Deciphering Long Covid: Next Emergent Healthcare Dilemma

Objective: To determine the prevalence of Long Haul COVID–19 Syndrome among Pakistani Population. Methods: This cross-sectional analytical study was conducted after approval from the ethical review committee of the Foundation University College of Dentistry, Islamabad from June 2021 to September 2021. A non-probability consecutive sampling methodology was employed and a total of (168) participants after voluntary consent were enrolled in the study, after explaining the study protocol to the patients. The final Questionnaire is comprised of three sections. Section – I focused on the demographic profile (Age, Gender, Profession) of the participants. Section – II was designed to investigate COVID – 19 disease history, comorbid, coronavirus disease severity along with the number of individuals infected in the family, duration of positive polymerase chain reaction results, and management destination (Hospital or Home). Section – III addressed the frequency of persistent symptoms (Gastrointestinal, Systemic, Cardiovascular, Musculoskeletal, Immunological, Dermatological, Neuropsychiatric, Ophthalmological, Pulmonary, Otorhinolaryngological, Endocrine, Reproductive and Genitourinary systems). Results: 168 responders participated in this survey study,48 (28.6%) males while 120 (71.4%) females. About 36 (11.9%) were found to be suffering from comorbidity, 84 (50.0%) suffered from mild disease symptoms, while only 4 (2.4%) experienced the severe disease. The disease was managed at home for a major chunk of responders, 140 (83.3%).132 (78.6%) were found to have suffered from long COVID syndrome with the persistence of symptoms beyond four weeks of infection. The most common symptoms included fatigue (78.8%), fever (60.0%), loss of taste (57.8%), dry cough (45.5%), headache (42.4%), post-exertional malaise (45.5%), shortness of breath (39.4%), insomnia (39.0%), loss of smell (36.4%), loss of appetite (33.3%) and depression (33.3%).Male gender (p=0.009), with existing chronic illnesses (p<0.001), moderate and severe disease (p<0.001), higher age group (p<0.001) and isolated at hospital (p=0.002). Conclusion: In conclusion, this study has shown that persistence of COVID disease symptoms (most common symptoms included fatigue, fever, loss of taste, dry cough, headache, post-exertional malaise, shortness of breath, insomnia, loss of smell, loss of appetite, and depression) are common in Pakistani population. Male gender, existing chronic illnesses, moderate and severe disease, higher age group, and isolation at the hospital are the probable risk factors.

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Post-acute sequelae of COVID-19 in a non-hospitalized cohort: results from the Arizona CoVHORT

10.1101/2021.03.29.21254588 ◽

2021 ◽

Author(s):

Melanie L Bell ◽

Collin J Catalfamo ◽

Leslie V. Farland ◽

Kacey C Ernst ◽

Elizabeth T Jacobs ◽

...

Keyword(s):

Clinical Presentation ◽

Severe Disease ◽

Median Number ◽

Population Based ◽

Diverse Population ◽

Shortness Of Breath ◽

Persistent Symptoms ◽

Estimate Prevalence ◽

Hispanic White

AbstractClinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as post-acute sequelae of SAR-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of various symptoms of PASC, defined as experiencing at least one symptom 30 days or longer. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95%CI 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.

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Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT

PLoS ONE ◽

10.1371/journal.pone.0254347 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0254347

Author(s):

Melanie L. Bell ◽

Collin J. Catalfamo ◽

Leslie V. Farland ◽

Kacey C. Ernst ◽

Elizabeth T. Jacobs ◽

...

Keyword(s):

Clinical Presentation ◽

Severe Disease ◽

Median Number ◽

Population Based ◽

Diverse Population ◽

Shortness Of Breath ◽

Persistent Symptoms ◽

Estimate Prevalence ◽

Hispanic White

Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30–250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1–20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.

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What Predicts Stable Mental Health in the 18–29 Age Group Compared to Older Age Groups? Results from the Stockholm Public Health Cohort 2002–2014

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122859 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2859 ◽

Cited By ~ 1

Author(s):

Regina Winzer ◽

Kimmo Sorjonen ◽

Lene Lindberg

Keyword(s):

