Spinal cord infarction attributed to SARS-CoV-2, with post-acute sequelae of COVID-19: A case report

BACKGROUND While stroke and lower extremity venous thromboemboli have been commonly reported following acute infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),spinal cord infarction or ischemia has been extremely rare.Findings of long coronavirus disease(COVID)in this select population have not been studied.CASE SUMMARY We present the case of a 70-year-old female with sudden onset of trunk and lower extremity sensorimotor loss due to spinal cord infarction,attributed to acute infection with SARS-CoV-2.Diagnostic work up confirmed a T3 complete(ASIA impairment Scale A)paraplegia resulting from a thrombotic infarct.Her reported myalgias,neuropathic pain,spasticity,bladder spasms,and urinary tract infections exceeded the frequency and severity of many spinal cord injury(SCI)individuals of similar age and degree of neurologic impairment.In her first year after contracting COVID-19,she underwent 2 separate inpatient rehabilitation courses,but also required acute hospitalization 6 additional times for subsequent infections or uncontrolled pain.Yet other complications of complete non-traumatic SCI(NTSCI),including neurogenic bowel and temperature hypersens-itivity,were mild,and pressure injuries were absent.She has now transitioned from the acute to chronic phase of spinal cord injury care,with subsequent development of post-acute sequelae of SARS-CoV-2 infection(PASC).CONCLUSION This individual experienced significant challenges with the combined effects of acute T3 NTSCI and acute COVID-19,with subsequent progression to PASC.Core Tip:Although stroke and venous thromboembolism have been frequently observed with acute coronavirus disease 2019(COVID-19),spinal cord infarction leading to paraplegia has rarely been seen.We report a case of spinal cord infarction shortly following infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Consequently,this individual has experienced severe neurologic disability,with subsequent development of long COVID.Symptoms such as myalgias,neuropathic pain,muscle spasms,and frequent bacterial infections are present in post-acute sequelae of SARS-CoV-2 infection(PASC),independent of spinal cord injury(SCI).Over the past 3 years,the dual presence of PASC and recent SCI may have led to increased severity of symptoms shared by both conditions.INTRODUCTION Among vascular events,spinal cord infarction is relatively rare,accounting for only 0.3%-1%of all strokes[1]and 5%-8%of acute myelopathies[2].One cause of spinal cord infarction arises from a thrombotic event in vulnerable areas of the thoracic cord,particularly between T8-12,which is supplied by the artery of Adamkiewicz.While deep vein thrombosis,pulmonary embolism,and stroke are commonly observed complications of coronavirus disease 2019(COVID-19),spinal cord infarction is comparatively infrequent[3-6].The cytokine release following acute infection,which peaks 7 d after contracting the virus,may be responsible for the increase in thrombotic events associated with acute infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)[7,8].This case discussed in this report differs from other published accounts describing spinal cord infarcts attributed to acute SARS-CoV-2,because we have followed this individual for nearly 3 years after contracting COVID-19,covering her difficulties with“long COVID,”which has now officially named post-acute sequelae of SARS-CoV-2 infection(PASC)by the World Health Organization[9].The term PASC may be assigned to“individuals with a history of probable or confirmed SARS-CoV-2 infection,usually 3 mo from the onset of COVID-19 with symptoms that last for at least 2 mo and cannot be explained by an alternative diagnosis”.The definition further states that PASC generally impacts everyday functioning and that symptoms may be of new onset,follow initial recovery from an acute COVID-19 episode,or persist from the initial illness.Moreover,symptoms may also fluctuate or relapse over time[9].Common complaints of PASC include fatigue,cough shortness of breath,cognitive deficits or“brain fog”.Reported features of PASC may also involve headache,heart palpitations,exercise intolerance,joint pain or swelling,myalgias,vertigo,peripheral neuropathy,altered taste or smell,disordered sleep,anxiety,depression,and thromboembolic events[10-13].While a number of the above symptoms may occur subsequent to SCI,many would be unusual,such as persistent cough,fatigue months after SCI,changes in taste or smell,continued exercise intolerance,new onset cognitive deficits or“brain fog”,unrelated to any sedating medications or concomitant brain injury.Our patient became symptomatic prior to COVID-19 vaccine availability and has given written consent to share her story for educational publication.This project was approved by the Institutional Review Board of the MetroHealth System.

