Evaluation of Clinical Characteristics and Plasma Cortisol Concentrations in Individuals with COVID-19 and Post-COVID Syndrome

COVID-19 generates systematic alterations in humans both in active stages of infection and over time, called post-COVID syndrome. Cortisol is a hormone that is overexpressed in inflammation and cellular stress processes. Its main function is to return to physiological homeostasis, so its evaluation together with other clinical parameters can allow us to determine the degree of systemic affectation by COVID-19. Objective: To evaluate changes in clinical parameters and plasma cortisol concentrations in patients with active COVID-19 and post-COVID syndrome. Material and Methods: Healthy patients, in stages of mild infection, critical and with post-COVID syndrome, were recruited, obtaining, through clinical diagnoses and interviews, their main clinical characteristics, in addition to plasma, in which cortisol concentrations were determined using competitive ELISA. Results: The critical stage group had higher frequencies of comorbidities, clinical symptoms, as well as more altered laboratory parameters compared to the other subgroups. In the post-COVID syndrome group after the initial infection, most laboratory parameters recovered, however, several clinical symptoms remained latent over time. The determination of cortisol showed an increase in its concentration, being higher in patients in critical stage and with post-COVID syndrome. Conclusion: COVID-19 disease generates clinical alterations that trigger an increase in plasma cortisol. These alterations increase as the stages of infection become more severe and some of them remain altered in patients with post-COVID syndrome.

Effectiveness of simulation-based learning regarding management of post-COVID complications in terms of knowledge,clinical decision-making ability,and self-efficacy among nursing students:A quasi-experimental study

Objective:To assess the effectiveness of simulation-based learning regarding the management of post-COVID complications in terms of knowledge,clinical decision-making ability,and self-efficacy among nursing students.Methods:This was a quasi-experimental study conducted among 1152nd-year nursing students.The participants were selected by a simple random sampling technique.The participants were divided into an experimental(n=56)and a comparison group(n=59)by a random table method.Data were analyzed using descriptive and inferential statistics with SPSS version 20.Results:There were significant differences in mean post-test knowledge scores(P=0.03)and mean post-test self-efficacy scores(P=0.001)between the experimental and the comparison groups while the difference in mean post-test clinical decision-making ability scores between the two groups was non-significant(P=0.07).A positive correlation was found between knowledge and clinical decision-making ability in pre-test(P=0.03)and in post-test(P<0.001)and a non-significant correlation was found between pre-test knowledge and self-efficacy score(P=0.52)among the experimental group.Conclusions:Simulation-based learning regarding the management of post-COVID complications is effective among nursing students.Simulation labs should be established in health care settings where simulation training can be provided for updating the knowledge,clinical decision-making ability,and self-efficacy of nursing personnel during program installment and continuous nursing education.

Associations between Continuing Symptoms and Quality of Life in Post-COVID-19 Patients (2023)

COVID-19 is a multisystem disease that can cause various symptoms which last even after the acute stage and negatively impact the quality of life of patients. It is of utmost importance to comprehensively evaluate how COVID-19 affects not only patients’ physical and mental health, but also their family and social life. This knowledge plays a significant role in the creation of effective ways to assist those suffering from long COVID to address health-related quality of life issues in a timely manner.

Examining the Effectiveness of Virtual Training under the Kirkpatrick Model:A Post-COVID Study

Teaching and training through online tools were used by most Higher Education Institute(HEIs)worldwide during COVID-19 to cater to the needs of students who stay far away from educational institutions.After the pandemic,the virtual model of education and training became a trend.The students and teachers are also more used to this trend which is giving more opportunities to both learners and instructors.One of the notable benefits of virtual teaching and learning platform is that it provides a flexible environment to gain knowledge,skills,and attitude simultaneously along with formal off-line education.From the earlier studies it is found that the majority of studies have focused on traditional,offline training methods and only a few studies have focused on virtual training.Therefore,the present study examined the effectiveness of virtual training using the Kirkpatrick model.For this purpose,a research instrument based on the Kirkpatrick model was constructed and distributed among the UG and PG students in Mangalore City.A total of 143 responses were collected,of which 132 were completed responses and all of them were considered for analysis.Descriptive statistics and one sample t-test are employed to analyse and interpret the data.The findings revealed that virtual training is more effective compared to traditional and offline training methods.Henceforth,the training and education provided through virtual platforms made significant contributions to the employability of youngsters.

