scholarly journals Follow-Ups on Persistent Symptoms and Pulmonary Function Among Post-Acute COVID-19 Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Qiuyue Long ◽  
Jiwei Li ◽  
Xiaoyi Hu ◽  
Yangyuyan Bai ◽  
Yali Zheng ◽  
...  
Keyword(s):  
Lung Function ◽  
Cohort Studies ◽  
Acute Phase ◽  
Meta Analysis ◽  
Psychosocial Health ◽  
Post Discharge ◽  
Persistent Symptoms ◽  
Lung Functions

Objective: As the number of recovering COVID-19 patients increases worldwide, the persistence of symptoms and signs through the post-acute phase indicates an urgent need for prolonged follow-up care. To explore existing data about post-acute COVID-19 syndrome, this meta-analysis assesses the prevalence of persistent manifestations in multiple systems and abnormalities in lung function, as well as their related risks in patients with various severities.Methods: Articles about discharged COVID-19 patients (published from January 1, 2020 to February 23, 2021) were obtained by searching four databases. Cohort studies with follow-up periods >1 month post-discharge or >2 months post-admission were included.Results: A total of 4,478 COVID-19 patients from 16 cohort studies were included in this meta-analysis. Fatigue or weakness (47%) were the most prevalent physical effects of post-acute COVID-19 syndrome, while psychosocial (28%) symptoms were the most common manifestations among several systems. Abnormalities in lung function of recovering patients, i.e., DLCO <80% (47%, 95% CI: 32–61%) persisted for long periods. Severe patients were more likely to present joint pain (OR 1.84, 95% CI: 1.11–3.04) and decreased lung functions compared with non-severe patients, with pooled ORs for abnormal TLC, FEV1, FVC, and DLCO of 3.05 (95% CI: 1.88–4.96), 2.72 (95% CI: 1.31–5.63), 2.52 (95% CI: 1.28–4.98), and 1.82 (95% CI: 1.32–2.50), respectively.Conclusions: Our research indicates that patients recovering from COVID-19 manifest long-term, multi-system symptoms, and the adverse effects on psychosocial health and lung functions were the most extensive and persistent. These findings together may facilitate much needed in-depth study of clinical treatments for long-term, post-acute phase symptoms that affect a great number of recovering COVID-19 patients.

scholarly journals 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

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.

Abstract TP456: Coated-platelets Levels After Subarachnoid Hemorrhage Predict Post-discharge Short-term Cognitive Outcome

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Bappaditya Ray ◽  
Vijay M Pandav ◽  
Eleanor A Mathews ◽  
David M Thompson ◽  
Aminata A Traore ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Acute Phase ◽  
Delayed Cerebral Ischemia ◽  
Cognitive Outcome ◽  
Short Term ◽  
Post Discharge ◽  
Acute Hospitalization ◽  
Symptomatic Vasospasm

Introduction: Delayed cerebral ischemia (DCI) is a determinant of short-term and long-term morbidity after subarachnoid hemorrhage (SAH). DCI is likely due to neurohumoral activation and inflammation-thrombosis cross-talk during the acute phase. Coated-platelets (CP), a subset of procoagulant platelets, contribute to systemic thrombogenicity and are associated with recurrent ischemic stroke. Hypothesis: We hypothesized that high CP levels during first 3 weeks of SAH (acute hospitalization) would be associated with worse short-term clinical outcome. Methods: A prospective cohort of 28 patients with post-discharge clinical follow-up (average 12 weeks) was studied. Outcomes were assessed using modified Rankin Scale (mRS) and Montreal Cognitive Outcome Assessment (MOCA). Blood samples to measure CP levels were performed - 1) during acute hospitalization and 2) at follow-up visit (defined as patient’s baseline). Trend of CP during acute hospitalization was analyzed against weighted mean baseline CP level to test hypothesis. Results: Average age of cohort was 52.6±12.2 years with 71.5% women. During acute phase 9 (32.1%) patients developed symptomatic vasospasm and 14 (50%) had DCI on imaging. Baseline CP levels did not differ (p=0.118) between patients with MOCA ≥26 (41.3%, n=13) and MOCA <26 (29.5%, n=15). However, patients with MOCA <26 had significantly higher CP levels during first 5 days than baseline (50.4% vs 29.5%, p=0.0004). These levels decreased by 1.77%/day from 6-21 days as compared to 1.55%/day for patients with MOCA ≥26 (p=0.723). In contrast, 20 (71.4%) patients with mRS 0-2 had average baseline CP levels of 37.3% vs 8 (28.6%) with mRS 3-6 having CP levels of 31.7%. For patients with mRS 0-2 and mRS 3-6, CP levels increased from baseline during first 5 days after SAH by 10.3% and 16.5% respectively (not statistically significant). Rate of CP decrease during 6-21 days was 1.43%/day and 2.02%/day (p=0.259) for mRS 0-2 and mRS 3-6 respectively. Conclusion: Elevated CP levels during the acute phase of SAH are strongly associated with lower MOCA scores at 12 weeks but not with higher mRS assessment. These results suggest that increased thrombogenicity after SAH leads to cognitive impairment despite good physical outcomes.

scholarly journals Long COVID in the Faroe Islands - a longitudinal study among non-hospitalized patients

2020 ◽  
Author(s):  
Maria Skaalum Petersen ◽  
Marnar Fríðheim Kristiansen ◽  
Katrin Dahl Hanusson ◽  
Marjun Eivindardóttir Danielsen ◽  
Bjarni á Steig ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Acute Phase ◽  
Clinical Characteristics ◽  
Hospitalized Patients ◽  
Faroe Islands ◽  
Rt Pcr ◽  
Persistent Symptoms ◽  
Detailed Questionnaire

