in the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with mild versus severe disease remains poorly understood. Recent scientific advances have recognised the vital role of both B cells and T cells; however, many questions remain unanswered, particularly for T cell responses. T cells are essential for helping the generation of SARS-CoV-2 antibody responses but have also been recognised in their own right as a major factor influencing COVID-19 disease outcomes. The identification of T cell receptor (TCR) family differences over a 12-month period in patients with varying COVID-19 disease severity is crucial for understanding T cell responses to SARS-CoV-2. Accordingly, using TCR vb family data, we analyse COVID-19 patient responses (n = 151) across multiple timepoints and disease severities alongside SARS-CoV-2 infection-naïve (healthy control) individuals (n = 62). Applying a machine learning approach, we can classify blood samples from hospital in-patients with moderate, severe, or critical disease with an accuracy of 94%. Furthermore, we identify significant variances in TCR vb family specificities between disease and control subgroups, suggesting advantageous and disadvantageous TCR repertoire patterns in relation to disease severity. Following validation in larger cohorts, our methodology may be useful in detecting protective immunity and the assessment of long-term outcomes, particularly as we begin to unravel the immunological mechanisms leading to post-COVID complications. Full article

The Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has prompted a massive global vaccination campaign, leading to the rapid development and deployment of several vaccines. Various COVID-19 vaccines are under different phases of clinical trials and include the whole virus or its parts like DNA, mRNA, or protein subunits administered directly or through vectors. Beginning in 2020, a few mRNA (Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273) and adenovirus-based (AstraZeneca ChAdOx1-S and the Janssen Ad26.COV2.S) vaccines were recommended by WHO for emergency use before the completion of the phase 3 and 4 trials. These vaccines were mostly administered in two or three doses at a defined frequency between the two doses. While these vaccines, mainly based on viral nucleic acids or protein conferred protection against the progression of SARS-CoV-2 infection into severe COVID-19, and prevented death due to the disease, their use has also been accompanied by a plethora of side effects. Common side effects include localized reactions such as pain at the injection site, as well as systemic reactions like fever, fatigue, and headache. These symptoms are generally mild to moderate and resolve within a few days. However, rare but more serious side effects have been reported, including allergic reactions such as anaphylaxis and, in some cases, myocarditis or pericarditis, particularly in younger males. Ongoing surveillance and research efforts continue to refine the understanding of these adverse effects, providing critical insights into the risk-benefit profile of COVID-19 vaccines. Nonetheless, the overall safety profile supports the continued use of these vaccines in combating the pandemic, with regulatory agencies and health organizations emphasizing the importance of vaccination in preventing COVID-19’s severe outcomes. In this review, we describe different types of COVID-19 vaccines and summarize various adverse effects due to autoimmune and inflammatory response(s) manifesting predominantly as cardiac, hematological, neurological, and psychological dysfunctions. The incidence, clinical presentation, risk factors, diagnosis, and management of different adverse effects and possible mechanisms contributing to these effects are discussed. The review highlights the potential ambivalence of human response post-COVID-19 vaccination and necessitates the need to mitigate the adverse side effects. Full article

