Clinical Consequences of COVID-19

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (15 July 2023) | Viewed by 27729

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Department of General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
Interests: intensive care medicine; lung-kidney-liver transplants; ECMO; COVID-19
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Guest Editor
Department of General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
Interests: intensive care medicine; ECCO2R; delirium; ultrasound; COVID-19; polytrauma
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
Interests: critical care; intensive care medicine; anesthesiology; ecmo; extracorporeal
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In 2019, a novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) caused a global pandemic, representing a major public health crisis. SARS-CoV-2 can infect all age groups, regardless of gender, ethnicity, and general health status. Direct contact, aerosol, and droplet transmission are the three main routes of SARS-CoV-2 transmission. Although the pulmonary system is its primary entry site, several non-respiratory clinical symptoms alongside cumulating anatomical evidence have demonstrated the virus’s potential to invade multiple organs throughout the body, including the nervous system. There is wide consensus that the COVID-19 pandemic not only affects physical health, but also mental health and wellbeing. Because COVID-19 is a new disease, much about the clinical course and the possible long-term health consequences remains uncertain.

Dr. Francesco Pugliese
Dr. Francesco Alessandri
Dr. Giovanni Giordano
Guest Editors

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Keywords

  • COVID-19
  • long COVID-19
  • SARS-CoV-2
  • mental health
  • COVID-19 health consequences

Published Papers (18 papers)

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Editorial

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2 pages, 189 KiB  
Editorial
Special Issue “Clinical Consequences of COVID-19”: Taking a Look at Complexity
by Giovanni Giordano, Francesco Alessandri and Francesco Pugliese
J. Clin. Med. 2023, 12(24), 7756; https://doi.org/10.3390/jcm12247756 - 18 Dec 2023
Viewed by 520
Abstract
The consequences of SARS-CoV-2 infection are far from being fully understood or accounted for [...] Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)

Research

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11 pages, 503 KiB  
Article
The Effect of the COVID-19 Pandemic on Self-Reported Health Status and Smoking and Drinking Habits in the General Urban Population
by Magdalena Chlabicz, Aleksandra Szum-Jakubowska, Paweł Sowa, Małgorzata Chlabicz, Sebastian Sołomacha, Łukasz Kiszkiel, Łukasz Minarowski, Katarzyna Guziejko, Piotr P. Laskowski, Anna M. Moniuszko-Malinowska and Karol A. Kamiński
J. Clin. Med. 2023, 12(19), 6241; https://doi.org/10.3390/jcm12196241 - 27 Sep 2023
Viewed by 733
Abstract
The coronavirus disease 2019 pandemic created a significant crisis in global health. The aim of the study was to compare the impact of the COVID-19 pandemic on self-rated health status and smoking and alcohol habits. The Bialystok PLUS cohort study was conducted in [...] Read more.
The coronavirus disease 2019 pandemic created a significant crisis in global health. The aim of the study was to compare the impact of the COVID-19 pandemic on self-rated health status and smoking and alcohol habits. The Bialystok PLUS cohort study was conducted in 2018–2022. A total of 1222 randomly selected city residents were examined and divided into two groups: before and during the COVID-19 pandemic. The participants’ lifestyle habits and medical history were collected from self-reported questionnaires. The Alcohol Use Disorders Identification Test (AUDIT) and the Fagerström Test for Nicotine Dependence (FTND) were used to assess the degree of alcohol and nicotine dependence. The survey revealed a reduced frequency of reported allergies vs. an increased frequency of reported sinusitis and asthma; increased incidence of declared hypercholesterolemia and visual impairment; a reduced number of cigarettes smoked per day, lower FTND score, and a greater desire to quit smoking in the next six months; and an increase in hs-CRP and FeNO levels in the population during the pandemic compared to the pre-pandemic population. The COVID-19 pandemic had a measurable impact on the general population’s prevalence of certain medical conditions and lifestyle habits. Further research should continue to examine the long-term health implications of the pandemic. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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10 pages, 636 KiB  
Article
Reduced Reliability of Procalcitonin (PCT) as a Biomarker of Bacterial Superinfection: Concerns about PCT-Driven Antibiotic Stewardship in Critically Ill COVID-19 Patients—Results from a Retrospective Observational Study in Intensive Care Units
by Giancarlo Ceccarelli, Francesco Alessandri, Giuseppe Migliara, Valentina Baccolini, Giovanni Giordano, Gioacchino Galardo, Carolina Marzuillo, Corrado De Vito, Alessandro Russo, Massimo Ciccozzi, Paolo Villari, Mario Venditti, Claudio M. Mastroianni, Francesco Pugliese and Gabriella d’Ettorre
J. Clin. Med. 2023, 12(19), 6171; https://doi.org/10.3390/jcm12196171 - 24 Sep 2023
Cited by 1 | Viewed by 1151
Abstract
Background: The aim of this study was to assess whether procalcitonin levels is a diagnostic tool capable of accurately identifying sepsis and ventilator-associated pneumonia (VAP) even in critically ill COVID-19 patients. Methods: In this retrospective, observational study, all critically ill COVID-19 patients who [...] Read more.
