Connect with us

Covid19

Discrimination and Harassment in the Cardiology Workplace

Published

on

Along with the myriad challenges affecting healthcare providers since the coronavirus disease 2019 (COVID-19) pandemic began, some clinicians have the burden of dealing with various forms of discrimination and harassment that may contribute to a hostile work environment (HWE). Findings from 2 recent studies elucidated the extent of these issues within the field of cardiology.

In the first paper recently published in the Journal of the American College of Cardiology, researchers investigated the prevalence of HWE in medicine, addressing not only gender discrimination but also emotional harassment.1  Cardiologists from around the world were surveyed (n=5931, 77% men and 23% women). The survey responders self-identified as White (54%), Asian (17%), Hispanic (17%), and Black (3%). In addition, 73% of responding physicians were ≤54 years of age.

Over 40% of respondents reported experiencing HWE, with the highest rates reported among women (68% vs 37%; P <.001 odds ratio [OR], 3.58; 95% CI, 3.14-4.07) and Black cardiologists (53% vs 43%; OR, 1.46 vs Whites). Specific components of HWE affected women more often than men: Emotional harassment (43% vs 26%), discrimination (56% vs 22%), and sexual harassment (12% vs 1%). The most common reasons for discrimination were gender (44%), age (37%), race (24%), religion (15%), and sexual orientation (5%). Multivariate analysis demonstrated the highest odds of experiencing HWE among women (OR, 3.39; 95% CI, 2.97-3.86; P <.001) and early-career cardiologists (OR, 1.27; 95% CI, 1.14-1.43; P <.001) compared with other physicians surveyed.


Continue Reading

Factors that independently protected against HWE included working in a physician-owned practice (OR, 0.75; 95% CI, 0.63-0.88; P =.001), being married (OR, 0.81; 95% CI, 0.71-0.92; P =.001), and White race (OR, 0.88; 95% CI, 0.79-0.98; P =.017). Respondents reported that HWE had adverse effects on interactions with patients (53%) and colleagues (75%), as well as several aspects of career satisfaction.

In the second study published in the journal Heart2, London-based researchers examined the frequency and types of sexism affecting female and male cardiologists in the United Kingdom. Of the 174 cardiologists (24% female, 76% male) who completed a validated online survey, 61.9 of female physicians had experienced discrimination – most often focused on gender and parenting – compared with 19.7% of male physicians. The survey responses also showed that 35.7% of female cardiologists (vs 6.1% of male cardiologists) had “experienced unwanted sexual comments, attention or advances from a superior or colleague.” Sexual harassment had a greater negative impact on professional confidence in female vs male cardiologists (42.9% vs 3.0%), and 33.3% of female cardiologists (vs 2.3% of males) reported that sexism negatively affected opportunities for career advancement.

The results of these 2 studies are consistent with previous findings, including the American College of Cardiology third decennial Professional Life Survey published in 2017, which indicated that 65% of female cardiologists (vs 23% of males) experienced workplace harassment or discrimination.3 “Women are especially likely to experience gender harassment, which includes both verbal and nonverbal behaviors that treat women or men as inferior through hostility, objectification, disparagement, or exclusion”, noted researchers in the JACC study.1

Given the potential effects of these findings on providers and their patients, organizational structure and system processes should be examined to optimize patient care. We spoke with Laxmi Mehta, MD, lead study author of the JACC study and professor in the division of cardiovascular medicine, director of the Lipids Clinic, and director of Preventative Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center in Columbus about how to address these findings.   

What are some of the factors believed to be driving the high levels of hostility in the cardiology workplace?

Women and minorities are underrepresented in cardiology. Organizational and individual practices and beliefs can contribute to the hostile work environment. Micro- and macro-aggressions also contribute to hostility in the workplace.

What are the potential effects of HWE on patient care and provider well-being? 

Working in a HWE can negatively impact professional activities with colleagues and patient care. HWE may also result in disengagement and burnout for some people when they feel discriminated against or threatened.

What actions are needed on the institutional and employer level to reduce HWE? 

There should be a zero-tolerance policy for egregious acts of discrimination and harassment. For serious incidents of such behavior, human resources interventions and legal interventions are necessary to curb the acts. People need to feel that it is safe to voice their concerns and seek help in a non-threatening fashion, and victims should not be blamed. External review of complaints can mitigate internal suspicion of favoritism. Creation of a culture of workplace wellbeing is essential.

What are suggestions for clinicians in terms of supporting and advocating for colleagues who may be experiencing HWE?  

The American College of Cardiology and the American Heart Association just published an online Professionalism and Ethics document that outlines recommendations to address bias, structural racism, and structural sexism.4 Everyone in the cardiovascular community is responsible and must do their part to recognize and eliminate structural racism and sexism.