(1) With persistent symptoms emerging as a possible global consequence of COVID-19, the need to understand, diagnose, and treat them is paramount. This systematic review aims to explore the potential of optical coherence tomography (OCT) and/or optical coherence tomography angiography (OCTA) in effectively diagnosing long COVID. (2) The database PubMed and, to reduce selection bias, the AI research assistant Elicit, were used to find relevant publications in the period between February 2021 and March 2024. Included publications on OCT and OCTA analysis of participants with acute COVID symptoms, those after recovery, and participants with long COVID symptoms were organized in a table. Studies with participants under the age of 18, case reports, and unrelated studies, such as pure slit-lamp examinations and subgroup analyses were excluded. (3) A total of 25 studies involving 1243 participants and 960 controls were reviewed, revealing several changes in the posterior eye. Long COVID participants displayed significant thinning in retinal layers in the OCT, including the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL). Divergent findings in recovered cohorts featured mRNFL reduction, GCL increase and decrease, and GCL-IPL decrease. Long COVID OCTA results revealed reduced vessel density (VD) in the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). In recovered patients, SCP consistently showed a reduction, and DCP exhibited a decrease in five out of six publications. The foveal avascular zone (FAZ) was enlarged in five out of nine publications in recovered participants. (4) During various stages of COVID-19, retinal changes were observed, but a comparison between long COVID and recovered cohorts was aggravated by diverse inclusion and exclusion criteria as well as small sample sizes. Changes in long COVID were seen in most OCT examinations as thinning or partial thinning of certain retinal layers, while in OCTA a consistently reduced vessel density was revealed. The results suggest retinal alterations after COVID that are variable in OCT and more reliably visible in OCTA. Further research with larger samples is important for advancing long COVID diagnosis and management. Full article

Background and Objectives: Pregnant women face an increased risk of experiencing negative consequences due to COVID-19 infection. Our study aimed to identify outcomes for both mothers and fetuses associated with COVID-19 during each trimester, as well as to identify post-COVID symptoms in this population. Materials and Methods: Among the total population, 14 females were infected during the first trimester, 25 during the second, and 66 during the third trimester. Weekly follow-ups were conducted until delivery. Seventy-five females (71.4%; 95% CI:26.9–115.9%) were admitted to the hospital secondary to COVID-19 infection. Maternal hospitalization was independently associated with COVID-19 severity (adjusted odds ratio (aOR) = 3.9; 95% CI: 1.6–9.2 at p = 0.002 relative to the reference group (mild infection)) and the presence of dyspnea at initial assessment (aOR = 6.9; 95% CI: 1.7–28.2 at p = 0.007 relative to nondyspneic patients). Results: The duration of hospitalization (mean ± SD) was higher in the third trimester than the first and second trimesters (10.1 ± 0.8 vs. 4.0 ± 1.2 days and 10.1 ± 0.8 vs. 6.2 ± 1.4 days, respectively, at p < 0.05). The number of maternal deaths in the third trimester was higher than in the first and second trimesters (16 (24.2%) vs. no deaths and 16 (24.2%) vs. 1 (4%) deaths, respectively, at p < 0.05). In terms of fetal outcomes, a good fetal condition was more likely if the mother was infected during the first trimester (92.9%) than the second (80%) or third trimesters (66.7%), but the difference was not significant. The percentage of preterm deliveries was insignificantly higher in the second trimester (16%) than the first (7.1%) and third (4.5%) trimesters. Conclusions: The most common post-COVID symptoms included persistent loss of smell, dry eyes, post-partum depression, knee pain, and myalgia. Post-COVID symptoms were more prevalent in patients infected during the third trimester. The adverse outcomes of COVID-19 infection for both mother and fetus were more severe in cases where the infection occurred during the third trimester compared to the second and first trimesters. Therefore, it is crucial to adhere to precautionary measures against COVID-19, prioritize vaccination, and provide comprehensive care for pregnant mothers. Full article

Background/Objectives: Chronic fatigue syndrome (CFS) and post-COVID syndrome (PCS) pose a substantial socioeconomic burden. The aim of this systematic review was to assess current evidence regarding the effect of the most popular forms of movement-based mindful exercises, i.e., qigong, tai chi, and yoga, on fatigue and associated symptoms in CFS and PCS. Methods: CINAHL, Embase, PsycINFO, PubMed, Scopus, and the Cochrane Library were searched from inception to October 2023. Randomized controlled trials (RCTs) where qigong, tai chi, or yoga were compared with waitlist, no intervention, or active controls were included. Independent reviewers participated in data extraction, and evaluated risk of bias, spin of information, completeness of intervention description, and certainty of the evidence (GRADE). Meta-analyses were conducted. The primary outcome was the level of fatigue. Secondary measures were the severity of anxiety and depressive symptoms and sleep quality. Results were expressed as mean difference (MD) or standardized mean difference (SMD) with a 95% confidence interval (CI). Results: Thirteen RCTs with 661 participants were included, with most studies presenting a moderate or high risk of bias. Mindful exercises were more effective than control interventions to alleviate fatigue: SMD (95%CI) = −0.44 (−0.63 to −0.25), I² = 48%, p < 0.0001. Positive effects were also observed for secondary outcomes. The certainty of the evidence was low or very low. Conclusions: Qigong, tai chi, and yoga may be effective to reduce fatigue and improve anxiety, depression, and sleep quality in adults with CFS or PCS. However, serious methodological concerns limit the clinical applicability of these findings. Full article