Public Health ◽

Mental Health ◽

Physical Activity ◽

Social Capital ◽

Health Behavior ◽

Social Determinants ◽

Emotional Support ◽

Male Gender ◽

Financial Strain ◽

Age Group

Mental health has decreased in young people since the 1990s, and mental health promotion is an urgent matter. A first step is to identify which social determinants could be of importance for intervention. We used the Stockholm Public Health Cohort, a longitudinal population-based health survey, completed by 31,000 inhabitants in the Stockholm County. We focused on the 18–29 age group, n = 3373 (60% females, 40% males) and aimed at assessing which social determinants predict stable mental health, measured as scoring <3 points on the General Health Questionnaire 12 at all time points: 2002, 2007, 2010, and 2014. Forty-six percent of males and 36% of females reported stable mental health. Among the 17 predictors on sociodemographics, socioeconomics, social capital, health behavior, and victimization, six predicted stable mental health in the following order: occupation and especially employment, emotional support, male gender, being born in Sweden, absence of financial strain, and consumption of fruit and berries. In the 30–84 age group, 66% males and 55% females reported stable mental health. Nine determinants in the following rank predicted stable mental health: absence of financial strain, occupation and especially being self-employed, emotional support, male gender, physical activity, instrumental support, interpersonal trust, community trust, and absence of hazardous alcohol consumption. Interaction analysis showed significant difference between the younger and older group regarding physical activity and absence of financial strain with importance being higher for the older group. Our findings indicate that the determinants of health differ across the life-course with fewer predictors related to social capital and health behavior in the younger group compared to the older. We conclude that health-promoting interventions should be lifespan-sensitive.

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A Diagnostic Dilemma of Cryptogenic Organising Pneumonia

Journal of Nepal Medical Association ◽

10.31729/jnma.377 ◽

2012 ◽

Vol 52 (188) ◽

Cited By ~ 1

Author(s):

K Gurung

Keyword(s):

Steroid Therapy ◽

Lung Biopsy ◽

Early Recognition ◽

Steroid Treatment ◽

Age Group ◽

Shortness Of Breath ◽

Diagnostic Dilemma ◽

Good Outcome ◽

Lung Condition

Cryptogenic Organising Pneumonia is a rare lung condition, which has incidence of 6-9 cases per 1000,000 people with onset at age group between 50-60. The pathogenesis of this condition remains unknown. It mimics like pneumonia but has a good outcome with steroid treatment. Early recognition is very important and treatment with steroid therapy can save lives. This case highlights the unusual cause of shortness of breath due to COP and co existing incidental severe AS where we faced a diagnostic dilemma till lung biopsy was performed. Keywords: Cryptogenic organising pneumonia; Pneumonia.

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Age-wise and Gender-wise Prevalence of Hepatitis B Virus (HBV) Infection in Lahore, Pakistan

BioScientific Review ◽

10.32350/bsr.0104.03 ◽

2019 ◽

Vol 01 (04) ◽

pp. 20-28

Author(s):

Aqib Nazeer ◽

Shahid Ali ◽

Imran Tipu

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Hepatitis B Surface Antigen ◽

Hbv Infection ◽

Age Group ◽

Pakistani Population ◽

Blood Samples ◽

Significant Difference ◽

B Virus ◽

And Gender

Background The prevalence of hepatitis B virus (HBV) in the Pakistani population has been reported previously, however, studies with a city-oriented approach and focus on age and gender distribution are very limited. Therefore, the current study was designed to unravel the age-wise and gender wise prevalence of HBV in Lahore, Pakistan. Methods A total of 350 blood samples of both male and female patients who visited National Genetic Laboratory, Lahore between February 2019 and July 2019 and who were suspected of HBV infection were screened. Sandwich based ELISA was used to detect rapid hepatitis B surface antigen (HbsAg) according to the manufacturer’s instruction. Real time PCR was used to detect HBV using HBV Rotor Gene PCR kit. Results Out of 350 blood samples screened for HBV infection (n= 350), 180 (51.43%) were of males and 170 (48.57%) were of females. Mean age (years) with SD (standard deviation) of the screened population was 37.22 ± 12.16 years. Overall, 224 samples (64%) were found to be positive for HBV infection. In our study, the number of females with this infection (52.24%) was slightly higher than males (47.76%). However, we observed no statistically significant difference (p = 0.225) between them. Conclusion Our study concludes that HBV is highly prevalent in Lahore, Pakistan. Females are slightly more susceptible to HBV infection as compared to males. This study also reports that HBV is more prevalent in the 20-40 age group.

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Pythium myriotylum is recovered most frequently from Pythium soft-rot infected ginger rhizomes in China

Plant Disease ◽

10.1094/pdis-05-21-0924-re ◽

2021 ◽

Author(s):

Paul Daly ◽

Yifan Chen ◽

Qimeng Zhang ◽

Hongli Zhu ◽

Jingjing Li ◽

...