Background: The aim of this study was to assess whether procalcitonin levels is a diagnostic tool capable of accurately identifying sepsis and ventilator-associated pneumonia (VAP) even in critically ill COVID-19 patients. Methods: In this retrospective, observational study, all critically ill COVID-19 patients who survived for ≥2 days in a single university hospital and had at least one serum procalcitonin (PCT) value and associated blood culture and/or culture from a lower respiratory tract specimen available were eligible for the study. Results: Over the research period, 184 patients were recruited; 67 VAP/BSI occurred, with an incidence rate of 21.82 episodes of VAP/BSI (95% CI: 17.18–27.73) per 1000 patient-days among patients who were included. At the time of a positive microbiological culture, an average PCT level of 1.25–3.2 ng/mL was found. Moreover, also in subjects without positive cultures, PCT was altered in 21.7% of determinations, with an average value of 1.04–5.5 ng/mL. Both PCT and PCT-72 h were not linked to a diagnosis of VAP/BSI in COVID-19 patients, according to the multivariable GEE models (aOR 1.13, 95% CI 0.51–2.52 for PCT; aOR 1.32, 95% CI 0.66–2.64 for PCT-72 h). Conclusion: Elevated PCT levels might not always indicate bacterial superinfections or coinfections in a severe COVID-19 setting. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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13 pages, 576 KiB  
Article
Long-Term Consequences of COVID-19 in Predominantly Immunonaive Patients: A Canadian Prospective Population-Based Study
by Justine Benoit-Piau, Karine Tremblay, Alain Piché, Frédéric Dallaire, Mathieu Bélanger, Marc-André d’Entremont, Jean-Charles Pasquier, Martin Fortin, Catherine Bourque, Fanny Lapointe, Jean-François Betala-Belinga, Geneviève Petit, Guillaume Jourdan, Renata Bahous, Camilo Maya, Amira Benzina, Muhammad Faiyaz Hossain, Marie-Audrey Peel, Olivier Houle, Marie-Sandrine Auger, Antoine Rioux and Paul Farandadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(18), 5939; https://doi.org/10.3390/jcm12185939 - 13 Sep 2023
Viewed by 846
Abstract
Background: Lingering symptoms are frequently reported after acute SARS-CoV-2 infection, a condition known as post-COVID-19 condition (PCC). The duration and severity of PCC in immunologically naïve persons remain unclear. Furthermore, the long-term consequences of these chronic symptoms on work and mental health [...] Read more.
Background: Lingering symptoms are frequently reported after acute SARS-CoV-2 infection, a condition known as post-COVID-19 condition (PCC). The duration and severity of PCC in immunologically naïve persons remain unclear. Furthermore, the long-term consequences of these chronic symptoms on work and mental health are poorly documented. Objective: To determine the outcome, the risk factors, and the impact on work and mental health associated with post-COVID-19 symptoms. Methods: This prospective population-based study assessed acute COVID-19 symptoms and their evolution for up to nine months following infection. Individuals aged 18 years and older with COVID-19 in three Canadian regions between 1 November 2020 and 31 May 2021 were recruited. Participants completed a questionnaire that was either administered by trained student investigators over the phone or self-administered online. Results: A total of 1349 participants with a mean age of 46.6 ± 16.0 years completed the questionnaire. Participants were mostly unvaccinated at the time of their COVID-19 episode (86.9%). Six hundred and twenty-two participants (48.0%) exhibited one symptom or more, at least three months post-COVID-19. Among participants with PCC, 23.0% to 37.8% experienced fatigue at the time of survey. Moreover, 6.1% expressed psychological distress. Risk factors for PCC and fatigue included female sex (OR = 1.996), higher number of symptoms (OR = 1.292), higher severity of episode (OR = 3.831), and having a mental health condition prior to the COVID-19 episode (OR = 5.155). Conclusions: In this multicenter cohort study, almost half (47%) of the participants reported persistent symptoms >3 months after acute infection. Baseline risk factors for PCC include female sex, number and severity of symptoms during acute infection, and a previous diagnosis of mental health disorder. Having PCC negatively impacted health-related quality of life and these patients were more likely to exhibit psychological distress, as well as fatigue. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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11 pages, 680 KiB  
Article
Quality of Life 6 Months after COVID-19 Hospitalisation: A Single-Centre Polish Registry
by Maciej Koźlik, Maciej Kaźmierski, Wojciech Kaźmierski, Paulina Lis, Anna Lis, Weronika Łowicka, Marta Chamera, Barbara Romanowska, Jakub Kufel, Maciej Cebula and Marek Jędrzejek
J. Clin. Med. 2023, 12(16), 5327; https://doi.org/10.3390/jcm12165327 - 16 Aug 2023
Viewed by 867
Abstract
Background: The COVID-19 pandemic, which affected the entire global population, had an impact on our health and quality of life. Many people had complications, were hospitalised or even died due to SARS-CoV-2 infection. The health systems of many countries had to radically change [...] Read more.