References

  1. Sharma G, Douglas PS, Hayes SN, et al. Global prevalence and impact of hostility, discrimination, and harassment in the cardiology workplace. J Am Coll Cardiol. 2021;77(19):2398-2409.
  2. Jaijee SK, Kamau-Mitchell C, Mikhail GW, Hendry C. Sexism experienced by consultant cardiologists in the United Kingdom. Heart. 2021;107(11):895-901. doi:10.1136/heartjnl-2020-317837
  3. Lewis SJ, Mehta LS, Douglas PS, et al; American College of Cardiology Women in Cardiology Leadership Council. Changes in the professional lives of cardiologists over 2 decades. J Am Coll Cardiol. 2017;69(4):452-462. doi:10.1016/j.jacc.2016.11.027
  4. Executive Committee, Benjamin IJ, Valentine CM, Oetgen WJ, et al. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: a consensus conference report. Published online May 5, 2021. J Am Coll Cardiol. doi:10.1016/j.jacc.2021.04.004

This article originally appeared on The Cardiology Advisor

Coinsmart. Beste Bitcoin-Börse in Europa
Source: https://www.medicalbag.com/home/news/addressing-hostile-work-environments-in-the-field-of-cardiology/

Covid19

The U.S. Has Hit 600,000 COVID Deaths, More Than Any Other Country

Published

on

Memorials hang from the front gate of Greenwood Cemetery in New York City during an event organized by Naming the Lost Memorials to remember and celebrate those who died during the COVID-19 pandemic. Spencer Platt/Getty Images hide caption

toggle caption

Spencer Platt/Getty Images

More than 15 months since the first confirmed death due to COVID-19 in the U.S., the coronavirus pandemic has claimed more than 600,000 lives across the country.

But that trend has slowed from thousands to hundreds per day in recent weeks, thanks largely to the ready availability of vaccines.

Over the winter, the nation was adding about 100,000 deaths each month. But as more and more people were vaccinated — particularly older Americans — the death rate fell precipitously. There are now about 375 deaths per day on average — down from more than 3,000 per day in January.

Worldwide, the U.S. still is reporting the greatest total deaths, followed by Brazil, India and Mexico. The total global death toll stands at 3.8 million.

The U.S. death toll, according to Johns Hopkins University, stood at 600,012 on Tuesday afternoon.

Even so, the cumulative number of deaths in the country clearly shows the recent positive impact of vaccines: Barely a month passed between 400,000 and a half-million deaths, but it has taken nearly four times as long to reach the 600,000 mark. At the same time, the trend in the number of new infections, which has closely mirrored deaths, reached a peak in January of more than 300,000 in a single day. Now the U.S. is hovering around an average of fewer than 15,000 confirmed infections, according to Johns Hopkins.

The positive trends have led many states to lift their coronavirus restrictions — with some dropping mask mandates altogether for vaccinated individuals and eliminating other social distancing requirements.

At the same time, however, many Americans have shown a reluctance to get vaccinated, with just over half of U.S. adults fully immunized. In parts of the Midwest and South, in particular, vaccine rates per 100,000 people still remain relatively low compared with the Northeast and parts of the West Coast, according to data from the U.S. Centers for Disease Control and Prevention. The divide has been particularly marked between rural and urban areas of the country.

Tuesday’s figures follow a study this week showing that a new vaccine, one made by Novavax, is 100% effective against the original strain of the coronavirus that causes COVID-19, and 93% effective against other variants.

The next step is for the company to seek regulatory approval from the Food and Drug Administration, which has issued emergency authorizations for three other vaccines – ones made by Pfizer, Moderna and Johnson & Johnson.

Coinsmart. Beste Bitcoin-Börse in Europa
Source: https://www.npr.org/sections/coronavirus-live-updates/2021/06/15/1006186695/the-u-s-has-hit-600-000-covid-deaths-more-than-any-other-country

Continue Reading

Covid19

Multispecialty Perspectives on Long COVID-19

Published

on

In the year since the global COVID-19 pandemic was declared in March 2020 by the World Health Organization,1 short-term treatments such as prone positioning of patients2 or the use of neutralizing antibody cocktails3 have been optimized, and strategies for patients who remain symptomatic for months or experience long-term sequelae4,5 are being developed. Although several effective vaccines6-9 have been developed and the end of the pandemic is now within sight, the long and laborious healing process for patients with long COVID and society as a whole is only just beginning.

“Politicians, key opinion leaders, and other stakeholders must realize that long-COVID-19 will have a big impact on society. If millions of people feel that they are unable to get back to work, it will mean a lot for society,” said Dr Daniel Kondziella, clinical research associate professor in the Department of Neurology at Rigshospitalet, Copenhagen University Hospital. “The after-effects [of the pandemic] will go on for many years to come.”