Abstract Background Little is known about long-term recovery from COVID-19 disease, especially in non-hospitalized individuals. In this longitudinal study we present symptoms registered during the acute phase as well as long COVID, i.e. long-lasting COVID-19 symptoms, in patients from the Faroe Islands. Methods All consecutive patients with confirmed RT-PCR testing from April to June 2020 were invited to participate in this study for the assessment of long COVID. Demographic and clinical characteristics and self-reported acute and persistent symptoms were assessed using a standardized detailed questionnaire administered at enrollment and at repeated phone interviews in the period 22 th April to Aug 16 th. Results Of the 180 participants (96.3% of the 187 eligible COVID-19 patients), 53.1% reported persistence of at least one symptom after a mean of 125 days after symptoms onset, 33.3% reported one or two symptoms and 19.4% three or more symptoms. At the last follow-up, 46.7% were asymptomatic compared with 4.4 % during the acute phase. The most prevalent persistent symptoms were fatigue, loss of smell and taste, and arthralgias. Conclusions Our results show that it might take months for symptoms to resolve, even among non-hospitalized persons with mild illness course in the acute phase. Continued monitoring for long COVID is needed.

Long-term Clinical Performance of Composite Resin or Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis

2021 ◽  
Vol 46 (1) ◽  
pp. 25-44
Author(s):  
J Fan ◽  
Y Xu ◽  
L Si ◽  
X Li ◽  
B Fu ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Cohort Studies ◽  
Composite Resin ◽  
Clinical Performance ◽  
Meta Analysis ◽  
Success Rates ◽  
Prospective Cohort Studies ◽  
Ceramic Inlays

Clinical Relevance Composite resin or ceramic inlays, onlays, and overlays can achieve high long-term survival and success rates. SUMMARY Objective: This study evaluated the long-term clinical performance and complications of composite resin or ceramic inlays, onlays, and overlays, as well as identified the factors that might influence the clinical outcome of the restorations. Method: A systematic literature search was conducted in the Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases until April 30, 2019, without language restrictions. Randomized clinical trials, clinical retrospective, and prospective cohort studies with a mean follow-up period of five years were included. Two reviewers extracted the study data independently. Newcastle-Ottawa Scale was applied for quality assessment. Meta-analysis was performed by the random-effects model and fixed-effects model. Results: After removal of duplicates, 2818 studies were identified. Finally, 13 observational studies were included in the meta-analysis based on retrospective and prospective cohort studies. The cumulative survival rate and success rate of composite resin inlays, onlays, and overlays were 91% and 84% after five years of follow-up, respectively. The survival rates of ceramic inlays and onlays were 90% at 5 years, 89% at 8 years and 85% at 10 years, while the success rates of ceramic inlays and onlays were 88% at 5 years and 77% at 10 years. Secondary caries and endodontic complications were the predominant failures for composite resin inlays, onlays, and overlays, while restoration fractures and endodontic complications were the main failures for ceramic inlays and onlays. No direct association between parafuntional habits and bruxism and the fractures of restorations was found. Nonvital teeth and multiple-surface restorations tended to increase the risk of failure. Regarding other factors influencing the clinical outcome, no definite conclusion could be drawn due to inconsistent results. Conclusions: The long-term clinical outcomes have been demonstrated to achieve high survival and success rates based on 10-year data for ceramic inlays and onlays, as well as 5-year data for resin inlays, onlays, and overlays.

scholarly journals 308 Sex-related differences in long COVID-19 syndrome

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giovanna Pelà ◽  
Marina Aiello ◽  
Emilia Solinas ◽  
Luca Mantovanelli ◽  
Chiara Cavalli ◽  
...  
Keyword(s):  
Sex Differences ◽  
Chest Pain ◽  
Sleep Disturbance ◽  
Acute Phase ◽  
Severe Disease ◽  
Thoracic Pain ◽  
Persistent Symptoms ◽  
Long Term Follow Up

Abstract Aims Sex-differences have been demonstrated in the acute phase of COVID-19 infection; females (f) were found to be less prone to develop a severe disease than males (M), but few studies have assessed sex-differences in Long-COVID-19 syndrome. Methods and results The aim of this prospective/retrospective study was to characterize the long-term consequences of this infection from a sex-perspective. For this purpose, we enrolled 223 patients (89 F and 134 M) who experienced a SARS-CoV-2 infection. In the acute phase of the illness, females reported more frequently than males: weakness, dysgeusia, anosmia, thoracic pain, palpitations, diarrhoea, and myalgia without significant differences in breathlessness, cough, and sleep disturbance. After a mean follow-up time of 5 months after the acute phase, females were significantly more likely than males to report weakness, thoracic pain, palpitations, and sleep disturbance but not myalgia and cough. At the multivariate logistic regression, women were statistically significantly likely to experience persistent symptoms such as dyspnoea, fatigue, chest pain, and palpitations. On the contrary, myalgia, cough and sleep disturbance were not influenced by sex. Conclusions We demonstrated that females were more symptomatic than males not only in the acute phase but also at follow-up. Sex was found to be an important determinant of Long-COVID syndrome because it is a significant predictor of persistent symptoms in females, such as dyspnoea, fatigue, chest pain, and palpitations. Our results suggest the need for long-term follow-up of these patients from a sex-perspective in order to implement early preventive and personalized therapeutic strategies.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

scholarly journals Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis

2021 ◽  
pp. 1-11
Author(s):  
Maxi Weber ◽  
Sarah Schumacher ◽  
Wiebke Hannig ◽  
Jürgen Barth ◽  
Annett Lotzin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Stress Disorder ◽  
Psychological Treatment ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Long Term Outcomes ◽  
Psychological Treatments

Abstract Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.

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