Eight months follow-up study on pulmonary function, lung radiographic, and related physiological characteristics in COVID-19 survivors

AbstractTo describe the long-term health outcomes of patients with COVID-19 and investigate the potential risk factors. Clinical data during hospitalization and at a mean (SD) day of 249 (15) days after discharge from 40 survivors with confirmed COVID-19 (including 25 severe cases) were collected and analyzed retrospectively. At follow-up, severe cases had higher incidences of persistent symptoms, DLCO impairment, and higher abnormal CT score as compared with mild cases. CT score at follow-up was positively correlated with age, LDH level, cumulative days of oxygen treatment, total dosage of glucocorticoids used, and CT peak score during hospitalization. DLCO% at follow-up was negatively correlated with cumulative days of oxygen treatment during hospitalization. DLCO/VA% at follow-up was positively correlated with BMI, and TNF-α level. Among the three groups categorized as survivors with normal DLCO, abnormal DLCO but normal DLCO/VA, and abnormal DLCO and DLCO/VA, survivors with abnormal DLCO and DLCO/VA had the lowest serum IL-2R, IL-8, and TNF-α level, while the survivors with abnormal DLCO but normal DLCO/VA had the highest levels of inflammatory cytokines during hospitalization. Altogether, COVID-19 had a greater long-term impact on the lung physiology of severe cases. The long-term radiological abnormality maybe relate to old age and the severity of COVID-19. Either absent or excess of inflammation during COVID-19 course would lead to the impairment of pulmonary diffusion function.

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Risk factors for the adverse cardiac outcomes in the patients with Takayasu’s arteritis.

10.21203/rs.3.rs-16850/v1 ◽

2020 ◽

Author(s):

Yu-Jiao Wang ◽

Li-Li Ma ◽

Yan Yan ◽

Ying Sun ◽

Yong-Shi Wang ◽

...

Keyword(s):

Risk Factors ◽

Ventricular Hypertrophy ◽

Structure And Function ◽

Cardiac Structure ◽

Tnf Α ◽

Cardiac Structure And Function ◽

Α Level ◽

And Function

Abstract Background : This study was aimed to investigate the long-term cardiac outcomes and find out risk factors for the deterioration of cardiac structure and function in patients with Takayasu’s arteritis (TAK).Methods : One hundred and ninety-eight TAK patients were recruited in the Department of Rheumatology, Zhongshan Hospital, Fudan University from January 2012 to December 2017. The endpoint of observation was December 31, 2019. Patients were divided into normal, mild-moderate and severe subgroups based on the severity of structural and functional impairment of heart. Comparison of baseline characteristics and treatment among these three subgroups was conducted to identify the risk factors for adverse cardiac outcomes.Results : A total of 60.1% (119/198) of TAK patients exhibited heart involvement on echocardiography at baseline. 70.6% (84/119) and 79.8% (95/119) cases showed pathological valvular and atrioventricular abnormalities, respectively. 68.7% (136/198) of patients were followed up and the median follow-up duration was 28.6 (12.3-43.4) months. 42.7% (58/136) and 22.8% (31/136) of patients had progress in heart’s structure and function. Cox regression showed that serum TNF-α level (HR=1.028, p= 0.021), aortic regurgitation (HR=3.109, p<0.001) and ventricular hypertrophy (HR=2.090, p= 0.006) at baseline were risk factors for the deterioration of cardiac structure. The cases with serum TNF-α levels (≥8.1pg/ml), mild aortic regurgitation and ventricular hypertrophy at baseline had highest risk of structural progression at 83.4%. Using normal subgroup as a control, the deterioration of cardiac structure and function was the most severe in the severe subgroup, with hazard ratios of 16.2 (95% CI, 6.0-44.1, p < 0.001) and 9.0 (95% CI, 3.3-24.5, p<0.001), respectively. The deteriorating events typically occurred within 2 years after diagnosis.Conclusions : To find out if there is heart involvement and progress, it’s indispensable to regularly monitor the serum TNF-α level and cardiac structure in TAK patients during the long-term follow-up.

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High Levels of TNF-α and TIM-3 as a Biomarker of Immune Reconstitution Inflammatory Syndrome in People with HIV Infection

Life ◽

10.3390/life11060527 ◽

2021 ◽

Vol 11 (6) ◽

pp. 527

Author(s):

Lucero A. Ramon-Luing ◽

Ranferi Ocaña-Guzman ◽

Norma A. Téllez-Navarrete ◽

Mario Preciado-García ◽

Dámaris P. Romero-Rodríguez ◽

...