The Evidence


Continue Reading

A detailed follow-up of 150 patients who were treated at the University of Tours Hospital in France showed that 2 months after symptom onset, more than half (68%) of patients presented with 1 or more lingering symptom of COVID-19. The most common symptoms included diarrhea (33.3%), anosmia/ageusia (22.7%), flu-like symptoms (21.5%), a greater than 5% weight loss (17.2%), arthralgia (16.3%), chest pain (13.1%), cutaneous signs (11.5%), palpitations (10.9%), and dyspnea (7.7%).8

A longer-term, larger study of 1733 Chinese patients who were followed up at 6 months after hospital discharge revealed that most (63%) of the patients experienced fatigue and muscle weakness, and many reported difficulty sleeping (23%), below-average 6-minute walking distances (24%), anxiety or depression (23%), and diffusion impairments (22%).9

The Respiratory System

SARS-CoV-2 infection primarily affects the respiratory tract, causing pneumonia in severe cases with a proinflammatory response.10,11 “We categorize pneumonia as typical or atypical, involving different parts of the lungs. COVID-19 is an atypical pneumonia,” explained Dr Ali Gholamrezanezhad, a radiologist and assistant professor of clinical radiology with Keck Medicine of the University of Southern California, in Los Angeles.

Because COVID-19 may manifest as an atypical pneumonia, patients with severe disease can present with peripheral or posterior distribution of bilateral, multilobar ground-glass opacification, septal and/or pleural thickening, bronchiectasis, and subpleural involvement.11

In the long term, patients who present with complex lung manifestations seen on computed tomographic imaging are at increased risk for tissue scarring. “For patients who needed to be admitted into the hospital for COVID-19, the number [of patients with scarring] can be up to 30% to 40%. In patients who are not admitted, this number is much less, possibly less than 10%. It depends on the severity of the disease,” Dr Gholamrezanezhad added. For example, 6 weeks after discharge from University Hospital RWTH Aachen in Germany, 33 patients who did not require ventilation still presented with symptoms of fatigue (45%), cough (33%), and dyspnea (33%), but there was no evidence of widespread scarring.12

The Cardiovascular System

Although primarily a disease of the respiratory tract, extrapulmonary symptoms have been highly penetrant across tissue systems,10 and many of the lingering symptoms appear to involve other organs.8,9

Dr Valentina Püntmann, consultant physician, cardiologist, clinical pharmacologist, and assistant professor in the Department of Cardiology at the University Hospital Frankfurt, and colleagues recruited 100 patients who had recently recovered from COVID-19. Most patients had acute illness, with only 33% requiring hospitalization. Using cardiovascular magnetic resonance imaging a median of 71 days after their COVID-19 diagnosis, most patients presented with persistent cardiac involvement.13

“We actually thought we were not going to find anything because we were only permitted to scan patients later in their recovery,” said Dr Püntmann. “We also didn’t think at the time about COVID-19 as a cardiac condition. And yet, we were surprised to see myocardial inflammation, scarring, and also pericarditis persisting a few months after the original infection,” she continued.

In total, 78% of the patients had abnormal cardiovascular magnetic resonance scans, most commonly elevated myocardial native T1 (73%) and T2 (60%), myocardial late gadolinium (32%), and pericardial (22%) enhancement.13 These results are particularly intriguing, as they were sourced primarily from individuals who recovered at home, indicating that patients who experience even mild symptoms can have persistent myocardial inflammation and scarring for months.

“We are following up with these patients regularly, and for many patients, things do get better. They may not get better very quickly, which is perhaps something that is long-COVID specific,” stated Dr Püntmann. “But there is also a number of patients who don’t get better. I think we definitely need to get much better at understanding why some patients don’t improve, as well as work on developing effective treatments that we can administer early.”

The Nervous System

Throughout the pandemic, hospitalized patients have presented with a wide range of neurologic manifestations, thrombotic events, delirium, seizure-like events, encephalopathy, periodic discharges, ischemic lesions, and white matter lesions, among others.14,15 There has been little to no evidence collected during hospitalization to suggest there is widespread infiltration by the SARS-CoV-2 virus across the blood-brain barrier.14,16-17 With little direct evidence, it has been speculated these presentations occur as a result of neuroinflammation.15,18

During a 3-month follow-up of 61 patients admitted to Rigshospitalet, Copenhagen University Hospital in Denmark, nearly half (45.9%) of the patients had persistent central and peripheral nervous system complications.14

“Many patients actually still have affected cognitive ability. The average MOCA [Montreal Cognitive Assessment] score was 22 out of 30. Particularly, patients [who] were discharged from the intensive care unit had 19.5 out of 30, so they’re affected cognitively,” described Dr Michael E. Benros, professor of immuno-psychiatry in the Department of Immunology and Microbiology at the University of Copenhagen.

Dr Kondziella added, “There are 3 main ways by which COVID-19 might affect the nervous system. First, the virus itself has some sort of neurotropism. That means the virus crosses the blood-brain barrier and enters the brain, where it damages the tissue directly. The other option is that there is an autoimmune response by which cross-reaction toward the virus particles induces a neuroinflammatory pathway in the brain. We did find that in our study to a relatively lesser extent, compared to the third category, which is peripheral nervous system damage not directly caused by the virus or by autoimmune responses, but more because of treatment-related disorders.”

Because many of these nervous system manifestations were attributed to treatment-related complications (n=34 vs unresolved [n=4] vs para/postinfectious [n=3]),14 many of the younger, fitter patients likely will improve over time with rehabilitation after several months, predicted Dr Benros. However, patients who experience stroke or other thrombotic events may experience life-long COVID-19 complications.