A cross-sectional study of post-COVID syndrome at a tertiary care center in Turkey

Objective:To investigate long-term symptoms after acute COVID-19,the link between symptoms and respiratory function,radiological changes in the post-COVID period,and risk factors for post-COVID syndrome.Methods:In this cross-sectional study,123 participants who were admitted within the first 3 months were categorized as group 1,and those who applied after 3 months were categorized as group 2.According to thoracic imaging and pulmonary function tests,patients were split into 3 groups as mild,moderate and severe.Results:At least one symptom was present in 91.9%and 61.8%in acute and post-COVID period,respectively.Pulmonary function tests were normal in 60(70.6%)in the first three months,and 30(78.9%)in 91-days to 1-year period after acute COVID-19 infection.After 3 months,22.4%of chest X-rays and 7.9%of computerized tomography revealed progression.Patients who developed acute complications(OR 9.91,95%CI 1.93-50.87),had 2 or more symptoms at admission(OR 7.73,95%CI 2.56-23.33),had 1%to 14%CT involvement(OR 3.05,95%CI 1.06-8.79),or had 50%or more CT involvement(OR 14.68,95%CI 1.24-172.55)had a higher risk of developing post-COVID syndrome.Conclusions:COVID-19 symptoms can last for long time.Severity of symptoms,acute complications,and the extent of radiological involvement may all contribute to elevated risk of post-COVID syndrome.As a result,patients with COVID-19 should be checked for long-term clinical difficulties on regular basis.

COVID-19-induced gastrointestinal autonomic dysfunction:A systematic review

BACKGROUND It is common for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection to occur in the gastrointestinal tract,which can present itself as an initial symptom.The severity of coronavirus disease 2019(COVID-19)is often reflected in the prevalence of gastrointestinal symptoms.COVID-19 can damage the nerve supply to the digestive system,leading to gastrointestinal autonomic dysfunction.There is still much to learn about how COVID-19 affects the autonomic nervous system and the gastrointestinal tract.AIM To thoroughly explore the epidemiology and clinical aspects of COVID-19-induced gastrointestinal autonomic dysfunction,including its manifestations,potential mechanisms,diagnosis,differential diagnosis,impact on quality of life,prognosis,and management and prevention strategies.METHODS We conducted a thorough systematic search across various databases and performed an extensive literature review.Our review encompassed 113 studies published in English from January 2000 to April 18,2023.RESULTS According to most of the literature,gastrointestinal autonomic dysfunction can seriously affect a patient's quality of life and ultimate prognosis.Numerous factors can influence gastrointestinal autonomic nervous functions.Studies have shown that SARS-CoV-2 has a well-documented affinity for both neural and gastrointestinal tissues,and the virus can produce various gastrointestinal symptoms by reaching neural tissues through different pathways.These symptoms include anorexia,dysgeusia,heartburn,belching,chest pain,regurgitation,vomiting,epigastric burn,diarrhea,abdominal pain,bloating,irregular bowel movements,and constipation.Diarrhea is the most prevalent symptom,followed by anorexia,nausea,vomiting,and abdominal pain.Although COVID-19 vaccination may rarely induce autonomic dysfunction and gastrointestinal symptoms,COVID-19-induced autonomic effects significantly impact the patient's condition,general health,prognosis,and quality of life.Early diagnosis and proper recognition are crucial for improving outcomes.It is important to consider the differential diagnosis,as these symptoms may be induced by diseases other than COVID-19-induced autonomic dysfunction.Treating this dysfunction can be a challenging task.CONCLUSION To ensure the best possible outcomes for COVID-19 patients,it is essential to take a multidisciplinary approach involving providing supportive care,treating the underlying infection,managing dysfunction,monitoring for complications,and offering nutritional support.Close monitoring of the patient's condition is crucial,and prompt intervention should be taken if necessary.Furthermore,conducting thorough research on the gastrointestinal autonomic dysfunction caused by COVID-19 is vital to manage it effectively.

Characteristics and prospect of geothermal industry in China under the“dual carbon”target

Geothermal energy utilization in China had been promoted actively during the 13^(th)Five-Year Plan period(2016-2020),with resultant achievements showing unique Chinese characteristics.Buildings(measured by areas)heated/cooled by intermediate-to-deep geothermal energy increased more rapidly than those by shallow geothermal energy.Geothermal power generation was restricted by the distribution of the resource and the sufficiency of local power supply.With the proposition of“dual carbon goal”by the central government of China and the coming era of great development of renewable energy,geothermal energy will be provided more development opportunities in room heating/cooling and power generation in the country ever than before.However,tackling technology bottlenecks and introduction of appropriate policy support are still urgently needed for nurturing a healthy environment for geothermal industry.Analysis suggests that a near-to medium-term development of geothermal energy shall be focused on a comprehensive and efficient utilization both through heating/cooling and power generation.Room heating/cooling by intermediate-to-deep and shallow geothermal energy shall be promoted nationwide according to local resource endowment and economic conditions.Geothermal power generation in Yunnan and Tibet shall be pushed forward in an orderly way.For medium-and long-term development,focus shall be put on power generation by using low to medium temperature geothermal energy and hot dry rocks.The"hot spring+"model shall be adapted in steps on a regular basis.To achieve these,measures including attaching importance to tackling key technologies,promoting standards for geothermal energy development and utilization,strengthening geothermal energy exploration and evaluation,and seeking for necessary policy support shall be taken.