Psychiatric sequelae in COVID-19 survivors:A narrative review

In December 2019,a novel coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)was initially reported in Wuhan,China.Previous epidemics including SARS and middle east respiratory syndrome raises concern that COVID-19 infection may pose a significant threat to the mental health of affected individuals.Studies and reviews have shown the acute psychiatric manifestations in COVID-19 patients,although long term psychiatric sequelae are predicted,there are only few review studies about the long term psychiatry outcome in COVID-19 survivors.Clinically significant posttraumatic stress disorder,anxiety,and/or depression among COVID-19 survivors during 14-90 d were observed following the diagnosis.Risk of anxiety or depression were higher in patients with more severe illness at 6 mo follow-up,early convalescence,and at 1 mo follow-up.Diagnosis of COVID-19 Led to more first diagnoses and relapses of psychiatric illness during the first 14-90 d after COVID-19 diagnosis.The possible underlying mechanisms of psychiatric sequelae in COVID-19 infection are neurotropism,immune response to SARS-CoV-2,hypothalamo-pituitary-adrenal axis hyperactivity,disrupted neuronal circuits in several brain regions,increased stress levels,neuroinflammation,and neuronal death.This study will review the psychiatric sequelae in previous coronavirus pandemics,current studies,risk factors,and thorough explanation on pathophysiology of the psychiatric sequalae in COVID-19 survivors.

COVID-19 sequelae:Clinical features and research progress

With the increasing number of COVID-19 patients cured and discharged,the emergence of associated sequelae has become a new global health crisis following acute infection.The sequela of COVID-19 involves many systems such as respiration,circulation,nerve,digestion,psychological cognition,and so on,with varying duration and severity,seriously affecting people's physical and mental health,as well as the development of society.This paper summarizes the clinical characteristics and research progress of COVID-19 sequelae through extensive review of relevant domestic and foreign literature,in order to provide reference for the development of a comprehensive and systematic management system.

Molecular imaging as a tool for evaluation of COVID-19 sequelae-A review of literature

Coronavirus disease 2019(COVID-19)is caused by the novel viral pathogen,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).COVID-19 primarily involves the lungs.Nucleic acid testing based on reverse-transcription polymerase chain reaction of respiratory samples is the current gold standard for the diagnosis of SARS-CoV-2 infection.Imaging modalities have an established role in triaging,diagnosis,evaluation of disease severity,monitoring disease progression,extra-pulmonary involvement,and complications.As our understanding of the disease improves,there has been substantial evidence to highlight its potential for multi-systemic involvement and development of longterm sequelae.Molecular imaging techniques are highly sensitive,allowing noninvasive visualization of physiological or pathological processes at a cellular or molecular level with potential for detection of functional changes earlier than conventional radiological imaging.The purpose of this review article is to highlight the evolving role of molecular imaging in evaluation of COVID-19 sequelae.Though not ideal for diagnosis,the various modalities of molecular imaging play an important role in assessing pulmonary and extra-pulmonary sequelae of COVID-19.Perfusion imaging using single photon emission computed tomography fused with computed tomography(CT)can be utilized as a first-line imaging modality for COVID-19 related pulmonary embolism.^(18)F-fluorodeoxyglucose positron emission tomography(PET)/CT is a sensitive tool to detect multi-systemic inflammation,including myocardial and vascular inflammation.PET in conjunction with magnetic resonance imaging helps in better characterization of neurological sequelae of COVID-19.Despite the fact that the majority of published literature is retrospective in nature with limited sample sizes,it is clear that molecular imaging provides additional valuable information(complimentary to anatomical imaging)with semi-quantitative or quantitative parameters to define inflammatory burden and can be used to guide therapeutic strategies and assess response.However,widespread clinical applicability remains a challenge owing to longer image acquisition times and the need for adoption of infection control protocols.