Psychiatry

The neurologic presentations observed among patients with COVID-19 may have psychiatric consequences. “Symptoms from long-term COVID-19 are commonly fatigue, headache, insomnia, and brain fog,” stated Dr Samoon Ahmad, professor in the Department of Psychiatry at New York University Grossman School of Medicine and Unit Chief of Inpatient Psychiatry at Bellevue Hospital Center. “However, we don’t know whether these symptoms are neurologic or caused by depression.”

Dr Ahmad explained that approximately 30% of patients who recovered from COVID-19 went on to develop post-traumatic stress disorder (PTSD).19,20 Symptoms of PTSD also have been reported in multiple studies of highly exposed individuals working in the healthcare sector.21

The observation of PTSD among healthcare workers is important because it brings to the forefront the fact that by no means do you need to be infected with the virus to be experiencing psychiatric consequences from SARS-CoV-2.

Dr Ahmad expounded, “Using data from 2019, on average we see that around 8% of people have anxiety disorders, and 6% [have] depressive disorders. If you look at the most recent data in a similar population, it is mind-boggling because rates of anxiety and depression have fluctuated between 34% and 42%. It’s just remarkable that during the pandemic, about 4 in 10 adults have reported symptoms of anxiety or depressive disorders.”

Dr Ahmad commented that the extent of the psychiatric consequences from the pandemic are likely far from being realized. Future research is needed to focus on the long-term psychiatric effects among patients who have recovered from severe illness, healthcare workers who were exposed to traumatic situations, the general public who experienced increased loneliness or the loss of loved ones, and children who were isolated because of the suspension of schools.

Future Perspectives

The need for ongoing collection of highly robust data and for the streamlining of definitions, data collection strategies, and patient stratification such that more consistent data become available is apparent. A more collaborative approach to conducting SARS-CoV-2 research would not only improve understanding but allow for more precise communication with the general public, which is imperative for successful vaccination campaigns and COVID-19 rule compliance.

In the meantime, Dr Püntmann implores fellow clinicians not to ignore the exercise intolerance that persists for weeks or months after infection among some COVID-19 patients. They may offer advice to patients to slow down for 3 to 6 months and not try to push themselves back to their former fitness too early. “By [not] doing that, they can make the symptoms a lot worse and slow down their recovery. This may feel very counterintuitive, especially to the young and fit patients because they are used to getting fit as soon as possible after a flu or a cold. Recovery after COVID-19 is a different, much more protracted process.”

The other largely protracted process will be to overcome the long-term stress associated with the pandemic. “In the short term it is easy to put mental health concerns on the back burner. This sort of constant stress will eventually have an impact on mental health in general,” cautioned Dr Ahmad. “At a certain point, people just reach their breaking point.” He stated that there is a great need for large-scale improved access to basic mental health support, such that everyone can be armed with basic tools to reduce stress and develop healthy routines.

References

1. World Health Organization. Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19). Published February 16-24, 2020. Accessed June 1, 2021. http://who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

2. Guérin C, Albert RK, Beitler J, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020;46(12):2385-2396. doi:10.1007/s00134-020-06306-w

3. Weinreich DM, Sivapalasingam S, Norton T, et al. REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19. N Engl J Med. 2021;384(3):238-251. doi:10.1056/NEJMoa2035002

4. Ella R, Vadrevu KM, Jogdand H, et al. Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: a double-blind, randomised, phase 1 trial. Lancet Infect Dis. 2021;21(5):637-646. doi:10.1016/S1473-3099(20)30942-7

5. Voysey M, Clemens SAC, Madhi SA, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269):99-111. doi:10.1016/S0140-6736(20)32661-1

6. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403-416. doi:10.1056/NEJMoa2035389

7. Sadoff J, Le Gars M, Shukarev G, et al. Interim results of a phase 1–2a trial of Ad26.COV2.S Covid-19 vaccine. 2021;NEJMoa2034201. N Engl J Med. doi:10.1056/NEJMoa2034201

8. Carvalho-Schneider C, Laurent E, Lemaignen A, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021;27(2):258-263. doi:10.1016/j.cmi.2020.09.052

9. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-232. doi:10.1016/S0140-6736(20)32656-8

10. Behzad S, Aghaghazvini L, Radmard AR, Gholamrezanezhad A. Extrapulmonary manifestations of COVID-19: radiologic and clinical overview. Clin Imaging. 2020;66:35-41. doi:10.1016/j.clinimag.2020.05.013

11. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 Patients. AJR Am J Roentgenol. 2020;215(1):87-93. doi:10.2214/AJR.20.23034

12. Daher A, Balfanz P, Cornelissen C, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): pulmonary and extrapulmonary disease sequelae. Respir Med. 2020;174:106197. doi:10.1016/j.rmed.2020.106197

13. Puüntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(11):1265-1273. doi:10.1001/jamacardio.2020.3557

14. Nersesjan V, Amiri M, Lebech A-M, et al. Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up. J Neurol. Published online January 13, 202. doi:10.1007/s00415-020-10380-x