Recovery rates of persistent post-COVID-19 olfactory dysfunction using psychophysical assessment:A longitudinal cohort study

Objectives:Persistent olfactory dysfunction(OD)following loss of smell associated with SARS-CoV-2 infection is a major feature of long COVID.Perspectives on the prevalence of persistent OD predominantly rely on self-reported olfactory function.Few studies have tracked longitudinal rates of recovery using psychophysical assessment among patients presenting for evaluation of persistent OD beyond a window of acute recovery.Data anchored in standardized testing methods are needed to counsel patients who fail to acutely regain their sense of smell.This study aims to quantify the degree of persistent OD in post-COVID-19 patients who experience subjective and psychophysical OD.Methods:We grouped participants presenting for OD evaluation into cohorts based on both subjective and psychophysical olfactory status at a baseline assessment and assessed their olfactory abilities with a visual analogue scale and the Sniffin'Sticks extended test at baseline and 1-year time points.Participants had confirmed a history of COVID-19 by lab evaluation or clinical diagnosis if lab evaluation was not available.Results:Baseline olfactory evaluation was completed by 122 participants,53 of whom completed the 1-year follow-up assessment.Among participants presenting with perceived OD,74.5%had confirmed psychophysical OD at baseline,with 55.1%at 1-year follow-up.Participants had reliable trends in self-rated versus psychophysically tested olfactory function at both time points.The total threshold,discrimination,and identification(TDI)score improved by+3.25 points in the cohort with psychophysical OD(p=0.0005),with this improvement largely attributable to an increase in median threshold scores(+2.75 points;p=0.0004).Conclusions:OD persists in a significant number of patients who fail to acutely recovery their sense of smell after COVID-19,with many demonstrating lingering deficits at 1-year.Improvements in threshold,but not discrimination or identification,most significantly mediate improvement of total TDI score at follow-up.

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.

COVID-19 Induced Mixed Connective Tissue Disease (MCTD)—Case Report

Mixed connective tissue disease (MCTD) is a rare systemic autoimmune disorder that damages multiple organs simultaneously and is associated with chronic inflammation, in which the signs of systemic sclerosis, systemic lupus erythematosus, and polymyositis can co-occur. Its distinctive feature and the basis for the diagnosis of MCTD is the presence of an antibody against the uridine-rich RNP of the cell nucleus (Anti-U1-RNP). It has been observed that intercurrent infections can trigger autoimmune diseases, however, the fact that viral infections—such as SARS-CoV-2—induce them is currently poorly understood. The present study raises the etiological role of the SARS-CoV-2 virus in the development of the disease. Authors describe the case of a 38-year-old patient in good general condition, who was diagnosed with mixed connective tissue disease three months after COVID-19 infection.

Clinical-based phenotypes in children with pediatric post-COVID-19 condition

Background Pediatric post coronavirus disease 2019(COVID-19)condition(PPCC)is a heterogeneous syndrome,which can significantly affect the daily lives of children.This study aimed to identify clinically meaningful phenotypes in children with PPCC,to better characterize and treat this condition.Methods Participants were children with physician-diagnosed PPCC,referred to the academic hospital Amsterdam UMC in the Netherlands between November 2021 and March 2023.Demographic factors and information on post-COVID symptoms,comorbidities,and impact on daily life were collected.Clinical clusters were identified using an unsupervised and unbiased approach for mixed data types.Results Analysis of 111 patients(aged 3–18 years)revealed three distinct clusters within PPCC.Cluster 1(n=62,median age=15 years)predominantly consisted of girls(74.2%).These patients suffered relatively more from exercise intolerance,dyspnea,and smell disorders.Cluster 2(n=33,median age=13 years)contained patients with an even gender distribution(51.5%girls).They suffered from relatively more sleep problems,memory loss,gastrointestinal symptoms,and arthralgia.Cluster 3(n=16,median age=11 years)had a higher proportion of boys(75.0%),suffered relatively more from fever,had significantly fewer symptoms(median of 5 symptoms compared to 8 and 10 for clusters 1 and 2 respectively),and experienced a lower impact on daily life.Conclusions This study identified three distinct clinical PPCC phenotypes,with variations in sex,age,symptom patterns,and impact on daily life.These findings highlight the need for further research to understand the potentially diverse underlying mechanisms contributing to post-COVID symptoms in children.