Effective strategies against COVID-19 and the importance of infection sequelae

COVID-19 is a serious threat to human health and development.The acute burden of the pandemic includes more than 18.2 million deaths worldwide,and is unprecedented in modern times.This represents only a fraction of the total burden,as it excludes infection sequelae.An effective global strategic paradigm has been missing throughout the pandemic.The‘flattening the curve’approach neglected the importance of infection sequelae,and being centered on healthcare capacity was conceptually contrary to a people-centered health system.In March 2022,the World Health Organization revised its pandemic approach,importantly shifting emphasis away from managing transmission and towards prevention.Despite limitations,this now recognizes the role of infection sequelae,whose impact is becoming clearer in both variety and scale.Drawing on the foundational concepts of Sun Tzu and Carl von Clausewitz,most country approaches do not qualify as strategies,but rather as operational plans.They are also largely ineffective,neglecting infection sequelae,viral evolution dangers and other parameters.The purpose of this article is to summarize the evidence on COVID-19 infection sequelae,and alongside other contextual parameters use this to motivate that infection should be prevented.This is then used to answer the question:What is an effective strategy against COVID-19?

Non-alcoholic fatty liver disease and COVID-19: Harmless companions or disease intensifier?

The pandemics of coronavirus disease 2019(COVID-19)and non-alcoholic fatty liver disease(NAFLD)coexist.Elevated liver function tests are frequent in COVID-19 and may influence liver damage in NAFLD,while preexisting liver damage from NAFLD may influence the course of COVID-19.However,the prognostic relevance of this interaction,though,is unclear.Obesity is a risk factor for the presence of NAFLD as well as a severe course of COVID-19.Cohort studies reveal conflicting results regarding the influence of NAFLD presence on COVID-19 illness severity.Striking molecular similarities of cytokine pathways in both diseases,including postacute sequelae of COVID-19,suggest common pathways for chronic low-activity inflammation.This review will summarize existing data regarding the interaction of both diseases and discuss possible mechanisms of the influence of one disease on the other.

Treatment Outcomes in COVID-19 Patients with Brucellosis:Case Series in Heilongjiang and Systematic Review of Literature

Objective Clinical characteristics and outcome in COVID-19 with brucellosis patients has not been well demonstrated,we tried to analyze clinical outcome in local and literature COVID-19 cases with brucellosis before and after recovery.Methods We retrospectively collected hospitalization data of comorbid patients and prospectively followed up after discharge in Heilongjiang Infectious Disease Hospital from January 15,2020 to April29,2022.Demographics,epidemiological,clinical symptoms,radiological and laboratory data,treatment medicines and outcomes,and follow up were analyzed,and findings of a systematic review were demonstrated.Results A total of four COVID-19 with brucellosis patients were included.One patient had active brucellosis before covid and 3 patients had nonactive brucellosis before brucellosis.The median age was54.5 years,and all were males(100.0%).Two cases(50.0%)were moderate,and one was mild and asymptomatic,respectively.Three cases(75.0%)had at least one comorbidity(brucellosis excluded).All4 patients were found in COVID-19 nucleic acid screening.Case C and D had only headache and fever on admission,respectively.Four cases were treated with Traditional Chinese medicine,western medicines for three cases,no adverse reaction occurred during hospitalization.All patients were cured and discharged.Moreover,one case(25.0%)had still active brucellosis without re-positive COVID-19,and other three cases(75.0%)have no symptoms of discomfort except one case fell fatigue and anxious during the follow-up period after recovery.Conducting the literature review,two similar cases have been reported in two case reports,and were both recovered,whereas,no data of follow up after recovery.Conclusion These cases indicate that COVID-19 patients with brucellosis had favorable outcome before and after recovery.More clinical studies should be conducted to confirm our findings.

