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 ischemi...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.展开更多
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 ...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.展开更多
BACKGROUND Regional anesthesia is a promising method in patients with post coronavirus disease 2019(COVID-19)pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications,co...BACKGROUND Regional anesthesia is a promising method in patients with post coronavirus disease 2019(COVID-19)pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications,compared with general anesthesia.CASE SUMMARY We provided surgical anesthesia and analgesia suitable for breast surgery by performing pectoral nerve block type II(PECS-II),parasternal,and intercostobrachial nerve blocks with intravenous dexmedetomidine administration in a 61-year-old female patient with severe pulmonary sequelae after COVID-19infection.CONCLUSION Sufficient analgesia for 7 h was provided via PECS-II,parasternal,and intercostobrachial blocks perioperatively.展开更多
Objective:To study cardiovascular sequelae of post-COVID-19 patients with moderate to severe computed tomography(CT)severity score.Methods:A prospective,non-randomized,observational study was conducted on 100 post-COV...Objective:To study cardiovascular sequelae of post-COVID-19 patients with moderate to severe computed tomography(CT)severity score.Methods:A prospective,non-randomized,observational study was conducted on 100 post-COVID-19 patients with moderate to severe CT severity scores from January 2021 to December 2021.Fifty-nine were male[mean age(54.1±12.2)years]and 41 were female[mean age(46.9±15.1)years].Patients with previous cardiovascular disease,previous chronic lung disease,and pre-existing primary or secondary pulmonary hypertension were excluded.Patients were examined,and serial electrocardiogram and 2D echocardiography were performed to detect any cardiovascular abnormality.Results:Post-COVID-19 patients had persistent symptoms,the most common being fatigue(59%).Most of these symptoms were relieved on follow-up.A rise in systolic,diastolic blood pressure,and pulse rate was observed.The electrocardiographic evaluation revealed ST-T segment changes,sinus tachycardia,ventricular hypertrophy,and arrhythmias among a considerable number of patients.On echocardiography,left ventricular diastolic dysfunction was most common(43%).Pulmonary hypertension,as evidenced by elevated pulmonary artery systolic pressure,was seen in 15%of patients.Conclusions:The present findings reveal an increased incidence of cardiovascular complications after recovery from COVID-19 infection in those without pre-existing cardiovascular or chronic lung disease.展开更多
目的:分析新型冠状病毒感染(COVID-19)相关心律失常的文献,探索该领域的研究现状、热点并预测未来的趋势,为后来的研究者提供借鉴。方法:选择Web of Science的核心合集数据库,每项研究都进行了文献计量和视觉分析,使用CiteSpace和VOSvie...目的:分析新型冠状病毒感染(COVID-19)相关心律失常的文献,探索该领域的研究现状、热点并预测未来的趋势,为后来的研究者提供借鉴。方法:选择Web of Science的核心合集数据库,每项研究都进行了文献计量和视觉分析,使用CiteSpace和VOSviewer软件生成知识图谱。结果:共鉴定出768篇文章,发文涉及美国、意大利和中国为首的319个国家/地区和4 366个机构,领先的研究机构是梅奥诊所和哈佛医学院。New England Journal of Medicine是该领域最常被引用的期刊。在6 687位作者中,Arbelo Elena撰写的研究最多,Guo T被共同引用的次数最多,心房纤颤是最常见的关键词。结论:随着COVID-19的暴发,对COVID-19所致新发/进行性心律失常事件的研究蓬勃发展,未来的研究者可能会对COVID-19感染后新发或遗留的快速性心律失常/缓慢性心律失常的发生机制进行进一步的探索。展开更多
Background:Solid organ transplant(SOT)activities,such as liver transplant,have been greatly influenced by the pandemic of coronavirus disease 2019(COVID-19),a disease caused by severe acute respiratory syndrome corona...Background:Solid organ transplant(SOT)activities,such as liver transplant,have been greatly influenced by the pandemic of coronavirus disease 2019(COVID-19),a disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Immunosuppressed individuals of liver transplant recipients(LTRs)tend to have a high risk of COVID-19 infection and related complications.Therefore,COVID-19 vaccination has been recommended to be administered as early as possible in LTRs.Data sources:The keywords“liver transplant”,“SARS-CoV-2”,and“vaccine”were used to retrieve articles published in PubMed.Results:The antibody response following the 1st and 2nd doses of vaccination was disappointingly low,and the immune responses among LTRs remarkably improved after the 3rd or 4th dose of vaccination.Although the 3rd or 4th dose of COVID-19 vaccine increased the antibody titer,a proportion of patients remained unresponsive.Furthermore,recent studies showed that SARS-CoV-2 vaccine could trigger adverse events in LTRs,including allograft rejection and liver injury.Conclusions:This review provides the recently reported data on the antibody response of LTRs following various doses of vaccine,risk factors for poor serological response and adverse events after vaccination.展开更多
文摘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.