Keyword(s):

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Control Group ◽

Hiv Patients ◽

Art Initiation ◽

Tnf Α ◽

Ifn Γ ◽

Α Level ◽

Inflammatory Syndrome

Immune reconstitution inflammatory syndrome (IRIS) is an exacerbated immune response that can occur to HIV+ patients after initiating antiretroviral therapy (ART). IRIS pathogenesis is unclear, but dysfunctional and exhausted cells have been reported in IRIS patients, and the TIM-3/Gal-9 axis has been associated with chronic phases of viral infection. This study aimed to evaluate the soluble levels of TIM-3 and Gal-9 and their relationship with IRIS development. TIM-3, Gal-9, TNF-α, IFN-γ, IL-6, TNFR1, TNFR2, E-cadherin, ADAM10, and ADAM17 were measured to search for IRIS-associated biomarkers in plasma samples from 0-, 4-, 8-, 12-, and 24-weeks after ART initiation of 61 HIV+ patients (15 patients developed IRIS, and 46 did not). We found that patients who developed IRIS had higher levels of TIM-3 [median 4806, IQR: 3206–6182] at the time of the IRIS events, compared to any other follow-up time evaluated in these patients or compared with a control group of patients who did not develop IRIS. Similarly, IRIS patients had a higher TNF-α level [median 10.89, IQR: 8.36–12.34] at IRIS events than any other follow-up time evaluated. Other molecules related to the TIM-3 and TNF-α pathway (Gal-9, IL-6, IFN-γ, TNFR1, TNFR2, ADAM-10, and ADAM-17) did not change during the IRIS events. In conclusion, our data suggest that a high level of soluble TIM-3 and TNF-α could be used as an IRIS biomarker.

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A23 NUTRITIONAL DEFICIENCIES ARE FREQUENT IN CELIAC PATIENTS ON A GLUTEN-FREE DIET, REGARDLESS OF THE DURATION AND COMPLIANCE OF THE DIET

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.022 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 27-28

Author(s):

A Jivraj ◽

V Connan ◽

T Balart ◽

E Ching ◽

A Marwaha ◽

...

Keyword(s):

Tissue Transglutaminase ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Free ◽

Dietary Compliance ◽

Persistent Symptoms ◽

Funding Agencies ◽

Adherence Test

Abstract Background The only available treatment for celiac disease (CD) is adherence to a strict gluten-free diet (GFD). CD is associated with several nutritional deficiencies, which could be explained by malabsorption when the disease is active. However, the magnitude of nutritional deficiencies in treated CD and how this is influenced by the duration and compliance of GFD is less clear. Aims We aim to evaluate the presence of nutritional deficiencies in celiac patients on short term (≤2yrs) vs long-term (>2yrs) GFD, and in those with persistent symptoms or asymptomatic in the follow up. Methods We included consecutive biopsy-proven CD patients attending the McMaster Adult Celiac Clinic. GFD adherence was assessed by validated Celiac Dietary Adherence Test (CDAT) and by anti-tissue transglutaminase antibody IgA(tTG IgA) levels. Serology, vitamins and minerals were measured in blood samples collected at enrolment. Continuous data was expressed as Median (IQR) and categorical data as proportion%. Mann-U-Whitney and Chi2 were used to compare difference between groups. Results We enrolled 171 CD patients (80% female; Median age 43 years). 76/171 (44%) of CD patients were following a GFD for over 2 years. Eighty-two percent of the patients (141/171) had persistent symptoms in the follow up and 80.7% had normal tTG IgA levels. The most common nutritional abnormalities were deficiencies in zinc (56%), iron (23%), copper (20%). Chromium was increased in 74% of patients. There were no differences in nutritional deficiencies between group of patients with short and long-term duration of GFD, nor between those strictly compliant with GFD compared to those fairly compliant (p>0.05). Conclusions Nutritional deficiencies are frequent in celiac patients on a GFD regardless of the presence of symptoms, dietary compliance or duration. The previous suggest that nutrients deficiencies may be more related to GFD nutritional inadequacy rather than malabsorption. Funding Agencies None

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Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint

Hand ◽

10.1177/1558944719878841 ◽

2019 ◽

pp. 155894471987884

Author(s):

Charles A. Cefalu ◽

Philip E. Blazar ◽

Barry P. Simmons ◽

Brandon E. Earp

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Metacarpophalangeal Joint ◽

Persistent Symptoms ◽

Academic Center ◽

End Stage ◽

Implant Dislocation ◽

Thumb Metacarpophalangeal Joint

Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.