Background: The COVID-19 pandemic, which affected the entire global population, had an impact on our health and quality of life. Many people had complications, were hospitalised or even died due to SARS-CoV-2 infection. The health systems of many countries had to radically change their way of functioning and scientists around the world worked intensively to develop a vaccine for the SARS-CoV-2 virus. Aim: The aim of this work is to assess the quality of life of patients who were hospitalised for COVID-19, using the SF-36 questionnaire. Methods: Between May and August 2022, we conducted a telephone assessment of quality of life in patients who were hospitalised for COVID-19 at the Temporary Hospital in Pyrzowice (Silesia, Poland), between November 2021 and January 2022. Results: Quality of life was significantly lower in women (p = 0.040), those with DM2 (p = 0.013), CKD (p = 0.041) and the vaccinated (p = 0.015). Conclusions: People with chronic kidney disease, diabetes mellitus and women had a lower quality of life after COVID-19 disease. However, people who were vaccinated for SARS-CoV-2 had a lower quality of life than non-vaccinated people did. This is possibly due to the higher mean age, and probably the higher disease burden, in the vaccinated group. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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10 pages, 273 KiB  
Article
Indirect Effects of the COVID-19 Pandemic on In-Hospital Outcomes among Internal Medicine Departments: A Double-Center Retrospective Study
by Maurizio Di Marco, Nicoletta Miano, Simona Marchisello, Giuseppe Coppolino, Giuseppe L’Episcopo, Sabrina Scilletta, Concetta Spichetti, Serena Torre, Roberto Scicali, Luca Zanoli, Agostino Gaudio, Pietro Castellino, Salvatore Piro, Francesco Purrello and Antonino Di Pino
J. Clin. Med. 2023, 12(16), 5304; https://doi.org/10.3390/jcm12165304 - 15 Aug 2023
Viewed by 684
Abstract
The coronavirus disease 19 (COVID-19) emergency led to rearrangements of healthcare systems with a significant impact on those internal medicine departments that had not been converted to COVID-19 wards. A reduced number of departments, indeed, had to cope with the same number of [...] Read more.
The coronavirus disease 19 (COVID-19) emergency led to rearrangements of healthcare systems with a significant impact on those internal medicine departments that had not been converted to COVID-19 wards. A reduced number of departments, indeed, had to cope with the same number of patients along with a lack of management of patients’ chronic diseases. We conducted a retrospective study aimed at examiningthe consequences of the COVID-19 pandemic on internal medicine departments that were not directly managing COVID-19 patients. Data from 619 patients were collected: 247 subjects hospitalized in 2019 (pre-COVID-19 era), 178 in 2020 (COVID-19 outbreak era) and 194 in 2021 (COVID-19 ongoing era). We found that in 2020 in-hospital mortality was significantly higher than in 2019 (17.4% vs. 5.3%, p = 0.009) as well as length of in-hospital stay (LOS) (12.7 ± 6.8 vs. 11 ± 6.2, p = 0.04). Finally, we performed a logistic regression analysis of the major determinants of mortality in the entire study population, which highlighted an association between mortality, being bedridden (β = 1.4, p = 0.004), respiratory failure (β = 1.5, p = 0.001), glomerular filtration rate (β = −0.16, p = 0.03) and hospitalization in the COVID-19 outbreak era (β = 1.6, p = 0.005). Our study highlights how the COVID-19 epidemic may have caused an increase in mortality and LOS even in patients not directly suffering from this infection. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
12 pages, 1931 KiB  
Article
Early Hospital Discharge Using Remote Monitoring for Patients Hospitalized for COVID-19, Regardless of Need for Home Oxygen Therapy: A Descriptive Study
by Samy Talha, Sid Lamrous, Loic Kassegne, Nicolas Lefebvre, Abrar-Ahmad Zulfiqar, Pierre Tran Ba Loc, Marie Geny, Nicolas Meyer, Mohamed Hajjam, Emmanuel Andrès and Bernard Geny
J. Clin. Med. 2023, 12(15), 5100; https://doi.org/10.3390/jcm12155100 - 03 Aug 2023
Cited by 2 | Viewed by 1039
Abstract
Aim: Since beds are unavailable, we prospectively investigated whether early hospital discharge will be safe and useful in patients hospitalized for COVID-19, regardless of their need for home oxygen therapy. Population and Methods: Extending the initial inclusion criteria, 62 patients were included and [...] Read more.