基金supported by grants from the National Key R&D Program of China(2020YFC0860900)Military Logistics Research Project(BLB19J017).
文摘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.
文摘BACKGROUND Regional anesthesia is a promising method in patients with post coronavirus disease 2019(COVID-19)pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications,compared with general anesthesia.CASE SUMMARY We provided surgical anesthesia and analgesia suitable for breast surgery by performing pectoral nerve block type II(PECS-II),parasternal,and intercostobrachial nerve blocks with intravenous dexmedetomidine administration in a 61-year-old female patient with severe pulmonary sequelae after COVID-19infection.CONCLUSION Sufficient analgesia for 7 h was provided via PECS-II,parasternal,and intercostobrachial blocks perioperatively.
文摘Objective:To study cardiovascular sequelae of post-COVID-19 patients with moderate to severe computed tomography(CT)severity score.Methods:A prospective,non-randomized,observational study was conducted on 100 post-COVID-19 patients with moderate to severe CT severity scores from January 2021 to December 2021.Fifty-nine were male[mean age(54.1±12.2)years]and 41 were female[mean age(46.9±15.1)years].Patients with previous cardiovascular disease,previous chronic lung disease,and pre-existing primary or secondary pulmonary hypertension were excluded.Patients were examined,and serial electrocardiogram and 2D echocardiography were performed to detect any cardiovascular abnormality.Results:Post-COVID-19 patients had persistent symptoms,the most common being fatigue(59%).Most of these symptoms were relieved on follow-up.A rise in systolic,diastolic blood pressure,and pulse rate was observed.The electrocardiographic evaluation revealed ST-T segment changes,sinus tachycardia,ventricular hypertrophy,and arrhythmias among a considerable number of patients.On echocardiography,left ventricular diastolic dysfunction was most common(43%).Pulmonary hypertension,as evidenced by elevated pulmonary artery systolic pressure,was seen in 15%of patients.Conclusions:The present findings reveal an increased incidence of cardiovascular complications after recovery from COVID-19 infection in those without pre-existing cardiovascular or chronic lung disease.
文摘目的:分析新型冠状病毒感染(COVID-19)相关心律失常的文献,探索该领域的研究现状、热点并预测未来的趋势,为后来的研究者提供借鉴。方法:选择Web of Science的核心合集数据库,每项研究都进行了文献计量和视觉分析,使用CiteSpace和VOSviewer软件生成知识图谱。结果:共鉴定出768篇文章,发文涉及美国、意大利和中国为首的319个国家/地区和4 366个机构,领先的研究机构是梅奥诊所和哈佛医学院。New England Journal of Medicine是该领域最常被引用的期刊。在6 687位作者中,Arbelo Elena撰写的研究最多,Guo T被共同引用的次数最多,心房纤颤是最常见的关键词。结论:随着COVID-19的暴发,对COVID-19所致新发/进行性心律失常事件的研究蓬勃发展,未来的研究者可能会对COVID-19感染后新发或遗留的快速性心律失常/缓慢性心律失常的发生机制进行进一步的探索。
基金the National Natural Science Foundation of China(82103662).
文摘Background:Solid organ transplant(SOT)activities,such as liver transplant,have been greatly influenced by the pandemic of coronavirus disease 2019(COVID-19),a disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Immunosuppressed individuals of liver transplant recipients(LTRs)tend to have a high risk of COVID-19 infection and related complications.Therefore,COVID-19 vaccination has been recommended to be administered as early as possible in LTRs.Data sources:The keywords“liver transplant”,“SARS-CoV-2”,and“vaccine”were used to retrieve articles published in PubMed.Results:The antibody response following the 1st and 2nd doses of vaccination was disappointingly low,and the immune responses among LTRs remarkably improved after the 3rd or 4th dose of vaccination.Although the 3rd or 4th dose of COVID-19 vaccine increased the antibody titer,a proportion of patients remained unresponsive.Furthermore,recent studies showed that SARS-CoV-2 vaccine could trigger adverse events in LTRs,including allograft rejection and liver injury.Conclusions:This review provides the recently reported data on the antibody response of LTRs following various doses of vaccine,risk factors for poor serological response and adverse events after vaccination.