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Progression of acromegalic arthropathy despite long-term biochemical control: a prospective, radiological study

Acta Endocrinologica ◽

10.1530/eje-12-0147 ◽

2012 ◽

Vol 167 (2) ◽

pp. 235-244 ◽

Cited By ~ 26

Author(s):

K M J A Claessen ◽

S R Ramautar ◽

A M Pereira ◽

J W A Smit ◽

F Roelfsema ◽

...

Keyword(s):

Radiographic Progression ◽

Controlled Trial ◽

Joint Space ◽

Research Society ◽

Joint Disease ◽

Biochemical Control ◽

Point Increase ◽

Potential Risk Factors

ObjectiveArthropathy is an invalidating complication of acromegaly, of which the prognosis and determinants are currently unknown in treated acromegaly. Therefore, the objective of the present study was to investigate the radiographic progression of arthropathy over a mean follow-up period of 2.6 years and determinants of outcome in patients with long-term, well-controlled acromegaly.DesignProspective follow-up study.MethodsIn a prospective cohort study we studied 58 patients (mean age 62, women 41%) with controlled acromegaly for a mean of 17.6 years. Radiographic progression of joint disease was defined by the Osteoarthritis Research Society International classification as a 1-point increase in joint space narrowing (JSN) or osteophyte scores on radiographs of the hands, knees, and hips obtained at the first study visit and after 2.6 years. Potential risk factors for progression were assessed.ResultsProgression of osteophytes and JSN was observed in 72 and 74% of patients respectively. Higher age predisposed for osteophyte progression. Patients with biochemical control by somatostatin (SMS) analogs had more progression of osteophytosis than surgically cured patients (odds ratio=18.9, P=0.025), independent of age, sex, BMI, baseline IGF1 SDS and exon 3 deletion of the GHR. This was also evident for JSN progression, as were higher age and higher baseline IGF1 SDS.ConclusionsAcromegalic patients have progressive JSN and osteophytosis, despite long-term biochemical control. Parameters reflecting GH/IGF1 activity were associated with progressive joint disease. Remarkably, biochemical control by SMS analogs was associated with more progression than surgical cure. Although the present study is not a randomized controlled trial, this may indicate insufficient GH control according to current criteria and the need for more aggressive therapy.

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Incidence of Long-term Post-acute Sequelae of SARS-CoV-2 Infection Related to Pain and Other Symptoms: A Living Systematic Review and Meta-analysis

10.1101/2021.04.08.21255109 ◽

2021 ◽

Author(s):

Hiroshi Hoshijima ◽

Takahiro Mihara ◽

Hiroyuki Seki ◽

Shunsuke Hyuga ◽

Norifumi Kuratani ◽

...

Keyword(s):

Data Extraction ◽

Meta Analysis ◽

Persistent Symptoms ◽

Initial Stage ◽

Study Selection ◽

Inverse Variance ◽

Meta Regression ◽

Substantial Heterogeneity

Importance: Persistent symptoms are reported in patients who survive the initial stage of COVID-19, often referred to as ″long COVID″ or ″post-acute sequelae of SARS-CoV-2 infection″ (PASC); however, evidence on incidence is still lacking, and symptoms relevant to pain are yet to be assessed. Objective: To determine long-term symptoms in COVID-19 survivors after infection. Data Sources: A literature search was performed using the electronic databases PubMed, EMBASE, Scopus, and CHINAL and preprint servers MedRχiv and BioRχiv through January 15, 2021. Study Selection: Eligible studies were those reporting patients with a confirmed diagnosis of SARS-CoV-2 and who showed any symptoms persisting beyond the acute phase. Data Extraction and Synthesis: Incidence rate of symptoms were pooled using inverse variance methods with a DerSimonian-Laird random-effects model. Main Outcomes and Measures: The primary outcome was pain-related symptoms such as headache or myalgia. Secondary outcomes were symptoms relevant to pain (depression or muscle weakness) and symptoms frequently reported (anosmia and dyspnea). Heterogeneity among studies and publication bias for each symptom were estimated. The source of heterogeneity was explored using meta-regression, with follow-up period, age and sex as covariates. Results: In total, 35 studies including 18,711 patients were eligible. Eight pain-related symptoms and 26 other symptoms were identified. The highest pooled incidence among pain-related symptoms was chest pain (17%, 95% CI, 12%-25%), followed by headache (16%, 95% CI, 9%-27%), arthralgia (13%, 95% CI, 7%-24%), neuralgia (12%, 95% CI, 3%-38%) and abdominal pain (11%, 95% CI, 7%-16%). The highest pooled incidence among other symptoms was fatigue (45%, 95% CI, 32%-59%), followed by insomnia (26%, 95% CI, 9%-57%), dyspnea (25%, 95% CI, 15%-38%), weakness (25%, 95% CI, 8%-56%) and anosmia (19%, 95% CI, 13%-27%). Substantial heterogeneity was identified (I2, 50-100%). Meta-regression analyses partially accounted for the source of heterogeneity, and yet, 53% of the symptoms remained unexplained. Conclusions and Relevance: The current meta-analysis may provide a complete picture of incidence in PASC. It remains unclear, however, whether post-COVID symptoms progress or regress over time or to what extent PASC are associated with age or sex.