Aim: Since beds are unavailable, we prospectively investigated whether early hospital discharge will be safe and useful in patients hospitalized for COVID-19, regardless of their need for home oxygen therapy. Population and Methods: Extending the initial inclusion criteria, 62 patients were included and 51 benefited from home telemonitoring, mainly assessing clinical parameters (blood pressure, heart rate, respiratory rate, dyspnea, temperature) and peripheral saturation (SpO2) at follow-up. Results: 47% of the patients were older than 65 years; 63% needed home oxygen therapy and/or presented with more than one comorbidity. At home, the mean time to dyspnea and tachypnea resolutions ranged from 21 to 24 days. The mean oxygen-weaning duration was 13.3 ± 10.4 days, and the mean SpO2 was 95.7 ± 1.6%. The nurses and/or doctors managed 1238 alerts. Two re-hospitalizations were required, related to transient chest pain or pulmonary embolism, but no death occurred. Patient satisfaction was good, and 743 potential days of hospitalization were saved for other patients. Conclusion: The remote monitoring of vital parameters and symptoms is safe, allowing for early hospital discharge in patients hospitalized for COVID-19, whether or not home oxygen therapy was required. Oxygen tapering outside the hospital allowed for a greater reduction in hospital stay. Randomized controlled trials are necessary to confirm this beneficial effect. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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13 pages, 307 KiB  
Article
Post-Traumatic Stress Disorder among Polish Healthcare Staff in the Era of the COVID-19 Pandemic
by Grzegorz Kobelski, Katarzyna Naylor, Robert Ślusarz and Mariusz Wysokiński
J. Clin. Med. 2023, 12(12), 4072; https://doi.org/10.3390/jcm12124072 - 15 Jun 2023
Cited by 2 | Viewed by 1237
Abstract
Introduction: The COVID-19 pandemic has brought many adverse phenomena, particularly in the area of health for both individuals and society as a whole. Healthcare staff also suffered dire consequences. Aim: The aim of this study was to assess whether the COVID-19 pandemic increased [...] Read more.
Introduction: The COVID-19 pandemic has brought many adverse phenomena, particularly in the area of health for both individuals and society as a whole. Healthcare staff also suffered dire consequences. Aim: The aim of this study was to assess whether the COVID-19 pandemic increased the risk of post-traumatic stress disorder among healthcare professionals in Poland. Material and method: The survey was conducted between 4 April 2022 and 4 May 2022. The study applied the Computer Assisted Web Interview (CAWI) technique using the standardised Peritraumatic Distress Inventory (PDI) questionnaire. Results: The average score obtained by the respondents on the PDI was 21.24 ± 8.97. There was a statistically significant difference between the average PDI score obtained based on the gender of the subject (Z = 3.873, p = 0.0001.) The score obtained amongst nurses was statistically significantly higher compared to the paramedic group (H = 6.998, p = 0.030). There was no statistically significant difference between the average PDI score obtained based on the age of the participants (F = 1.282, p = 0.281), nor with their length of service (F = 0.934, p = 0.424). A total of 82.44% of the respondents received 14 PDI points, the cut-off point indicating the risk of PTSD that was adopted in the study. It was concluded that 6.12% of respondents did not require intervention (<7 PDI score); 74.28% of respondents needed further follow-up for PTSD and a reassessment of the PDI approximately 6 weeks after the initial testing; and 19.59% required coverage for PTSD prevention and mitigation (>28 PDI score). Conclusions: The study has shown a high risk of post-traumatic stress disorder among healthcare professionals in Poland. This risk is related to the gender of the respondents, with an indication of a higher risk of PTSD among women. The results have also shown a correlation between increased risk of post-traumatic stress disorder and occupation, with nurses being the most affected group. In contrast, no association has been found in terms of age and length of service for an increase in the risk of PTSD, following exposure to trauma in relation to healthcare services during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
10 pages, 934 KiB  
Article
Physical Activity Modifies the Severity of COVID-19 in Hospitalized Patients—Observational Study
by Edyta Sutkowska, Agata Stanek, Katarzyna Madziarska, Grzegorz K. Jakubiak, Janusz Sokołowski, Marcin Madziarski, Karolina Sutkowska-Stępień, Karolina Biernat, Justyna Mazurek, Adrianna Borowkow-Bulek, Jakub Czyżewski, Gabriela Wilk, Arkadiusz Jagasyk and Dominik Marciniak
J. Clin. Med. 2023, 12(12), 4046; https://doi.org/10.3390/jcm12124046 - 14 Jun 2023
Cited by 3 | Viewed by 1514
Abstract
Background and aim: Physical activity (PA) can modulate the immune response, but its impact on infectious disease severity is unknown. We assess if the PA level impacts the severity of COVID-19. Methods: Prospective, cohort study for adults hospitalized due to COVID-19, who filled [...] Read more.