15. Lambrecq V, Hanin A, Munoz-Musat E, et al. Association of clinical, biological, and brain magnetic resonance imaging findings with electroencephalographic findings for patients with COVID-19. JAMA Netw Open. 2021;4(3):e211489. doi:10.1001/jamanetworkopen.2021.1489

16. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020;94:55-58. doi:10.1016/j.ijid.2020.03.062

17. Domingues RB, Mendes-Correa MC, de Moura Leite FBV, et al. First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease. J Neurol. 2020;267(11):3154-3156. doi:10.1007/s00415-020-09996-w

18. Boldrini M, Canoll PD, Klein RS. How COVID-19 affects the brain. JAMA Psychiatry. Published online March 26, 2021. doi:10.1001/jamapsychiatry.2021.0500

19. Forte G, Favieri F, Tambelli R, Casagrande M. COVID-19 pandemic in the Italian population: validation of a post-traumatic stress disorder questionnaire and prevalence of PTSD symptomatology. Int J Environ Res Public Health. 2020;17(11):4151. doi:10.3390/ijerph17114151

20. Janiri D, Carfì A, Kotzalidis GD, et al. Posttraumatic stress disorder in patients after severe COVID-19 infection. JAMA Psychiatry. 2021;78(5):567-569. doi:10.1001/jamapsychiatry.2021.0109

21. Tucker P, Czapla CS. Post-COVID stress disorder: another emerging consequence of the global pandemic. Psychiatric Times. 2021;38(1).

This article originally appeared on Infectious Disease Advisor

Coinsmart. Beste Bitcoin-Börse in Europa
Source: https://www.medicalbag.com/home/news/multispecialty-perspectives-on-long-covid-19/

Continue Reading

Covid19

Multispecialty Perspectives on Long COVID-19

Published

on

In the year since the global COVID-19 pandemic was declared in March 2020 by the World Health Organization,1 short-term treatments such as prone positioning of patients2 or the use of neutralizing antibody cocktails3 have been optimized, and strategies for patients who remain symptomatic for months or experience long-term sequelae4,5 are being developed. Although several effective vaccines6-9 have been developed and the end of the pandemic is now within sight, the long and laborious healing process for patients with long COVID and society as a whole is only just beginning.

“Politicians, key opinion leaders, and other stakeholders must realize that long-COVID-19 will have a big impact on society. If millions of people feel that they are unable to get back to work, it will mean a lot for society,” said Dr Daniel Kondziella, clinical research associate professor in the Department of Neurology at Rigshospitalet, Copenhagen University Hospital. “The after-effects [of the pandemic] will go on for many years to come.”

The Evidence


Continue Reading

A detailed follow-up of 150 patients who were treated at the University of Tours Hospital in France showed that 2 months after symptom onset, more than half (68%) of patients presented with 1 or more lingering symptom of COVID-19. The most common symptoms included diarrhea (33.3%), anosmia/ageusia (22.7%), flu-like symptoms (21.5%), a greater than 5% weight loss (17.2%), arthralgia (16.3%), chest pain (13.1%), cutaneous signs (11.5%), palpitations (10.9%), and dyspnea (7.7%).8

A longer-term, larger study of 1733 Chinese patients who were followed up at 6 months after hospital discharge revealed that most (63%) of the patients experienced fatigue and muscle weakness, and many reported difficulty sleeping (23%), below-average 6-minute walking distances (24%), anxiety or depression (23%), and diffusion impairments (22%).9

The Respiratory System

SARS-CoV-2 infection primarily affects the respiratory tract, causing pneumonia in severe cases with a proinflammatory response.10,11 “We categorize pneumonia as typical or atypical, involving different parts of the lungs. COVID-19 is an atypical pneumonia,” explained Dr Ali Gholamrezanezhad, a radiologist and assistant professor of clinical radiology with Keck Medicine of the University of Southern California, in Los Angeles.

Because COVID-19 may manifest as an atypical pneumonia, patients with severe disease can present with peripheral or posterior distribution of bilateral, multilobar ground-glass opacification, septal and/or pleural thickening, bronchiectasis, and subpleural involvement.11

In the long term, patients who present with complex lung manifestations seen on computed tomographic imaging are at increased risk for tissue scarring. “For patients who needed to be admitted into the hospital for COVID-19, the number [of patients with scarring] can be up to 30% to 40%. In patients who are not admitted, this number is much less, possibly less than 10%. It depends on the severity of the disease,” Dr Gholamrezanezhad added. For example, 6 weeks after discharge from University Hospital RWTH Aachen in Germany, 33 patients who did not require ventilation still presented with symptoms of fatigue (45%), cough (33%), and dyspnea (33%), but there was no evidence of widespread scarring.12

The Cardiovascular System

Although primarily a disease of the respiratory tract, extrapulmonary symptoms have been highly penetrant across tissue systems,10 and many of the lingering symptoms appear to involve other organs.8,9

Dr Valentina Püntmann, consultant physician, cardiologist, clinical pharmacologist, and assistant professor in the Department of Cardiology at the University Hospital Frankfurt, and colleagues recruited 100 patients who had recently recovered from COVID-19. Most patients had acute illness, with only 33% requiring hospitalization. Using cardiovascular magnetic resonance imaging a median of 71 days after their COVID-19 diagnosis, most patients presented with persistent cardiac involvement.13

“We actually thought we were not going to find anything because we were only permitted to scan patients later in their recovery,” said Dr Püntmann. “We also didn’t think at the time about COVID-19 as a cardiac condition. And yet, we were surprised to see myocardial inflammation, scarring, and also pericarditis persisting a few months after the original infection,” she continued.