3-to 24-month Follow-up on COVID-19 with Pulmonary Tuberculosis Survivors after Discharge:Results from a Prospective,Multicenter Study

Objective Coronavirus disease 2019(COVID-19)and tuberculosis(TB)are major public health and social issues worldwide.The long-term follow-up of COVID-19 with pulmonary TB(PTB)survivors after discharge is unclear.This study aimed to comprehensively describe clinical outcomes,including sequela and recurrence at 3,12,and 24 months after discharge,among COVID-19 with PTB survivors.Methods From January 22,2020 to May 6,2022,with a follow-up by August 26,2022,a prospective,multicenter follow-up study was conducted on COVID-19 with PTB survivors after discharge in 13 hospitals from four provinces in China.Clinical outcomes,including sequela,recurrence of COVID-19,and PTB survivors,were collected via telephone and face-to-face interviews at 3,12,and 24 months after discharge.Results Thirty-two COVID-19 with PTB survivors were included.The median age was 52(45,59)years,and 23(71.9%)were men.Among them,nearly two-thirds(62.5%)of the survivors were moderate,three(9.4%)were severe,and more than half(59.4%)had at least one comorbidity(PTB excluded).The proportion of COVID-19 survivors with at least one sequela symptom decreased from 40.6%at 3 months to 15.8%at 24 months,with anxiety having a higher proportion over a follow-up.Cough and amnesia recovered at the 12-month follow-up,while anxiety,fatigue,and trouble sleeping remained after 24months.Additionally,one(3.1%)case presented two recurrences of PTB and no re-positive COVID-19during the follow-up period.Conclusion The proportion of long symptoms in COVID-19 with PTB survivors decreased over time,while nearly one in six still experience persistent symptoms with a higher proportion of anxiety.The recurrence of PTB and the psychological support of COVID-19 with PTB after discharge require more attention.

Gastrointestinal manifestations of long-term effects after COVID-19 infection in patients with dialysis or kidney transplantation:An observational cohort study

BACKGROUND Prolonged symptoms after corona virus disease 2019(Long-COVID) in dialysisdependent patients and kidney transplant(KT) recipients are important as a possible risk factor for organ dysfunctions,especially gastrointestinal(GI)problems,during immunosuppressive therapy.AIM To identify the characteristics of GI manifestations of Long-COVID in patients with dialysis-dependent or KT status.METHODS This observational,prospective study included patients with COVID-19 infection,confirmed by reverse transcription polymerase chain reaction,with the onset of symptoms between 1 January 2022 and 31 July 2022 which was explored at 3 mo after the onset,either through the out-patient follow-up or by telephone interviews.RESULTS The 645 eligible participants consisted of 588 cases with hemodialysis(HD),38 patients with peritoneal dialysis(PD),and 19 KT recipients who were hospitalized with COVID-19 infection during the observation. Of these,577(89.5%) cases agreed to the interviews,while 64(10.9%)patients with HD and 4(10.5%) cases of PD were excluded. The mean age was 52 ± 11 years with 52% women. The median dialysis duration was 7 ± 3 and 5 ± 1 years for HD and PD groups,respectively,and the median time post-transplantation was 6 ± 2 years. Long-COVID was identified in 293/524(56%) and 21/34(62%) in HD and PD,respectively,and 7/19(37%) KT recipients. Fatigue was the most prevalent(96%) of the non-GI tract symptoms,whereas anorexia(90.9%),loss of taste(64.4%),and abdominal pain(62.5%) were the first three common GI manifestations of Long-COVID. Notably,there were 6 cases of mesenteric panniculitis from 19patients with GI symptoms in the KT group.CONCLUSION Different from patients with non-chronic kidney disease,there was a high prevalence of GI manifestations of Long-COVID in dialysis-dependent patients and KT recipients. An appropriate long-term follow-up in these vulnerable populations after COVID-19 infection is possibly necessary.

Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis:A modified Naranjo Score appraisal

BACKGROUND Acute pancreatitis(AP)is a disease spectrum ranging from mild to severe disease.During the coronavirus disease 2019(COVID-19)pandemic,numerous reports of AP have been published,with most authors concluding a causal relationship between COVID-19 and AP.Retrospective case reports or small case series are unable to accurately determine the cause-effect relationship between COVID-19 and AP.AIM To establish whether COVID-19 is a cause of AP using the modified Naranjo scoring system.METHODS A systematic review was conducted on PubMed,World of Science and Embase for articles reporting COVID-19 and AP from inception to August 2021.Exclusion criteria were cases of AP which were not reported to be due to COVID-19 infection,age<18 years old,review articles and retrospective cohort studies.The original 10-item Naranjo scoring system(total score 13)was devised to approximate the likelihood of a clinical presentation to be secondary to an adverse drug reaction.We modified the original scoring system into a 8-item modified Naranjo scoring system(total score 9)to determine the cause-effect relationship between COVID-19 and AP.A cumulative score was decided for each case presented in the included articles.Interpretation of the modified Naranjo scoring system is as follows:≤3:Doubtful,4-6:Possible,≥7:Probable cause.RESULTS The initial search resulted in 909 articles,with 740 articles after removal of duplicates.A total of 67 articles were included in the final analysis,with 76 patients which had AP reported to be due to COVID-19.The mean age was 47.8(range 18-94)years.Majority of patients(73.3%)had≤7 d between onset of COVID-19 infection and diagnosis of AP.There were only 45(59.2%)patients who had adequate investigations to rule out common aetiologies(gallstones,choledocholithiasis,alcohol,hypertriglyceridemia,hypercalcemia and trauma)of AP.Immunoglobulin G4 testing was conducted in 9(13.5%)patients to rule out autoimmune AP.Only 5(6.6%)patients underwent endoscopic ultrasound and/or magnetic resonance cholangiopancreatogram to rule out occult microlithiasis,pancreatic malignancy and pancreas divisum.None of the patients had other recently diagnosed viral infections apart from COVID-19 infection,or underwent genetic testing to rule out hereditary AP.There were 32(42.1%),39(51.3%)and 5(6.6%)patients with doubtful,possible,and probable cause-effect relationship respectively between COVID-19 and AP.CONCLUSION Current evidence is weak to establish a strong link between COVID-19 and AP.Investigations should be performed to rule out other causes of AP before establishing COVID-19 as an aetiology.

COVID-19 and the liver:Are footprints still there?

The coronavirus disease 2019(COVID-19)hit the entire world as a global pandemic and soon became the most important concern for all patients with chronic diseases.An early trend in higher mortality in patients with acute respiratory distress attracted all researchers to closely monitor patients for the involvement of other systems.It soon became apparent that patients with chronic liver diseases are at increased risk of mortality given their cirrhosis-associated immune dysfunction.Additionally,liver function abnormalities were noted in patients with severe COVID-19.Profound cytokine storm,direct viral infection,drugs and reactivation of viral infections were causes of deranged liver functions.Here,we discuss the relation between COVID-19 and chronic liver disease,specifically cirrhosis,hepatitis B,hepatitis C,and non-alcoholic fatty liver disease(NAFLD),as well as the liver manifestations of COVID-19.The metabolic syndrome,obesity,diabetes mellitus and NAFLD were found to worsen outcome in different studies reported worldwide.Decompensated cirrhosis should be considered a risk factor for death and severe COVID-19.Recently,COVID-19 related cholangiopathy has also been reported with changes of secondary sclerosing cholangitis.The long-term persistence of viral antigens in gut epithelia raises concern regarding the future risk of autoimmune liver diseases.

Transition beyond the acute phase of the COVID-19 pandemic: Need to address the long-term health impacts of COVID-19

Despite gaps in knowledge,long-term sequelae of coronavirus disease 2019(COVID-19)infections are globally acknowledged and thus require special attention by public health organizations and services.Therefore,it is necessary to support and promote public health initiatives that address long-term disability due to COVID-19.