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What are the long-term symptoms and complications of COVID-19: a protocol for a living systematic review

F1000Research ◽

10.12688/f1000research.27284.1 ◽

2020 ◽

Vol 9 ◽

pp. 1455

Author(s):

Melina Michelen ◽

Louise Sigfrid ◽

Lakshmi Manoharan ◽

Natalie Elkheir ◽

Claire Hastie ◽

...

Keyword(s):

Systematic Review ◽

Significant Proportion ◽

The Body ◽

Depression And Anxiety ◽

Policy Makers ◽

Duration Of Symptoms ◽

Persistent Symptoms ◽

New Evidence

Although the majority of patients with COVID-19 will experience mild to moderate symptoms and will recover fully, there is now increasing evidence that a significant proportion will experience persistent symptoms for weeks or months after the acute phase of the illness. These symptoms include, among others, fatigue, problems in breathing, lack of smell and taste, headaches, and also depression and anxiety. It has also become clear that the virus has lasting effects not only on the respiratory system but also on other parts of the body, including the heart, liver, and the nervous system. In this paper we present a protocol for a living systematic review that aims to synthesize the evidence on the prevalence and duration of symptoms and clinical features of post-acute COVID-19 and its long-term complications. The living systematic review will be updated regularly, initially monthly with update cycles under continuous review as the pace of new evidence generated develops through the pandemic. We will include studies that follow up with COVID-19 patients who have experienced persistent mild, moderate or severe symptoms, with no restrictions regarding country, setting, or language. We will use descriptive statistics to analyse the data and our findings will be presented as infographics to facilitate transcription to lay audiences. Ultimately, we aim to support the work of policy makers, practitioners, and patients when planning rehabilitation for those recovering from COVID-19. The protocol has been registered with PROSPERO (CRD42020211131, 25/09/2020).

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Long-Term Adherence to Physical Activity Among Older Veterans

Innovation in Aging ◽

10.1093/geroni/igaa057.3167 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 859-859

Author(s):

Candace Brown

Keyword(s):

Physical Activity ◽

Older Adults ◽

Body Mass Index ◽

Self Efficacy ◽

Moderate Intensity ◽

Social Barriers ◽

Initiation Phase ◽

Α Level

Abstract The benefits of physical activity (PA) are well-established and it is recommended that older adults achieve at least 150 to 300 minutes of moderate intensity PA and strengthening activities weekly. However, only 54.0% and 23.2% of older adults achieve these recommendations for endurance and strengthening (respectively), and 48% dropout within the first 6-months. Most PA research focuses on the 6-month initiation phase leaving a gap regarding long-term adherence. We explored predictors of long-term adherence (>2-years) to PA from 97participants at 6-month follow-up and yearly surveys. Variables examined included age, race, gender, body mass index (BMI), and self-reported comorbidities, symptoms, physical function, and barrier-specific self-efficacy scale (α-level 0.05). Lower BMI (29.1±5.1 versus 31.6±6.5, p=0.047) and higher self-efficacy to overcome environmental barriers (p=0.016) and social isolation (p=0.05) were associated with long-term adherence. Self-efficacy to overcome environmental and social barriers should be addressed to promote long-term adherence to exercise among older adults

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1330. Clinical Associations and Trajectory of “Long COVID”

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1522 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S753-S753

Author(s):

Karen Jacobson ◽

Vidhya Balasubramanian ◽

Hector F Bonilla ◽

Martina Madrigal ◽

Isabelle Hack ◽

...