Keyword(s):

Severe Disease ◽

Zingiber Officinale ◽

Soft Rot ◽

Temperature Dependent ◽

Pythium Myriotylum ◽

Disease Symptoms ◽

Ginger Rhizome ◽

Oomycete Pathogen ◽

Dependent Growth ◽

Pythium Soft Rot

Pythium soft rot is a major soil-borne disease of crops such as ginger (Zingiber officinale). Our objective was to identify which Pythium species were associated with Pythium soft-rot of ginger in China, where approximately 20% of global ginger production is from. Oomycetes infecting ginger rhizomes from seven provinces were investigated using two molecular markers, the internal transcribed spacer (ITS) and cytochrome c oxidase subunit II (CoxII). In total, 81 isolates were recovered and approximately 95% of the isolates were identified as Pythium myriotylum and the other isolates were identified as either P. aphanidermatum or P. graminicola. Notably, the P. myriotylum isolates from China did not contain the SNP in the CoxII sequence found previously in the P. myriotylum isolates infecting ginger in Australia. A subset of 36 of the isolates was analyzed repeatedly by temperature-dependent growth, severity of disease on ginger plants and aggressiveness of colonization of ginger rhizome sticks. In the pathogenicity assays, 32/36 of the isolates were able to significantly infect and cause severe disease symptoms on the ginger plants. A range of temperature-dependent growth, disease severity and aggressiveness in colonization was found with a significant moderate positive correlation between growth and aggressiveness of colonization of the ginger sticks. This study identified P. myriotylum as the major oomycete pathogen in China from infected ginger rhizomes and suggests that P. myriotylum should be a key target to control soft rot of ginger disease.

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ELEVATED INTERLEUKIN–6 AND FERRITIN LEVELS EXACERBATE SEVERITY OF 2019 NOVEL CORONAVIRUS DISEASE (COVID-19): A PILOT STUDY

10.36106/ijsr/9500536 ◽

2021 ◽

pp. 16-19

Author(s):

Shelesh Kumar Swami ◽

Nitesh Kumar Chauhan ◽

Shuchi Goyal ◽

A.K. Verma ◽

Shweta Biyani

Keyword(s):

Pilot Study ◽

Interleukin 6 ◽

Severe Disease ◽

Close Monitoring ◽

Medical Practitioners ◽

Resultant Data ◽

Initial Symptoms ◽

Severe Group ◽

Novel Coronavirus ◽

Loss Of Appetite

Background & objectives: The 2019 novel coronavirus disease (COVID-19) pandemic is a big challenge for scientic and medical eld. Progression of severe disease is a difcult problem in treatment. Therefore, there is essential need to recognize severe forms of COVID-19 early in the disease course. Identication of effective biomarkers are able to classify patients based on severity. In this pilot study, we aimed to validate the association between immunologic biomarkers Interleukin-6 and ferritin with the severity of the COVID-19. Methods: A total of 1443 patients diagnosed with COVID-19 were enrolled including a severe group and a nonsevere group. Baseline clinical characteristics were collected. Serum interleukin-6 and ferritin were measured and the resultant data was statistically analyzed. Results: The most common initial symptoms were fever (68.81%) and cough (47.82%), followed by loss of appetite (9.28%), fatigue (17.46%) and breathlessness (15.52%). Level of IL-6 and Ferritin were signicantly higher in the severe patients (p<.05 for both) compared with nonsevere patients. Interpretation & conclusions: This pilot study conrmed that IL-6 and ferritin biomarkers are closely associated with the severity of COVID-19. Assessment of these biomarkers could be helpful to medical practitioners in starting treatment and close monitoring against COVID-19 infection which could improve prognosis and lower mortality

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Attitudes of Terminally Ill Cancer Patients About Euthanasia and Assisted Suicide: Predominance of Psychosocial Determinants and Beliefs Over Symptom Distress and Subsequent Survival

Journal of Clinical Oncology ◽

10.1200/jco.2002.08.025 ◽

2002 ◽

Vol 20 (8) ◽

pp. 2134-2141 ◽

Cited By ~ 41

Author(s):

Maria E. Suarez-Almazor ◽

Catherine Newman ◽

John Hanson ◽

Eduardo Bruera

Keyword(s):