Background/Objectives: Depressive and anxiety syndromes are associated with elevated disability and are more prevalent in women. Data on the prevalence of depressive and anxiety disorders in the rural context are limited and contradictory. It is relevant to study common mental disorders in rural areas in the most vulnerable population of women, particularly in the post-COVID-19 pandemic era. Methods: This is a cross-sectional study that was conducted in two primary healthcare sites in the rural region of Farsala, Central Greece after the obviation of all restrictive measures that had been posed due to the COVID-19 pandemic. All consecutive female patients that attended the study sites for any non-emergent reason were asked to participate in the study. For the recording of symptoms of depression and anxiety, the self-reported Depression, Anxiety, Stress Scale-21 (DASS-21) was used. Results: The study sample consisted of 129 women. The majority of participants were >50 years, with 27.9% being older adults. A small percentage (13.2%) suffered a chronic physical disease. A large proportion of the sample, slightly exceeding 40%, reported clinically relevant symptoms of anxiety, whereas a lower percentage of women with depressive symptoms was detected (17.1%). Symptoms of anxiety and depression were found to be interrelated, while a number of sociodemographic variables were associated with both, such as older age, education (primary), living status (alone, OR 123.5; 95% CI: 7.3–2098.8 for anxiety; OR 3.5; 95% CI: 1.3–9.8 for depression), employment (not working, (OR 0.157; 95% CI: 0.06–0.41 for anxiety; OR 0.08; 95% CI: 0.01–0.62 for depression) and the history of a chronic disease (OR 33.8; 95% CI: 4.3–264.7 for anxiety; OR 37.2; 95% CI: 10–138.1 for depression). Self-rated financial status was not related to symptoms of anxiety or depression. Conclusions: The study highlights the importance of inquiring for symptoms of depression and anxiety in women attending the rural primary care setting. The use of valid and reliable self-reported instruments that are easy to administrate may be helpful in this regard. Full article

Background: Severe acute respiratory syndrome (SARS) and acute respiratory distress syndrome (ARDS) are often considered separate clinico-radiological entities. Whether these conditions also present a single process-specific systemic biomolecular phenotype and how this relates to patient outcomes remains unknown. A prospective cohort study was conducted, including adult patients admitted to the ICU and general floors for COVID-19-related (COVID+) or non-COVID-19-related (COVID−) acute respiratory failure during the main phase of the pandemic. The primary objective was to study blood biomarkers and outcomes among different groups and severity subsets. Results: A total of 132 patients were included, as follows: 67 COVID+, 54 COVID− (with 11 matched control subjects for biomarker reference), and 58 of these patients allowed for further pre- and post-analysis. The baseline apelin (APL) levels were higher in COVID+ patients (p < 0.0001 vs. COVID− patients) and in SARS COVID+ patients (p ≤ 0.02 vs. ARDS), while the IL-6 levels were higher in ARDS COVID− patients (p ≤ 0.0001 vs. SARS). Multivariable logistic regression analyses with cohort biomarkers and outcome parameters revealed the following: (i) log-transformed neprilysin (NEP) activity was significantly higher in COVID+ patients (1.11 [95% CI: 0.4–1.9] vs. 0.37 [95% CI: 0.1–0.8], fold change (FC): 1.43 [95% CI: 1.04–1.97], p = 0.029) and in SARS patients (FC: 1.65 [95% CI: 1.05–2.6], p = 0.032 vs. non-SARS COVID+ patients, and 1.73 [95% CI: 1.19–2.5], p = 0.005 vs. ARDS COVID− patients) and (ii) higher lysyl oxidase (LOX) activity and APL levels were respectively associated with death and a shorter length of hospital stay in SARS COVID+ patients (Odds Ratios (OR): 1.01 [1.00–1.02], p = 0.05, and OR: −0.007 [−0.013–0.0001], p = 0.048). Conclusion: Process-specific blood biomarkers exhibited distinct profiles between COVID+ and COVID− patients, and across stages of severity. NEP and LOX activities, as well as APL levels, are particularly linked to COVID+ patients and their outcomes (ClinicalTrials.gov Identifier: NCT04632732). Full article