Background and aim: Physical activity (PA) can modulate the immune response, but its impact on infectious disease severity is unknown. We assess if the PA level impacts the severity of COVID-19. Methods: Prospective, cohort study for adults hospitalized due to COVID-19, who filled out the International Physical Activity Questionnaire (IPAQ). Disease severity was expressed as death, transfer to intensive care unit (ICU), oxygen therapy (OxTh), hospitalization length, complications, C-reactive protein, and procalcitonin level. Results: Out of 326 individuals, 131 (57; 43.51% women) were analyzed: age: median—70; range: 20–95; BMI: mean—27.18 kg/m²; and SD: ±4.77. During hospitalization: 117 (83.31%) individuals recovered, nine (6.87%) were transferred to ICU, five (3.82%) died, and 83 (63.36%) needed OxTh. The median for the hospital stay was 11 (range: 3–49) for discharged patients, and mean hospitalization length was 14 (SD: ±5.8312) for deaths and 14.22 days (SD: ±6.92) for ICU-transferred patients. The median for MET-min/week was 660 (range: 0–19,200). Sufficient or high PA was found in recovered patients but insufficient PA was observed in dead or ICU-transferred patients (p = 0.03). The individuals with poor PA had a higher risk of death (HR = 2.63; ±95%CI 0.58–11.93; p = 0.037). OxTh was used more often in the less active individuals (p = 0.03). The principal component analysis confirmed a relationship between insufficient PA and an unfavorable course of the disease. Conclusion: A higher level of PA is associated with a milder course of COVID-19. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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9 pages, 1235 KiB  
Article
Correlation of ENT Symptoms with Age, Sex, and Anti-SARS-CoV-2 Antibody Titer in Plasma
by Aleksandra Kwaśniewska, Krzysztof Kwaśniewski, Andrzej Skorek, Dmitry Tretiakow, Anna Jaźwińska-Curyłło and Paweł Burduk
J. Clin. Med. 2023, 12(2), 610; https://doi.org/10.3390/jcm12020610 - 12 Jan 2023
Cited by 2 | Viewed by 1464
Abstract
Our objective is to evaluate the correlation between ENT symptom occurrence and antibody titer in convalescent plasma, as well as the influence of age and gender on ENT manifestations of COVID-19. We measured the levels of antibodies in 346 blood donors, who had [...] Read more.
Our objective is to evaluate the correlation between ENT symptom occurrence and antibody titer in convalescent plasma, as well as the influence of age and gender on ENT manifestations of COVID-19. We measured the levels of antibodies in 346 blood donors, who had PCR-confirmed previous infection and met the study inclusion criteria. We recorded otolaryngological symptoms during infection: dry cough, dyspnea, sore throat, smell/taste disturbances, vertigo, dizziness, nausea and vomiting, sudden unilateral loss of hearing, progressive loss of hearing, and tinnitus. In addition, we statistically analyzed the correlation between patients’ antibody levels, symptoms, age, and gender using a chi-square test or Fisher exact test. A p-value less than 0.05 determined statistical significance. The mean age of the convalescents was 39.8 ± 9.56 SD and the median of the measured anti-SARS-CoV2 plasma antibodies was 1:368.5. The most common ENT symptoms were smell/taste disturbances (62.43%), dry cough (40.46%), sore throat (24.86%), and dyspnea (23.7%). Smell and taste disturbances were more frequent in younger patients and the marked antibody titer was lower, which was contrary to a higher antibody titer associated with dry cough, dyspnea, and dizziness. Occurrence of sore throat was not correlated with age, sex, or antibody level. There were no significant differences in otological symptoms in female patients. Gender does not affect the occurrence of ENT symptoms. The symptomatic course of SARS-CoV-2 infection is not always associated with higher levels of antibodies in the blood. The age of the infected patients, unlike gender, affects the occurrence of some ENT symptoms. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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16 pages, 554 KiB  
Article
Post-COVID-19 Status and Its Physical, Nutritional, Psychological, and Social Effects in Working-Age Adults—A Prospective Questionnaire Study
by Tamara Nikolic Turnic, Ivana Vasiljevic, Magdalena Stanic, Biljana Jakovljevic, Maria Mikerova, Natalia Ekkert, Vladimir Reshetnikov and Vladimir Jakovljevic
J. Clin. Med. 2022, 11(22), 6668; https://doi.org/10.3390/jcm11226668 - 10 Nov 2022
Cited by 2 | Viewed by 1813
Abstract
Background: The main objective of this study was to evaluate the evolution of physical and daily routine, dietary habits, and mental and social health in individuals with recent COVID-19 infection. Methods: A qualitative prospective cross-sectional study was conducted from 01 October 2021 to [...] Read more.
Background: The main objective of this study was to evaluate the evolution of physical and daily routine, dietary habits, and mental and social health in individuals with recent COVID-19 infection. Methods: A qualitative prospective cross-sectional study was conducted from 01 October 2021 to 01 March 2022, which included 80 working-age adults from the territory of Central Serbia who had PCR-confirmed SARS-CoV-2 infection in the previous six months. Two structured pre-coded closed-ended questionnaires were submitted to the participants: a questionnaire about post-COVID-19 status (pCOVq) and a shortened version of the World Health Organization’s Quality of Life Scale (WHOQOL-BREF). Results: The presence of the COVID-19 disease in the previous period of 6 months among the working-age participants significantly affected the duration of aerobic, anaerobic, and high-intensity physical activities, but also the possibility of performing certain activities such as walking, which represents basic aerobic activity and a measure of general health among middle-aged participants. In the majority of cases (78%), in the post-COVID-19 period, participants indicated a decline in educational and productive activities. Conclusion: Post-COVID status in working-aged participants consists of reduced physical activity, lower quality of life, and similar nutritional habits. Health policies should be more focused on these findings. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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9 pages, 810 KiB  
Article
Quality of Life in COVID-19 Outpatients: A Long-Term Follow-Up Study
by Vincent Tarazona, David Kirouchena, Pascal Clerc, Florence Pinsard-Laventure and Bastien Bourrion
J. Clin. Med. 2022, 11(21), 6478; https://doi.org/10.3390/jcm11216478 - 31 Oct 2022
Cited by 15 | Viewed by 2862
Abstract
Background: The long-term issues faced by COVID-19 survivors remain unclear. Symptoms may persist for several months, even in non-hospitalized patients, probably impacting the quality of life. Objective: To assess the health-related quality of life of outpatients one year after SARS-CoV-2 infection. Design, Settings, [...] Read more.