Cancer Patients ◽

Assisted Suicide ◽

Religious Beliefs ◽

Terminally Ill ◽

Well Being ◽

Shortness Of Breath ◽

Terminally Ill Cancer Patients ◽

Symptom Intensity ◽

Loss Of Appetite ◽

Symptomatic Distress

PURPOSE: Although euthanasia and physician-assisted suicide (PAS) are controversial issues, the views of those most affected, terminal patients, are seldom explored. Our objective was to assess whether the attitudes about euthanasia/PAS of terminally ill cancer patients were determined by their symptomatic distress. PATIENTS AND METHODS: We conducted a survey of 100 patients with terminal cancer. Statements related to the legalization of euthanasia/PAS were scored using Likert scales. We also asked patients how often they had considered ending their lives. Their responses were analyzed in relation to disease characteristics, including an assessment of symptomatic severity, sociodemographic features, general beliefs about the suffering of cancer patients, and survival. RESULTS: Most patients (69%) supported euthanasia or PAS for one or more situations. The association between these attitudes and symptoms was weak, consistent in univariate analysis only for shortness of breath. No significant associations were observed with pain, nausea, well-being, loss of appetite, depression, or subsequent survival. Agreement with euthanasia was significantly related to male sex, lack of religious beliefs, and general beliefs about the suffering of cancer patients and their families. In multivariate analysis, the only characteristics that remained statistically associated with support were the strength of religious beliefs and the perception that patients with cancer are a heavy burden on their families. Frequency of suicidal ideation was associated with poor well-being, depression, anxiety, and shortness of breath, but not with other somatic symptoms such as pain, nausea, and loss of appetite. CONCLUSION: Symptom intensity had limited impact on the attitudes about euthanasia of terminally ill cancer patients. Our findings suggest that patient views are primarily determined by psychosocial traits and beliefs, as opposed to disease severity or symptomatic distress.

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Gender Differences in the Pathogenesis and Outcome of Lupus and of Lupus Nephritis

Clinical and Developmental Immunology ◽

10.1155/2012/604892 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 61

Author(s):

Julie Schwartzman-Morris ◽

Chaim Putterman

Keyword(s):

Immune Responses ◽

Lupus Erythematosus ◽

Severe Disease ◽

Clinical Manifestations ◽

Male Gender ◽

Gender Disparities ◽

Systemic Lupus ◽

Hematological Indices ◽

Treatment Regimens ◽

Tailored Treatment

Systemic Lupus Erythematosus (SLE) typically affects females at far greater rates than males; however male SLE patients often have more severe disease than females. The gender disparities have been reported in clinical manifestations and in serological and hematological indices as well. In particular, SLE complicated with nephritis is more frequent in men than women, and several groups identified male gender as a risk factor for progression to renal failure. The specific differences in pathogenesis amongst genders have yet to be conclusively defined, though genetic, hormonal, and immune responses have been analyzed thus far. Further research is warranted to further elucidate these differences and permit the development of gender-tailored treatment regimens.

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Patient-reported symptom burden and quality of life in advanced lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e16570 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e16570-e16570

Author(s):

Shrividya Iyer ◽

Alex Rider ◽

Gavin Taylor-Stokes ◽

Adam Roughley

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Performance Status ◽

Symptom Burden ◽

Shortness Of Breath ◽

Patient Reported ◽

And Performance ◽

Loss Of Appetite ◽

Nsclc Patients

e16570 Background: The main objective of our study was to assess patient reported symptom burden and impact on quality of life in advanced non small cell lung cancer (NSCLC) patients in the United States. Methods: Patients with advanced (stage IIIB/IV) NSCLC (N=450) were recruited with informed consent in a nationwide (US) lung cancer study from Oct-Dec 2011. Patient reported symptoms were assessed using the Lung Cancer Symptom Scale (LCSS) on a 0-100 visual analogue scale and included six symptoms: fatigue, appetite loss, shortness of breath, cough, pain and blood in sputum. An average symptom burden index was calculated. Quality of life was assessed using the Functional Assessment of Cancer Therapy- Lung (FACT-L).Higher scores indicate higher symptom severity on the LCSS and better quality of life on the FACT-L. Correlation between the total FACT-L score and LCSS symptom burden index was assessed. A multivariate regression analysis was performed with FACT-L total score as the dependent variable and LCSS symptom scores as predictors controlling for age, gender, stage and performance status. Results: Majority of the patients were male (59%), Caucasian (74%), smokers/ex-smokers (78%) with an average age of 64 years. Proportion of patients reporting each lung cancer symptom was: Fatigue (100%), loss of appetite (97%), shortness of breath (95%), cough (93%), pain (92%) and blood in sputum (63%). The average (SD) symptom burden index was 42.3 (21.5).The mean± SD severity scores on symptoms were: fatigue (53.2±24.7), loss of appetite (48.1±25.8), cough (48.4±29.9), shortness of breath (44.7± 27), pain (39.7± 28.1) and blood in sputum (18.4±23.6). The average (SD) FACT-L score was 71.7 (25.3). A significant negative correlation was found between the LCSS symptom burden index and FACT-L scores (ρ= -0.82; p<0.001). Loss of appetite (β=-0.204; p<0.001), cough (β= -0.145; p<0.01), pain (β=-0.265; p<0.001), shortness of breath (β = -0.145; p<0.01), age (β= 0.217; p<0.05) and performance status (β = 0.283; p<0.001) were found to be significant predictors of quality of life. Conclusions: Cough, pain, shortness of breath and loss of appetite contribute to symptom burden and have a significant negative impact on quality of life in advanced NSCLC patients.

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