Alzheimer’s disease risk after COVID-19:a view from the perspective of the infectious hypothesis of neurodegeneration

In light of the rising evidence of the association between viral and bacterial infections and neurodegeneration,we aimed at revisiting the infectious hypothesis of Alzheimer’s disease and analyzing the possible implications of COVID-19 neurological sequelae in long-term neurodegeneration.We wondered how SARS-CoV-2 could be related to the amyloid-βcascade and how it could lead to the pathological hallmarks of the disease.We also predict a paradigm change in clinical medicine,which now has a great opportunity to conduct prospective surveillance of cognitive sequelae and progression to dementia in people who suffered severe infections together with other risk factors for Alzheimer’s disease.

Preliminary Guidelines for the Use of IVIg during COVID-19

Infection with the severe acute respiratory syndrome novel type-2 novel coronavirus (SARS-CoV-2) responsible for the 2019 coronavirus disease (COVID-19) shows a highly heterogeneous clinical presentation and age affliction in children and adults, ranging from asymptomatic or mild disease to severe involvement, with potentially fatal respiratory failure and multiple organ dysfunction. As susceptibility to severe COVID-19 depends upon comorbid factors including immune competence, optimizing the latter through low-dose supplementation or high dose treatment with immune globulin therapy in those with primary immune deficiency and post-infectious immune sequelae of SARS-CoV-2 and existing autoimmune disorders is essential. There are no existing guidelines hence;this paper provides a framework for considering preliminary guidelines for the use of immune globulin therapy during COVID-19.

Legacy of neuropsychiatric symptoms associated with past COVID-19 infection:A cause of concern

Although primarily affecting the respiratory system,growing attention is being paid to the neuropsychiatric consequences of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infections.Acute and sub-acute neuropsychiatric manifestations of coronavirus disease 2019(COVID-19)disease and their mechanisms are better studied and understood currently than they had been when the pandemic began;however,many months or years will be necessary to fully comprehend how significant the consequences of such complications will be.In this editorial,we discuss the possible long-term sequelae of the COVID-19 pandemic,deriving our considerations on experiences drawn from past coronaviruses’outbreaks,such as the SARS and the middle east respiratory syndrome,and from the knowledge of the mechanisms of neurotropism and invasiveness of SARS-CoV-2.Acknowledging the global spread of COVID-19 and the vast number of people affected,to date amounting to many millions,the matter of this pandemic’s neuropsychiatric legacy appears concerning.Public health monitoring strategies and early interventions seem to be necessary to manage the possible emergence of a severe wave of neuropsychiatric distress among the survivors.

Molecular Phenomic Approaches to Deconvolving the Systemic Effects of SARS-CoV-2 Infection and Post-acute COVID-19 Syndrome

SARS COV-2 infection causes acute and frequently severe respiratory disease with associated multi-organ damage and systemic disturbances in many biochemical pathways.Metabolic phenotyping provides deep insights into the complex immunopathological problems that drive the resulting COVID-19 disease and is also a source of novel metrics for assess-ing patient recovery.A multiplatform metabolic phenotyping approach to studying the pathology and systemic metabolic sequelae of COVID-19 is considered here,together with a framework for assessing post-acute COVID-19 Syndrome(PACS)that is a major long-term health consequence for many patients.The sudden emergence of the disease presents a biological discovery challenge as we try to understand the pathological mechanisms of the disease and develop effective mitigation strategies.This requires technologies to measure objectively the extent and sub-phenotypes of the disease at the molecular level.Spectroscopic methods can reveal metabolic sub-phenotypes and new biomarkers that can be monitored during the acute disease phase and beyond.This approach is scalable and translatable to other pathologies and provides as an exem-plar strategy for the investigation of other emergent zoonotic diseases with complex immunological drivers,multi-system involvements and diverse persistent symptoms.