In total, 78% of the patients had abnormal cardiovascular magnetic resonance scans, most commonly elevated myocardial native T1 (73%) and T2 (60%), myocardial late gadolinium (32%), and pericardial (22%) enhancement.13 These results are particularly intriguing, as they were sourced primarily from individuals who recovered at home, indicating that patients who experience even mild symptoms can have persistent myocardial inflammation and scarring for months.

“We are following up with these patients regularly, and for many patients, things do get better. They may not get better very quickly, which is perhaps something that is long-COVID specific,” stated Dr Püntmann. “But there is also a number of patients who don’t get better. I think we definitely need to get much better at understanding why some patients don’t improve, as well as work on developing effective treatments that we can administer early.”

The Nervous System

Throughout the pandemic, hospitalized patients have presented with a wide range of neurologic manifestations, thrombotic events, delirium, seizure-like events, encephalopathy, periodic discharges, ischemic lesions, and white matter lesions, among others.14,15 There has been little to no evidence collected during hospitalization to suggest there is widespread infiltration by the SARS-CoV-2 virus across the blood-brain barrier.14,16-17 With little direct evidence, it has been speculated these presentations occur as a result of neuroinflammation.15,18

During a 3-month follow-up of 61 patients admitted to Rigshospitalet, Copenhagen University Hospital in Denmark, nearly half (45.9%) of the patients had persistent central and peripheral nervous system complications.14

“Many patients actually still have affected cognitive ability. The average MOCA [Montreal Cognitive Assessment] score was 22 out of 30. Particularly, patients [who] were discharged from the intensive care unit had 19.5 out of 30, so they’re affected cognitively,” described Dr Michael E. Benros, professor of immuno-psychiatry in the Department of Immunology and Microbiology at the University of Copenhagen.

Dr Kondziella added, “There are 3 main ways by which COVID-19 might affect the nervous system. First, the virus itself has some sort of neurotropism. That means the virus crosses the blood-brain barrier and enters the brain, where it damages the tissue directly. The other option is that there is an autoimmune response by which cross-reaction toward the virus particles induces a neuroinflammatory pathway in the brain. We did find that in our study to a relatively lesser extent, compared to the third category, which is peripheral nervous system damage not directly caused by the virus or by autoimmune responses, but more because of treatment-related disorders.”

Because many of these nervous system manifestations were attributed to treatment-related complications (n=34 vs unresolved [n=4] vs para/postinfectious [n=3]),14 many of the younger, fitter patients likely will improve over time with rehabilitation after several months, predicted Dr Benros. However, patients who experience stroke or other thrombotic events may experience life-long COVID-19 complications.

Psychiatry

The neurologic presentations observed among patients with COVID-19 may have psychiatric consequences. “Symptoms from long-term COVID-19 are commonly fatigue, headache, insomnia, and brain fog,” stated Dr Samoon Ahmad, professor in the Department of Psychiatry at New York University Grossman School of Medicine and Unit Chief of Inpatient Psychiatry at Bellevue Hospital Center. “However, we don’t know whether these symptoms are neurologic or caused by depression.”

Dr Ahmad explained that approximately 30% of patients who recovered from COVID-19 went on to develop post-traumatic stress disorder (PTSD).19,20 Symptoms of PTSD also have been reported in multiple studies of highly exposed individuals working in the healthcare sector.21

The observation of PTSD among healthcare workers is important because it brings to the forefront the fact that by no means do you need to be infected with the virus to be experiencing psychiatric consequences from SARS-CoV-2.

Dr Ahmad expounded, “Using data from 2019, on average we see that around 8% of people have anxiety disorders, and 6% [have] depressive disorders. If you look at the most recent data in a similar population, it is mind-boggling because rates of anxiety and depression have fluctuated between 34% and 42%. It’s just remarkable that during the pandemic, about 4 in 10 adults have reported symptoms of anxiety or depressive disorders.”

Dr Ahmad commented that the extent of the psychiatric consequences from the pandemic are likely far from being realized. Future research is needed to focus on the long-term psychiatric effects among patients who have recovered from severe illness, healthcare workers who were exposed to traumatic situations, the general public who experienced increased loneliness or the loss of loved ones, and children who were isolated because of the suspension of schools.

Future Perspectives

The need for ongoing collection of highly robust data and for the streamlining of definitions, data collection strategies, and patient stratification such that more consistent data become available is apparent. A more collaborative approach to conducting SARS-CoV-2 research would not only improve understanding but allow for more precise communication with the general public, which is imperative for successful vaccination campaigns and COVID-19 rule compliance.