Background: The long-term issues faced by COVID-19 survivors remain unclear. Symptoms may persist for several months, even in non-hospitalized patients, probably impacting the quality of life. Objective: To assess the health-related quality of life of outpatients one year after SARS-CoV-2 infection. Design, Settings, and Participants: This prospective multicentre study, conducted in France from February 2020 to February 2022, compared 150 COVID-19 cases (PCR+ and/or CT scan+) and 260 controls (PCR-) selected from a database of four COVID centres. Main outcomes: Health-related quality of life assessed using the EQ-5D-5L scale. Results: COVID-19 outpatients (n = 96) had significantly lower health-related quality of life than controls (n = 81) one year after SARS-CoV-2 infection: the EQ-5D-5L index averaged 0.87 in cases and 0.95 in controls (p = 0.002); the EQ- VAS averaged 78 in cases and 86.7 in controls (p < 0.001). This alteration in quality of life was more intense in the areas of pain or discomfort and daily activities. Conclusions: This study is the first to show an alteration in the quality of life of COVID-19 outpatients after one year. Appropriate guidance and community rehabilitation programs are required for outpatients with persistent symptoms of COVID-19. Research must continue to confirm these results in larger cohorts. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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8 pages, 641 KiB  
Article
Association of Clinical Features with Spike Glycoprotein Mutations in Iranian COVID-19 Patients
by Shahrzad Ahangarzadeh, Alireza Yousefi, Mohammad Mehdi Ranjbar, Arezou Dabiri, Atefeh Zarepour, Mahmoud Sadeghi, Elham Heidari, Fariba Mazrui, Majid Hosseinzadeh, Behrooz Ataei, Ali Zarrabi, Laleh Shariati and Shaghayegh Haghjooy Javanmard
J. Clin. Med. 2022, 11(21), 6315; https://doi.org/10.3390/jcm11216315 - 26 Oct 2022
Cited by 1 | Viewed by 1033
Abstract
Background: Mutations in spike glycoprotein, a critical protein of SARS-CoV-2, could directly impact pathogenicity and virulence. The D614G mutation, a non-synonymous mutation at position 614 of the spike glycoprotein, is a predominant variant circulating worldwide. This study investigated the occurrence of mutations in [...] Read more.
Background: Mutations in spike glycoprotein, a critical protein of SARS-CoV-2, could directly impact pathogenicity and virulence. The D614G mutation, a non-synonymous mutation at position 614 of the spike glycoprotein, is a predominant variant circulating worldwide. This study investigated the occurrence of mutations in the crucial zone of the spike gene and the association of clinical symptoms with spike mutations in isolated viruses from Iranian patients infected with SARS-CoV-2 during the second and third waves of the COVID-19 epidemic in Isfahan, the third-largest city in Iran. Methods: The extracted RNA from 60 nasopharyngeal samples of COVID-19 patients were subjected to cDNA synthesis and RT-PCR (in three overlapping fragments). Each patient’s reverse transcriptase polymerase chain reaction (RT-PCR) products were assembled and sequenced. Information and clinical features of all sixty patients were collected, summarized, and analyzed using the GENMOD procedure of SAS 9.4. Results: Analysis of 60 assembled sequences identified nine nonsynonymous mutations. The D614G mutation has the highest frequency among the amino acid changes. In our study, in 31 patients (51.66%), D614G mutation was determined. For all the studied symptoms, no significant relationship was observed with the incidence of D614G mutation. Conclusions: D614G, a common mutation among several of the variants of SARS-CoV-2, had the highest frequency among the studied sequences and its frequency increased significantly in the samples of the third wave compared to the samples of the second wave of the disease. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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12 pages, 863 KiB  
Article
Impact of COVID-19 Pandemic on Initiation of Immunosuppressive Treatment in Immune-Mediated Inflammatory Diseases in Austria: A Nationwide Retrospective Study
by Maximilian Kutschera, Valentin Ritschl, Berthold Reichardt, Tanja Stamm, Hans Kiener, Harald Maier, Walter Reinisch, Bernhard Benka and Gottfried Novacek
J. Clin. Med. 2022, 11(18), 5308; https://doi.org/10.3390/jcm11185308 - 09 Sep 2022
Cited by 3 | Viewed by 1952
Abstract
Objective: Conventional immunosuppressive and advanced targeted therapies, including biological medications and small molecules, are a mainstay in the treatment of immune-mediated inflammatory diseases (IMID). However, the COVID-19 pandemic caused concerns over these drugs’ safety regarding the risk and severity of SARS-CoV-2 infection. Thus, [...] Read more.