Acute adverse reactions to COVID-19 mRNA vaccines are a major concern, as autopsy reports indicate that deaths most commonly occur on the same day of or one day following vaccination. These acute reactions may be due to cytokine storms triggered by lipid nanoparticles (LNPs) and anaphylaxis induced by polyethene glycol (PEG), both of which are vital constituents of the mRNA-LNP vaccines. Kounis syndrome, in which anaphylaxis triggers acute coronary syndrome (ACS), may also be responsible for these cardiovascular events. Furthermore, COVID-19 mRNA-LNP vaccines encompass adjuvants, such as LNPs, which trigger inflammatory cytokines, including interleukin (IL)-1β and IL-6. These vaccines also produce spike proteins which facilitate the release of inflammatory cytokines. Apart from this, histamine released from mast cells during allergic reactions plays a critical role in IL-6 secretion, which intensifies inflammatory responses. In light of these events, early reduction of IL-1β and IL-6 is imperative for managing post-vaccine cytokine storms, ACS, and myocarditis. Corticosteroids can restrict inflammatory cytokines and mitigate allergic responses, while colchicine, known for its IL-1β-reducing capabilities, could also prove effective. The anti-IL-6 antibody tocilizumab also displays promising treatment of cytokine release syndrome. Aside from its significance for treating anaphylaxis, epinephrine can induce coronary artery spasms and myocardial ischemia in Kounis syndrome, making accurate diagnosis essential. The upcoming self-amplifying COVID-19 mRNA-LNP vaccines also contain LNPs. Given that these vaccines can cause a cytokine storm and allergic reactions post vaccination, it is crucial to consider corticosteroids and measure IL-6 levels for effective management. Full article

Long COVID affects millions of people worldwide and has emerged as a major health consequence of the COVID-19 pandemic. While quantitative studies have helped paint a picture of ongoing symptomatology, there are very few longitudinal qualitative studies that present patients’ perspectives about the significant and persistent impact Long COVID has on their daily lives. To address this gap, we conducted semi-structured qualitative interviews with nine Long COVID patients about 15 months after we performed an initial set of interviews with those patients who were seeking care at a Long COVID specialty clinic. Most patients that we re-interviewed reported having lingering symptoms that continue to impact their lives. Many described suffering with mental health issues, particularly depression and anxiety. Others described financial stress. Most reported not yet being unable to return to their pre-COVID level of health and well-being. Our work demonstrates the ongoing need to study Long COVID and provide robust social support, mental health resources, and healthcare focused on symptom relief. Full article