Effect of Different Factors on the Quality of Life and Sequelae of COVID-19 Patients After Discharge

Background The continued spread of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)remains an international public health emergency,resulting in a significant global disease burden.The long-term effects of SARS-CoV-2 infection in humans and the long-term prognosis of patients with coronavirus disease 2019(COVID-19)after discharge remain unclear.We aimed to assess the quality of life(QoL)and sequelae in patients with COVID-19 after discharge from the hospital by conducting multiple follow-up visits to understand the long-term effects of SARS-CoV-2 on patients'health and its possible influencing factors.Methods COVID-19 patients discharged from Huoshenshan Hospital(Wuhan,China)between February 15 and April 5,2020,were followed up at 6,9,and 12 months after discharge.They completed questionnaires on postdischarge QoL and sequelae under the guidance of medical staff with professional training.The demographic and clinical characteristics of the COVID-19 patients were analyzed using descriptive statistics.A generalized estimating equation model was used to analyze the QoL-related factors.Theχ2 test(or Fisher exact test)and multivariate logistic regression analysis were used to analyze the sequelae and influencing factors.Results A total of 175 patients participated in at least 1 follow-up visit,and 120 completed all 3 follow-up visits.Patients diagnosed with severe and critically ill COVID-19 had worse mental conditions(χ2=7.653,P=0.022)than those with the nonsevere type(not severe or critical)and were more likely to feel fatigued(χ2=4.836,P=0.028).Female patients had a higher risk of sleep disturbance(χ2=10.026,P=0.002)and dyspnea(χ2=5.672,P=0.017)and had more difficulty returning to their original work and life(χ2=8.922,P=0.003)than male patients.Patients with diabetes had a worse appetite(χ2=4.669,P=0.031)and were more prone to sleep disturbance(χ2=4.417,P=0.036)after discharge.The proportion of patients with at least 1 sequela increased from 29.76%(50/168)at 6 months to 51.11%(69/135)at 9 months(χ2=14.305,P<0.001).Compared with the nonsevere type,patients diagnosed with severe and critically ill COVID-19 had an odds ratio(OR)of 4.325(95%confidence interval[CI],1.215–15.401)for memory decline.Female patients had an OR of 4.632(95%CI,1.716–12.501)for joint or muscle pain.Patients with hypertension had an OR of 3.014(95%CI,1.193–7.615)for joint or muscle pain.Conclusion One year after discharge,there were still some patients with varying degrees of decline in QoL and sequelae,which occurred in all follow-up visits.Moreover,QoL and sequelae after discharge were related to sex,clinical classification of COVID-19,and underlying diseases.

Long COVID and gut candidiasis:What is the existing relationship?

Since the beginning of the coronavirus disease(COVID)2019 pandemic,thou-sands of articles on the topic have been published,and although there is a growing trend of research on another associated condition,long coronavirus disease,important points still remain to be clarified in this respect.Robust evidence has suggested a relevant link between new clinical discoveries and molecular mechanisms that could be associated with the manifestations of different signs and symptoms involving cases of long COVID.However,one of the existing gaps that requires further investigation concerns a possible rela-tionship between gut candidiasis and long COVID.While recent studies also suggest an interplay between the occurrence of these two conditions,it is not yet fully clear how this may happen,as well as the specifics regarding the possible pathophysiological mechanisms involved.In this connection and with the advent of a potential strengthening of the body of evidence supporting the hypothesis of a link between gut candidiasis and long COVID,a better understanding of the clinical presentation,pathophysiology and clinical management of such a relationship should be essential and useful for both,additional advances towards more targeted research and appropriate case management.Knowing more about the signs,symptoms,and complications associated with cases of long COVID is essential in order to more effectively mitigate the related burden and provide a higher quality of care and life for the affected population.In light of this and the need for better outcomes,here we review and discuss the content on different aspects of long COVID,including its pathophysiology and the existing evidence of a potential relationship between such a condition and gut candidiasis,as well as suggest propositions for future related research.INTRODUCTION Long coronavirus disease(COVID)is a condition characterized by the emergence of new symptoms or the persistence of existing symptoms for at least two months,three months after the initial infection[1].Although such a condition has initially been extensively studied,there are still many contradictions between the findings and methodologies of different related research articles[2,3].Within this context and since the middle of the COVID-19 pandemic,important studies have been published in the literature reporting the occurrence of fungal infections among COVID-19 patients[4,5],including mucormycosis,and oral candidiasis[6].On the other hand,evidence on a possible relationship between gut candidiasis and long COVID is still recent[7].Indeed,a marked gastrointestinal(GI)fungal dysbiosis together with perturbation of the lung-gut axis has been observed in severe COVID-19 patients.This combined with neutrophilia and an exacerbated worsening of the inflammatory response,which can be implicated in the acute and chronic immunopathology of such a viral disease[7,8].Furthermore,persistent changes in the immune system may also occur,resulting in a possible relationship with the occurrence of long COVID[7].However,more targeted evidence is still scarce and the specific topic related to gut candidiasis has been the subject of little discussion.In response to this,in this article we discuss general aspects of long COVID,the inherent pathophysiology and current evidence of a potential relationship between this condition and gut candidiasis,in addition to providing recommendations for future research.ACKNOWLEDGEMENTS Tovani-Palone MR thanks the Saveetha Institute of Medical and Technical Sciences for supporting this study.