In the meantime, Dr Püntmann implores fellow clinicians not to ignore the exercise intolerance that persists for weeks or months after infection among some COVID-19 patients. They may offer advice to patients to slow down for 3 to 6 months and not try to push themselves back to their former fitness too early. “By [not] doing that, they can make the symptoms a lot worse and slow down their recovery. This may feel very counterintuitive, especially to the young and fit patients because they are used to getting fit as soon as possible after a flu or a cold. Recovery after COVID-19 is a different, much more protracted process.”

The other largely protracted process will be to overcome the long-term stress associated with the pandemic. “In the short term it is easy to put mental health concerns on the back burner. This sort of constant stress will eventually have an impact on mental health in general,” cautioned Dr Ahmad. “At a certain point, people just reach their breaking point.” He stated that there is a great need for large-scale improved access to basic mental health support, such that everyone can be armed with basic tools to reduce stress and develop healthy routines.

References

1. World Health Organization. Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19). Published February 16-24, 2020. Accessed June 1, 2021. http://who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

2. Guérin C, Albert RK, Beitler J, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020;46(12):2385-2396. doi:10.1007/s00134-020-06306-w

3. Weinreich DM, Sivapalasingam S, Norton T, et al. REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19. N Engl J Med. 2021;384(3):238-251. doi:10.1056/NEJMoa2035002

4. Ella R, Vadrevu KM, Jogdand H, et al. Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: a double-blind, randomised, phase 1 trial. Lancet Infect Dis. 2021;21(5):637-646. doi:10.1016/S1473-3099(20)30942-7

5. Voysey M, Clemens SAC, Madhi SA, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269):99-111. doi:10.1016/S0140-6736(20)32661-1

6. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403-416. doi:10.1056/NEJMoa2035389

7. Sadoff J, Le Gars M, Shukarev G, et al. Interim results of a phase 1–2a trial of Ad26.COV2.S Covid-19 vaccine. 2021;NEJMoa2034201. N Engl J Med. doi:10.1056/NEJMoa2034201

8. Carvalho-Schneider C, Laurent E, Lemaignen A, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021;27(2):258-263. doi:10.1016/j.cmi.2020.09.052

9. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-232. doi:10.1016/S0140-6736(20)32656-8

10. Behzad S, Aghaghazvini L, Radmard AR, Gholamrezanezhad A. Extrapulmonary manifestations of COVID-19: radiologic and clinical overview. Clin Imaging. 2020;66:35-41. doi:10.1016/j.clinimag.2020.05.013

11. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 Patients. AJR Am J Roentgenol. 2020;215(1):87-93. doi:10.2214/AJR.20.23034

12. Daher A, Balfanz P, Cornelissen C, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): pulmonary and extrapulmonary disease sequelae. Respir Med. 2020;174:106197. doi:10.1016/j.rmed.2020.106197

13. Puüntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(11):1265-1273. doi:10.1001/jamacardio.2020.3557

14. Nersesjan V, Amiri M, Lebech A-M, et al. Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up. J Neurol. Published online January 13, 202. doi:10.1007/s00415-020-10380-x

15. Lambrecq V, Hanin A, Munoz-Musat E, et al. Association of clinical, biological, and brain magnetic resonance imaging findings with electroencephalographic findings for patients with COVID-19. JAMA Netw Open. 2021;4(3):e211489. doi:10.1001/jamanetworkopen.2021.1489

16. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020;94:55-58. doi:10.1016/j.ijid.2020.03.062

17. Domingues RB, Mendes-Correa MC, de Moura Leite FBV, et al. First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease. J Neurol. 2020;267(11):3154-3156. doi:10.1007/s00415-020-09996-w

18. Boldrini M, Canoll PD, Klein RS. How COVID-19 affects the brain. JAMA Psychiatry. Published online March 26, 2021. doi:10.1001/jamapsychiatry.2021.0500

19. Forte G, Favieri F, Tambelli R, Casagrande M. COVID-19 pandemic in the Italian population: validation of a post-traumatic stress disorder questionnaire and prevalence of PTSD symptomatology. Int J Environ Res Public Health. 2020;17(11):4151. doi:10.3390/ijerph17114151

20. Janiri D, Carfì A, Kotzalidis GD, et al. Posttraumatic stress disorder in patients after severe COVID-19 infection. JAMA Psychiatry. 2021;78(5):567-569. doi:10.1001/jamapsychiatry.2021.0109

21. Tucker P, Czapla CS. Post-COVID stress disorder: another emerging consequence of the global pandemic. Psychiatric Times. 2021;38(1).

