Long COVID - An Early Perspective

Author(s):  
Timothy Meagher

A new syndrome called “Long COVID” has emerged amongst the survivors of acute COVID-19 infection. Its protracted and debilitating nature will almost certainly result in many short and long-term disability claims. Insurers need to understand the nature of Long COVID, including its definition, its prevalence, its natural history, and underlying risk factors. This article will summarize current knowledge of Long COVID and provide a perspective on its evolution and its impact.

2021 ◽  
Vol 11 (6) ◽  
pp. 483
Author(s):  
Marwa Saadaoui ◽  
Manoj Kumar ◽  
Souhaila Al Khodor

The COVID-19 pandemic is a worldwide, critical public health challenge and is considered one of the most communicable diseases that the world had faced so far. Response and symptoms associated with COVID-19 vary between the different cases recorded, but it is amply described that symptoms become more aggressive in subjects with a weaker immune system. This includes older subjects, patients with chronic diseases, patients with immunosuppression treatment, and pregnant women. Pregnant women are receiving more attention not only because of their altered physiological and immunological function but also for the potential risk of viral vertical transmission to the fetus or infant. However, very limited data about the impact of maternal infection during pregnancy, such as the possibility of vertical transmission in utero, during birth, or via breastfeeding, is available. Moreover, the impact of infection on the newborn in the short and long term remains poorly understood. Therefore, it is vital to collect and analyze data from pregnant women infected with COVID-19 to understand the viral pathophysiology during pregnancy and its effects on the offspring. In this article, we review the current knowledge about pre-and post-natal COVID-19 infection, and we discuss whether vertical transmission takes place in pregnant women infected with the virus and what are the current recommendations that pregnant women should follow in order to be protected from the virus.


2016 ◽  
Vol 11 (2) ◽  
pp. 98 ◽  
Author(s):  
Michela Faggioni ◽  
◽  
Roxana Mehran ◽  

Contrast-induced acute kidney injury (CI-AKI) is characterised by a rapid deterioration of renal function within a few days of parenteral administration of contrast media (CM) in the absence of alternative causes. CI-AKI is the most common form of iatrogenic kidney dysfunction with an estimated prevalence of 12 % in patients undergoing percutaneous coronary intervention. Although usually selfresolving, in patients with pre-existing chronic kidney disease (CKD) or concomitant risk factors for renal damage, CI-AKI is associated with increased short- and long-term morbidity and mortality. Therefore, risk stratification based on clinical and peri-procedural characteristics is crucial in selecting patients at risk of CI-AKI who would benefit the most from implementation of preventive measures.


2009 ◽  
Vol 37 (3) ◽  
pp. 835-840
Author(s):  
L Sheng ◽  
J-S Wu ◽  
M Zhang ◽  
S-W Xu ◽  
J-X Gan ◽  
...  

Over 50% of road traffic injury (RTI) patients experience post-traumatic acute lung injury (ALI) and it is, therefore, extremely important to identify the risk factors related to the poor outcomes associated with ALI in RTI populations. This study evaluated 19 potential risk factors associated with the outcomes of ALI in 366 RTI patients. They were divided into two groups: a ‘favourable outcomes group’ and an ‘unfavourable outcomes group’. The results indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the presence of gastrointestinal haemorrhage may help predict the outcomes of ALI in the early post-trauma phase of treatment. The duration of trauma and sepsis were shown to impact strongly on both the short- and long-term outcomes of ALI. Age (≥ 65 years) and disseminated intravascular coagulation in the early RTI phase were also independent risk factors for a poorer short- and long-term outcome in ALI.


2020 ◽  
Author(s):  
Faisal Aziz ◽  
Berthold Reichardt ◽  
Caren Sourij ◽  
Hans-Peter Dimai ◽  
Daniela Reichart ◽  
...  

Abstract Background: Previous data show a high incidence of major lower extremity amputations (LEA) in Austria. Moreover, recent data on the epidemiology of major LEA are sparse in the Country. This study estimated the incidence and mortality rates of major LEA and assessed risk factors of post major LEA mortality in individuals with diabetes.Methods: A retrospective cohort analysis of 507,180 individuals with diabetes enrolled in the Austrian Health Insurance between 2014 and 2017 was performed. Crude and age-standardized rates of major LEA (hip, femur, knee, lower leg) were estimated by extracting their procedure codes from the database. Short- (30-day, 90-day) and long-term (1-year, 5-year) all-cause cumulative mortality after major LEA was estimated from the date of amputation till the date of death. Poisson regression was performed to compare rates by characteristics and assess the annual trend. The Cox-regression was performed to identify significant risk factors of all-cause mortality after major LEA.Results: A total of 2,165 individuals with diabetes underwent major LEA between 2014 and 2017. The mean age was amputees was 73.0 ±11.3 years, 62.7% were males, and 87.3% had a peripheral vascular disease (PVD). The overall age-standardized rate was 6.44 per 100,000 population. The rate increased with age (p<0.001) and was higher (p<0.001) in males (9.38) than females (5.66). The rate was 5.71 in 2014, 6.86 in 2015, 6.71 in 2016, and 6.66 in 2017, with an insignificant annual change of 3% (p=0.825). The cumulative 30-day mortality was 13.5%, 90-day was 22.0%, 1-year was 34.4%, and 5-year was 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short- and long-term mortality. Cancer, dementia, heart failure, PVD, and renal disease were only associated with long-term mortality.Conclusions: The rate of major LEA remained stable between 2014 and 2017 in Austria. Short and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, heart failure, and Charlson Index were significant predictors of both short- and long-term mortality, whereas, comorbidities such as cancer, dementia, PVD, and renal disease were significant predictors of long-term mortality only.


Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 545-552 ◽  
Author(s):  
Diego Spagnoli ◽  
Lucia Innocenti ◽  
Lorenzo Bello ◽  
Mauro Pluderi ◽  
Susanna Bacigaluppi ◽  
...  

Abstract OBJECTIVE: The influence of cerebrovascular disease (CVD) on the short- and long-term results of surgery was evaluated in a series of consecutive patients with idiopathic normal-pressure hydrocephalus (iNPH). METHODS: Patients with suspected iNPH admitted to our department between June 1996 and June 2003 were evaluated with four clinical and handicap scales. CVD and risk factors for vascular disease were rated. All patients underwent intracranial pressure monitoring via a spinal catheter. Sixty-six patients received a ventriculoperitoneal shunt with a programmable valve. Prospective assessments were programmed at 2 weeks and 3 months after surgery (short-term follow-up). Long-term follow-up evaluations were arranged in June 2004 with patients and/or relatives and health/home care assistants. RESULTS: At the short-term follow-up examination, a significant clinical improvement was globally present in 89% of the patients (P &lt; 0.05). CVD, such as leucoaraiosis or previous strokes, were present in 71% of the patients. Patients both with and without CVD and/or risk factors for vascular disease presented a significant improvement (P &lt; 0.05) after shunting; 85 and 100% of the patients with and without CVD, respectively. At the long-term follow-up examination (mean, 52 ± 24.8 mo), 24% of the patients were dead and 8% had experienced stroke. Globally, 60% of the patients were still improved (P &lt; 0.05); 52 and 79% of the patients with and without CVD, respectively. CONCLUSION: A high success rate in treatment of iNPH is possible in patients with and without CVD. Despite poorer short- and long-term treatment outcome of iNPH patients with CVD, a long-lasting improvement in their quality of life favors surgery.


2019 ◽  
Vol 20 (21) ◽  
pp. 5449 ◽  
Author(s):  
Anne I. Krämer ◽  
Christoph Handschin

Epigenetic changes are a hallmark of short- and long-term transcriptional regulation, and hence instrumental in the control of cellular identity and plasticity. Epigenetic mechanisms leading to changes in chromatin structure, accessibility for recruitment of transcriptional complexes, and interaction of enhancers and promoters all contribute to acute and chronic adaptations of cells, tissues and organs to internal and external perturbations. Similarly, the peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) is activated by stimuli that alter the cellular energetic demand, and subsequently controls complex transcriptional networks responsible for cellular plasticity. It thus is of no surprise that PGC-1α is under the control of epigenetic mechanisms, and constitutes a mediator of epigenetic changes in various tissues and contexts. In this review, we summarize the current knowledge of the link between epigenetics and PGC-1α in health and disease.


2019 ◽  
Vol 174 (1) ◽  
pp. 38-50 ◽  
Author(s):  
Patricia Ruiz ◽  
Claude Emond ◽  
Eva D McLanahan ◽  
Shivanjali Joshi-Barr ◽  
Moiz Mumtaz

Abstract Mixtures risk assessment needs an efficient integration of in vivo, in vitro, and in silico data with epidemiology and human studies data. This involves several approaches, some in current use and others under development. This work extends the Agency for Toxic Substances and Disease Registry physiologically based pharmacokinetic (PBPK) toolkit, available for risk assessors, to include a mixture PBPK model of benzene, toluene, ethylbenzene, and xylenes. The recoded model was evaluated and applied to exposure scenarios to evaluate the validity of dose additivity for mixtures. In the second part of this work, we studied toluene, ethylbenzene, and xylene (TEX)-gene-disease associations using Comparative Toxicogenomics Database, pathway analysis and published microarray data from human gene expression changes in blood samples after short- and long-term exposures. Collectively, this information was used to establish hypotheses on potential linkages between TEX exposures and human health. The results show that 236 genes expressed were common between the short- and long-term exposures. These genes could be central for the interconnecting biological pathways potentially stimulated by TEX exposure, likely related to respiratory and neuro diseases. Using publicly available data we propose a conceptual framework to study pathway perturbations leading to toxicity of chemical mixtures. This proposed methodology lends mechanistic insights of the toxicity of mixtures and when experimentally validated will allow data gaps filling for mixtures’ toxicity assessment. This work proposes an approach using current knowledge, available multiple stream data and applying computational methods to advance mixtures risk assessment.


2011 ◽  
Vol 105 (9) ◽  
pp. 1279-1287 ◽  
Author(s):  
F Hinten ◽  
L C G van den Einden ◽  
J C M Hendriks ◽  
A G J van der Zee ◽  
J Bulten ◽  
...  

2015 ◽  
Vol 25 (9) ◽  
pp. 704-715 ◽  
Author(s):  
Amina Tariq ◽  
Andrew Georgiou ◽  
Magdalena Raban ◽  
Melissa Therese Baysari ◽  
Johanna Westbrook

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