Severe SARS-CoV-2 Infection: Late Impact on the Retinal Ganglion Cell Layer Thickness

Purpose: The involvement of the ocular anterior segment by SARS-CoV-2 has been the subject of many studies, however, the repercussions on the posterior segment, particularly on the different layers of the retina and optic nerve, are still little known. The purpose of this study was to evaluate the impact of severe COVID-19 on the retinal ganglion cell layer (RGCL) thickness. Methods: This observational, prospective and analytical study was performed in the Ophthalmology Department of the FACISA University Center, Campina Grande. Three groups were included: group I (control), 29 healthy individuals who had not severe COVID-19;group II (infirmary), 24 individuals who had COVID-19 and were hospitalized in the infirmary;and group III, 25 individuals who had severe COVID-19 and required Intense Care Unit (ICU). All individuals had ophthalmologic examination and assessment of RGCL thickness using Optical Coherence Tomography (OCT). Statistical tests required p ≤ 0.05 to reject the null hypothesis. Results: The mean of RGCL thickness was significantly reduced in individuals from GIII (77.9 ± 8.9 µm), as compared with GII (83.9 ± 10.9 µm) and GI (82.8 ± 6.5 µm) (p = 0.0027). The mean measurements from the retinal neve fiber layer (RNFL) of the optic nerve head were similar. However, when evaluated sectoral, the mean of RNFL at the temporal sector of the optic disc was significantly lower in group GIII (p Conclusion: The RGCL thickness from patients with severe COVID-19 was significantly reduced. This finding supports that the SARS-CoV-2 has systemic action and affinity for nerve cells, including those from the retina and are related to the severity of the infection.

Neuropsychiatric symptoms associated with the COVID-19 and its potential nervous system infection mechanism:the role of imaging in the study

The epidemic of coronavirus disease 2019(COVID-19)has broken the normal spread mode of respiratory viruses,namely,mainly spread in winter,resulting in over 230 million confirmed cases of COVID-19.Many studies have shown that severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)can affect the nervous system by varying degrees.In this review,we look at the acute neuropsychiatric impacts of COVID-19 patients,including acute ischemic stroke,encephalitis,acute necrotizing encephalopathy,dysosmia,and epilepsy,as well as the long-term neuropsychiatric sequelae of COVID-19 survivors:mental disorder and neurodegenerative diseases.In particular,this review discusses long-term changes in brain structure and function associated with COVID-19 infection.We believe that the traditional imaging sequences are important in the acute phase,while the nontraditional imaging sequences are more meaningful for the detection of long-term neuropsychiatric sequelae.These long-term follow-up changes in structure and function may also help us understand the causes of neuropsychiatric symptoms in COVID-19 survivors.Finally,we review previous studies and discuss some potential mechanisms of SARS-CoV-2 infection in the nervous system.Continuous focus on neuropsychiatric sequelae and a comprehensive understanding of the long-term impacts of the virus to the nervous system is significant for formulating effective sequelae prevention andmanagement strategies,andmay provide important clues for nervous system damage in future public health crises.