Keyword(s):

Functional Impairment ◽

Generalized Estimating Equations ◽

Gastrointestinal Symptoms ◽

Estimating Equations ◽

Persistent Symptoms ◽

Long Term Follow Up ◽

Clinical Associations ◽

Generalized Estimating

Abstract Background Persistent symptoms after acute COVID-19 are being increasingly reported. To date, little is known about the cause, clinical associations, and trajectory of “Long COVID”. Methods Participants of an outpatient clinical trial of Peginterferon-Lambda as treatment for uncomplicated SARS-CoV-2 infection were invited to long term follow-up visits 4, 7, and 10 months after initial COVID-19 diagnosis. Ongoing symptoms and functional impairment measures (work productivity and activity index (WPAI), NIH toolbox smell test, 6-minute walk test) were assessed and blood samples obtained. “Long COVID” was defined as presence of 2 or more typical symptoms (fatigue, hyposmia/hypogeusia, dyspnea, cough, palpitations, memory problems, joint pain) at follow up. Associations between baseline characteristics, initial COVID-19 clinical course, and presence of “Long COVID” during follow-up were assessed using generalized estimating equations accounting for repeated measurements within individuals. Results Eighty-seven participants returned for at least one follow-up visit. At four months, 29 (34.1%) had “Long COVID”; 19 (24.7%) met criteria at 7 months and 18 (23.4%) at 10 months (Figure 1). Presence of “Long COVID” symptoms did not correlate significantly with functional impairment measures. Female gender (OR 3.01, 95% CI 1.37-6.61) and having gastrointestinal symptoms during acute COVID-19 illness (OR 5.37, 95% CI 1.02-28.18) were associated with “Long COVID” during follow-up (Figure 2). No significant associations with baseline immunologic signatures were observed. Figure 1. Alluvial plot of long term follow-up participants showing outcomes of symptoms at each visit. Figure 2. Generalized Estimating Equations Model showing associations with “Long COVID” (presence of 2+ symptoms) at month 4, 7, and 10 following acute infection using unstructured correlation matrix. Conclusion “Long COVID” was prevalent in this outpatient trial cohort and had low rates of resolution over 10 months of follow up. Female sex and gastrointestinal symptoms during acute illness were associated with “Long COVID”. Identifying modifiable risk factors associated with the development of persistent symptoms following SARS-CoV-2 infection remains a critical need. Disclosures All Authors: No reported disclosures

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Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol.

10.1101/2021.03.18.21253888 ◽

2021 ◽

Author(s):

Louise Sigfrid ◽

Tom M Drake ◽

Ellen Pauley ◽

Edwin C Jesudason ◽

Piero Olliaro ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Outcome Measures ◽

Symptom Onset ◽

Persistent Symptoms ◽

Patient Reported ◽

The Impact

Structured Abstract Objectives: The long-term consequences of severe Covid-19 requiring hospital admission are not well characterised. The objective of this study was to establish the long-term effects of Covid-19 following hospitalisation and the impact these may have on patient reported outcome measures. Design: A multicentre, prospective cohort study with at least 3 months follow-up of participants admitted to hospital between 5th February 2020 and 5th October 2020. Setting: 31 hospitals in the United Kingdom. Participants: 327 hospitalised participants discharged alive from hospital with confirmed/high likelihood SARS-CoV-2 infection. Main outcome measures and comparisons: The primary outcome was self-reported recovery at least ninety days after initial Covid-19 symptom onset. Secondary outcomes included new symptoms, new or increased disability (Washington group short scale), breathlessness (MRC Dyspnoea scale) and quality of life (EQ5D-5L). We compared these outcome measures across age, comorbidity status and in-hospital Covid-19 severity to identify groups at highest risk of developing long-term difficulties. Multilevel logistic and linear regression models were built to adjust for the effects of patient and centre level risk factors on these outcomes. Results: In total 53.7% (443/824) contacted participants responded, yielding 73.8% (327/443) responses with follow-up of 90 days or more from symptom onset. The median time between symptom onset of initial illness and completing the participant questionnaire was 222 days (Interquartile range (IQR) 189 to 269 days). In total, 54.7% (179/327) of participants reported they did not feel fully recovered. Persistent symptoms were reported by 93.3% (305/325) of participants, with fatigue the most common (82.8%, 255/308), followed by breathlessness (53.5%, 175/327). 46.8% (153/327) reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24.2% (79/327) of participants. Overall (EQ5D-5L) summary index was significantly worse at the time of follow-up (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age. Conclusions: Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present even in young, previously healthy working age adults, and were most common in younger females. Policymakers should fund further research to identify effective treatments for long-Covid and ensure healthcare, social care and welfare support is available for individuals with long-Covid.

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