Objective: Conventional immunosuppressive and advanced targeted therapies, including biological medications and small molecules, are a mainstay in the treatment of immune-mediated inflammatory diseases (IMID). However, the COVID-19 pandemic caused concerns over these drugs’ safety regarding the risk and severity of SARS-CoV-2 infection. Thus, we aimed to assess the impact of the COVID-19 pandemic on the initiation of these treatments in 2020. Study Design and Setting: We conducted a population-based retrospective analysis of real-world data of the Austrian health insurance funds on the initiation of conventional immunosuppressive and advanced targeted therapies. The primary objective was to compare the initiation of these medications in the year 2020 with the period 2017 to 2019. Initiation rates of medication were calculated by comparing a certain unit of time with an average of the previous ones. Results: 95,573 patients were included. During the first lockdown in Austria in April 2020, there was a significant decrease in the initiations of conventional immunosuppressives and advanced targeted therapies compared to previous years (p < 0.0001). From May 2020 onwards, numbers rapidly re-achieved pre-lockdown levels despite higher SARS-CoV-2 infection rates and subsequent lockdown periods at the end of 2020. Independent from the impact of the COVID-19 pandemic, a continuous increase of starts of advanced targeted therapies and a continuous decrease of conventional immunosuppressants during the observation period were observed. Conclusions: In IMID patients, the COVID-19 pandemic led to a significant decrease of newly started conventional immunosuppressive and advanced targeted therapies only during the first lockdown in Austria. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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Review

Jump to: Editorial, Research, Other

19 pages, 329 KiB  
Review
Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review
by Valeria Calcaterra, Veronica Maria Tagi, Raffaella De Santis, Andrea Biuso, Silvia Taranto, Enza D’Auria and Gianvincenzo Zuccotti
J. Clin. Med. 2023, 12(16), 5248; https://doi.org/10.3390/jcm12165248 - 11 Aug 2023
Cited by 3 | Viewed by 1340
Abstract
Since the advent of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increased incidence of several endocrinological anomalies in acute-phase and/or long-term complications has been described. The aim of this review is to provide a broad overview of the available literature [...] Read more.
Since the advent of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increased incidence of several endocrinological anomalies in acute-phase and/or long-term complications has been described. The aim of this review is to provide a broad overview of the available literature regarding changes in the worldwide epidemiology of endocrinological involvement in children since December 2019 and to report the evidence supporting its association with coronavirus disease 2019 (COVID-19). Although little is known regarding the involvement of endocrine organs during COVID-19 in children, the current evidence in adults and epidemiological studies on the pediatric population suggest the presence of a causal association between the virus and endocrinopathies. Untreated transient thyroid dysfunction, sick euthyroid syndrome, nonthyroidal illness syndrome, and hypothalamic–pituitary–adrenal (HPA) axis and central precocious puberty have been observed in children in acute infection and/or during multisystem inflammatory syndrome development. Furthermore, a higher frequency of ketoacidosis at onset in children with a new diagnosis of type 1 diabetes is reported in the literature. Although the direct association between COVID-19 and endocrinological involvement has not been confirmed yet, data on the development of different endocrinopathies in children, both during acute infection and as a result of its long-term complications, have been reported. This information is of primary importance to guide the management of patients with previous or current COVID-19. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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Graphical abstract

23 pages, 567 KiB  
Review
Psychological and Cognitive Effects of Long COVID: A Narrative Review Focusing on the Assessment and Rehabilitative Approach
by Rosaria De Luca, Mirjam Bonanno and Rocco Salvatore Calabrò
J. Clin. Med. 2022, 11(21), 6554; https://doi.org/10.3390/jcm11216554 - 04 Nov 2022
Cited by 7 | Viewed by 3851
Abstract
Long COVID is a clinical syndrome characterized by profound fatigue, neurocognitive difficulties, muscle pain, weakness, and depression, lasting beyond the 3–12 weeks following infection with SARS-CoV-2. Among the symptoms, neurocognitive and psychiatric sequelae, including attention and memory alterations, as well as anxiety and [...] Read more.