Backgrounds and Purpose: Post-COVID syndrome is characterized by persistent symptoms, including fatigue and cognitive impairment. These symptoms may be experienced by up to 80% of patients. We aimed to identify possible patterns of brain activation underlying post-COVID fatigue. Methods: The study used functional MRI (Siemens MAGNETOM Prisma 3T scanner with a specially created protocol) of the brain in 30 patients with post-COVID fatigue syndrome and 20 healthy volunteers. Task functional MRI (fMRI) was performed using a cognitive paradigm (modified Stroop test). Eligible patients included adults aged 18–50 years with a >12 weeks before enrolment (less than 12 months) prior history of documented COVID-19 with symptoms of fatigue not attributable to any other cause, and with MFI-20 score > 30 and MoCA at first visit. Healthy control participants had no prior history of COVID-19 and negative tests for severe acute coronavirus respiratory syndrome with MFI-20 score < 30 and MoCA at first visit. Task fMRI data were processed using the SPM12 software package based on MATLAB R2022a. Results: Cognitive task fMRI analysis showed significantly higher activation in the post-COVID group versus healthy volunteers’ group. Between-group analysis showed significant activation differences. Using a threshold of T > 3 we identified eight clusters of statistically significant activation: supramarginal gyri, posterior cingulate cortex, opercular parts of precentral gyri and cerebellum posterior lobe bilaterally. Conclusions: Post-COVID fatigue syndrome associated with subjective cognitive impairment could show changes in brain functional activity in the areas connected with information processing speed and quality. Full article

Objectives: This study aimed to evaluate the eicosanoid and pro-resolutive parameters in patients with Post-COVID Syndrome (PCS) during a 12-week supplementation with a marine oil enriched in specialized pro-resolving mediators (SPMs). Patient and methods: This study was conducted on 53 adult patients with PCS. The subjects included must have had a positive COVID-19 test (PCR, fast antigen test, or serologic test) and persistent symptoms related to COVID-19 at least 12 weeks before their enrolment in the study. The following parameters were evaluated: polyunsaturated fatty acids EPA, DHA, ARA, and DPA; specialized pro-resolving mediators (SPMs), 17-HDHA, 18-HEPE, 14-HDHA, resolvins, maresins, protectins, and lipoxins. The eicosanoids group included prostaglandins, thromboxanes, and leukotrienes. The development of the clinical symptoms of fatigue and dyspnea were evaluated using the Fatigue Severity Scale (FSS) and the Modified Medical Research Council (mMRC) Dyspnea Scale. Three groups with different intake amounts were evaluated (daily use of 500 mg, 1500 mg, and 3000 mg) and compared to a control group not using the product. Results: In the serum from patients with PCS, an increase in 17-HDHA, 18-HEPE, and 14-HDHA could be observed, and a decrease in the ratio between the pro-inflammatory and pro-resolutive lipid mediators was detected; both differences were significant (p < 0.05). There were no differences found between the three treatment groups. Fatigue and dyspnea showed a trend of improvement after supplementation in all groups. Conclusions: A clear enrichment in the serum of the three monohydroxylated SPMs could be observed at a dosage of 500 mg per day. Similarly, a clear improvement in fatigue and dyspnea was observed with this dosage. Full article

Background: Post COVID-19 syndrome or long COVID (LC) is a novel fluctuating condition with a protracted course in some patients. Specialist LC services have been operational in the UK since 2020 and deal with a high caseload of patients. Aims: To evaluate long-term outcomes in patients discharged from a community-based LC specialist service. Methods: A service evaluation study that included patients who were well engaged in the services [completed the standard Patient Reported Outcome Measures (PROMs) and received intervention from clinician(s)] and had been discharged for at least 3 months from the service. They consented to the study and completed standard PROMs: COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), EQ-5D-5L and National Institute for Health and Care Excellence (NICE) criteria for myalgia encephalomyelitis/chronic fatigue syndrome (ME/CFS). Results: Out of 460 patients contacted, 112 (average of 37.6 months since infection and 9.8 months post-discharge) completed the PROMs. Of these, 90.2% patients continued to experience LC symptoms and disability and had not returned to their pre-COVID-19 health status. The average EQ-5D-5L index score was 0.53 (SD 0.29), highlighting a significant disability and that LC had become a long-term condition (LTC) in the majority of patients who responded to the survey. Of these patients, 43% met the criteria for suspected ME/CFS. Conclusions: A proportion of LC patients develop persistent long COVID (PLC) consistent with a LTC and had a significant overlap with ME/CFS. Full article