Long COVID is a clinical syndrome characterized by profound fatigue, neurocognitive difficulties, muscle pain, weakness, and depression, lasting beyond the 3–12 weeks following infection with SARS-CoV-2. Among the symptoms, neurocognitive and psychiatric sequelae, including attention and memory alterations, as well as anxiety and depression symptoms, have become major targets of current healthcare providers given the significant public health impact. In this context, assessment tools play a crucial role in the early screening of cognitive alterations due to Long COVID. Among others, the general cognitive assessment tools, such as the Montreal Cognitive assessment, and more specific ones, including the State Trait Inventory of Cognitive Fatigue and the Digit Span, may be of help in investigating the main neurocognitive alterations. Moreover, appropriate neurorehabilitative programs using specific methods and techniques (conventional and/or advanced) through a multidisciplinary team are required to treat COVID-19-related cognitive and behavioral abnormalities. In this narrative review, we sought to describe the main neurocognitive and psychiatric symptoms as well as to provide some clinical advice for the assessment and treatment of Long COVID. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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Other

11 pages, 1069 KiB  
Systematic Review
The Impact of COVID-19 on Carotid–Femoral Pulse Wave Velocity: A Systematic Review and Meta-Analysis
by Iwona Jannasz, Michal Pruc, Mansur Rahnama-Hezavah, Tomasz Targowski, Robert Olszewski, Stepan Feduniw, Karolina Petryka and Lukasz Szarpak
J. Clin. Med. 2023, 12(17), 5747; https://doi.org/10.3390/jcm12175747 - 04 Sep 2023
Cited by 1 | Viewed by 1061
Abstract
COVID-19 is a complex multisystemic disease that can result in long-term complications and, in severe cases, death. This study investigated the effect of COVID-19 on carotid–femoral pulse wave velocity (cfPWV) as a measurement to evaluate its impact on arterial stiffness and might help [...] Read more.
COVID-19 is a complex multisystemic disease that can result in long-term complications and, in severe cases, death. This study investigated the effect of COVID-19 on carotid–femoral pulse wave velocity (cfPWV) as a measurement to evaluate its impact on arterial stiffness and might help predict COVID-19-related cardiovascular (CV) complications. PubMed, Web of Science, Embase, and the Cochrane Library were searched for relevant studies, and meta-analysis was performed. The study protocol was registered in PROSPERO (nr. CRD42023434326). The Newcastle–Ottawa Quality Scale was used to evaluate the quality of the included studies. Nine studies reported cfPWV among COVID-19 patients and control groups. The pooled analysis showed that cfPWV in COVID-19 patients was 9.5 ± 3.7, compared to 8.2 ± 2.2 in control groups (MD = 1.32; 95% CI: 0.38–2.26; p = 0.006). A strong association between COVID-19 infection and increased cfPWV suggests a potential link between the virus and increased arterial stiffness. A marked increase in arterial stiffness, a known indicator of CV risk, clearly illustrates the cardiovascular implications of COVID-19 infection. However, further research is required to provide a clearer understanding of the connection between COVID-19 infection, arterial compliance, and subsequent CV events. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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14 pages, 6356 KiB  
Case Report
The Implications of SARS-CoV-2 Infection in a Series of Neuro-Ophthalmological Manifestations—Case Series and Literature Review
by Nicoleta Anton, Camelia Margareta Bogdănici, Daniel Constantin Brănișteanu, Ovidiu-Dumitru Ilie, Irina Andreea Pavel and Bogdan Doroftei
J. Clin. Med. 2023, 12(11), 3795; https://doi.org/10.3390/jcm12113795 - 31 May 2023
Cited by 1 | Viewed by 2582
Abstract
The global pandemic impact of the COVID-19 infection included clinical manifestations that affected several organs and systems, with various neuro-ophthalmological manifestations associated with the infection. These are rare and occur either secondary to the presence of the virus or by an autoimmune mechanism [...] Read more.
The global pandemic impact of the COVID-19 infection included clinical manifestations that affected several organs and systems, with various neuro-ophthalmological manifestations associated with the infection. These are rare and occur either secondary to the presence of the virus or by an autoimmune mechanism secondary to viral antigens. The manifestations are atypical, being present even in the absence of the systemic symptoms typical of a SARS-CoV-2 infection. In this article, we introduce a series of three clinical cases with neuro-ophthalmological manifestations associated with COVID infection that were shown in Ophthalmology Clinic of St. Spiridon Emergency Hospital. Case 1 is that of a 45-year-old male patient with no personal history of general pathology or ophthalmology, with binocular diplopia, painful red eyes, and lacrimal hypersecretion with a sudden onset of about 4 days. Based on the evaluations, a positive diagnosis of orbital cellulitis in both eyes is made. Case 2 is that of a 52-year-old female patient with general PPA (personal pathological antecedents) of SARS-CoV-2 infection 1 month prior to presentation with decreased visual acuity in the right eye and a positive central scotoma, preceded by photopsia and vertigo with balance disorders. The diagnosis is made at the right eye for retrobulbar optic neuritis and post-SARS-CoV-2 infection status. The last clinical case is that of a 55-year-old male patient known to have high blood pressure (HBP) with a sudden, painless decrease in VARE approximately 3 weeks post-SARS-CoV-2 immunization (Pfizer vaccine first dose). The diagnosis is made after consulting all the RE results for central retinal vein thrombosis. Conclusions: Although the cases were quickly and efficiently investigated and the treatment was administered adequately by a multidisciplinary team (cases 1 and 3), the evolution was not favorable in all three situations. Atypical neuro-ophthalmological manifestations can also be present in the absence of systemic symptoms typical of SARS-CoV-2 infection. Full article
(This article belongs to the Special Issue Clinical Consequences of COVID-19)
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