Objectives: To develop a risk prediction model for the identification of features involved in the prediction of erectile dysfunction (ED) at 12 months following COVID-19 recovery. Methods: We performed an observational prospective multicentre study. Participants were classified according to their history of COVID-19: (I) patients with a past history of COVID-19 and (II) patients without a previous microbiological diagnosis of COVID-19. A total of 361 patients (past history of COVID-19, n = 166; no past history of COVID-19, n = 195) were assessed from January 2022 to March 2023. Patients with a past history of COVID-19 were assessed at 12 months following COVID-19 recovery. The primary outcome measure was ED, assessed through the 5-item International Index of Erectile Function (IIEF-5). Data concerning epidemiologic variables, comorbidities and active treatment were also collected. We performed a binary logistic regression to develop a risk predictive model. Among the models developed, we selected the one with the higher Area Under the Curve (AUC). Results: The median age was 55 years in both groups. The ED prevalence was 55.9% in patients with past history of COVID-19 and 44.1% in those with no past history of COVID-19. The best predictive model developed for ED comprised 40 variables and had an AUC of 0.8. Conclusions: We developed a regression model for the prediction of ED 12 months after COVID-19 recovery. The application of our predictive tool in a community setting could eventually prevent the adverse effects of ED on cardiovascular health and the associated unfavourable economic impact. Full article

Background/Objectives: Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication of COVID-19. MIS-C has overlapping features with other pediatric inflammatory disorders including Kawasaki Disease (KD), Macrophage Activation Syndrome (MAS), Toxic Shock Syndrome and sepsis. The exact mechanisms responsible for the clinical overlap between MIS-C and these conditions remain unclear, and biomarkers that could distinguish MIS-C from its clinical mimics are lacking. This study aimed to provide an overview of how proteomic methods, like Mass Spectrometry (MS) and affinity-based proteomics, can offer a detailed understanding of pathophysiology and aid in the diagnosis and prognosis of MIS-C. Methods: A narrative review of relevant studies published up to July 2024 was conducted. Results: We identified 15 studies and summarized their key proteomic findings. These studies investigated the serum or plasma proteome of MIS-C patients using MS, Proximity Extension, or Aptamer-based assays. The studies associated the proteomic profile of MIS-C with laboratory and clinical parameters and/or compared it with that of other diseases including acute COVID-19, KD, MAS, pediatric rheumatic diseases, sepsis and myocarditis or pericarditis following COVID-19 mRNA immunization. Depending on the method and the control group, different proteins were increased or decreased in the MIS-C group. The limitations and challenges in MIS-C proteomic research are also discussed, and future research recommendations are provided. Conclusions: Although proteomics appear to be a promising approach for understanding the pathogenesis and uncovering candidate biomarkers in MIS-C, proteomic studies are still needed to recognize and validate biomarkers that could accurately discriminate MIS-C from its clinical mimics. Full article

This review summarizes studies dedicated to the assessment of microvascular function based on microcirculatory oscillations monitored by the Flow-Mediated Skin Fluorescence (FMSF) technique. Two approaches are presented. The first approach uses oscillatory parameters measured under normoxic conditions, expressed as flowmotion (FM), vasomotion (VM), and the normoxia oscillatory index (NOI). These parameters have been used for the identification of impaired microcirculatory oscillations associated with intense physical exercise, post-COVID syndrome, psychological stress, and erectile dysfunction. The second approach involves characterization of the microcirculatory response to hypoxia based on the measurement of hypoxia sensitivity (HS). The HS parameter is used to characterize microvascular complications in diabetes, such as diabetic kidney disease and diabetic foot ulcers. Based on research conducted by the authors of this review, the FMSF parameter ranges characterizing microvascular function are presented. The diagnostic approach to assessing microvascular function based on flowmotion monitored by the FMSF technique has a wide range of applications and the potential to be integrated into widespread medical practice. Full article