This article originally appeared on Infectious Disease Advisor

Coinsmart. Beste Bitcoin-Börse in Europa
Source: https://www.medicalbag.com/home/news/multispecialty-perspectives-on-long-covid-19/

Continue Reading

Covid19

Multispecialty Perspectives on Long COVID-19

Published

on

In the year since the global COVID-19 pandemic was declared in March 2020 by the World Health Organization,1 short-term treatments such as prone positioning of patients2 or the use of neutralizing antibody cocktails3 have been optimized, and strategies for patients who remain symptomatic for months or experience long-term sequelae4,5 are being developed. Although several effective vaccines6-9 have been developed and the end of the pandemic is now within sight, the long and laborious healing process for patients with long COVID and society as a whole is only just beginning.

“Politicians, key opinion leaders, and other stakeholders must realize that long-COVID-19 will have a big impact on society. If millions of people feel that they are unable to get back to work, it will mean a lot for society,” said Dr Daniel Kondziella, clinical research associate professor in the Department of Neurology at Rigshospitalet, Copenhagen University Hospital. “The after-effects [of the pandemic] will go on for many years to come.”

The Evidence


Continue Reading

A detailed follow-up of 150 patients who were treated at the University of Tours Hospital in France showed that 2 months after symptom onset, more than half (68%) of patients presented with 1 or more lingering symptom of COVID-19. The most common symptoms included diarrhea (33.3%), anosmia/ageusia (22.7%), flu-like symptoms (21.5%), a greater than 5% weight loss (17.2%), arthralgia (16.3%), chest pain (13.1%), cutaneous signs (11.5%), palpitations (10.9%), and dyspnea (7.7%).8

A longer-term, larger study of 1733 Chinese patients who were followed up at 6 months after hospital discharge revealed that most (63%) of the patients experienced fatigue and muscle weakness, and many reported difficulty sleeping (23%), below-average 6-minute walking distances (24%), anxiety or depression (23%), and diffusion impairments (22%).9

The Respiratory System

SARS-CoV-2 infection primarily affects the respiratory tract, causing pneumonia in severe cases with a proinflammatory response.10,11 “We categorize pneumonia as typical or atypical, involving different parts of the lungs. COVID-19 is an atypical pneumonia,” explained Dr Ali Gholamrezanezhad, a radiologist and assistant professor of clinical radiology with Keck Medicine of the University of Southern California, in Los Angeles.

Because COVID-19 may manifest as an atypical pneumonia, patients with severe disease can present with peripheral or posterior distribution of bilateral, multilobar ground-glass opacification, septal and/or pleural thickening, bronchiectasis, and subpleural involvement.11

In the long term, patients who present with complex lung manifestations seen on computed tomographic imaging are at increased risk for tissue scarring. “For patients who needed to be admitted into the hospital for COVID-19, the number [of patients with scarring] can be up to 30% to 40%. In patients who are not admitted, this number is much less, possibly less than 10%. It depends on the severity of the disease,” Dr Gholamrezanezhad added. For example, 6 weeks after discharge from University Hospital RWTH Aachen in Germany, 33 patients who did not require ventilation still presented with symptoms of fatigue (45%), cough (33%), and dyspnea (33%), but there was no evidence of widespread scarring.12

The Cardiovascular System

Although primarily a disease of the respiratory tract, extrapulmonary symptoms have been highly penetrant across tissue systems,10 and many of the lingering symptoms appear to involve other organs.8,9

Dr Valentina Püntmann, consultant physician, cardiologist, clinical pharmacologist, and assistant professor in the Department of Cardiology at the University Hospital Frankfurt, and colleagues recruited 100 patients who had recently recovered from COVID-19. Most patients had acute illness, with only 33% requiring hospitalization. Using cardiovascular magnetic resonance imaging a median of 71 days after their COVID-19 diagnosis, most patients presented with persistent cardiac involvement.13

“We actually thought we were not going to find anything because we were only permitted to scan patients later in their recovery,” said Dr Püntmann. “We also didn’t think at the time about COVID-19 as a cardiac condition. And yet, we were surprised to see myocardial inflammation, scarring, and also pericarditis persisting a few months after the original infection,” she continued.

In total, 78% of the patients had abnormal cardiovascular magnetic resonance scans, most commonly elevated myocardial native T1 (73%) and T2 (60%), myocardial late gadolinium (32%), and pericardial (22%) enhancement.13 These results are particularly intriguing, as they were sourced primarily from individuals who recovered at home, indicating that patients who experience even mild symptoms can have persistent myocardial inflammation and scarring for months.

“We are following up with these patients regularly, and for many patients, things do get better. They may not get better very quickly, which is perhaps something that is long-COVID specific,” stated Dr Püntmann. “But there is also a number of patients who don’t get better. I think we definitely need to get much better at understanding why some patients don’t improve, as well as work on developing effective treatments that we can administer early.”

The Nervous System

Throughout the pandemic, hospitalized patients have presented with a wide range of neurologic manifestations, thrombotic events, delirium, seizure-like events, encephalopathy, periodic discharges, ischemic lesions, and white matter lesions, among others.14,15 There has been little to no evidence collected during hospitalization to suggest there is widespread infiltration by the SARS-CoV-2 virus across the blood-brain barrier.14,16-17 With little direct evidence, it has been speculated these presentations occur as a result of neuroinflammation.15,18

During a 3-month follow-up of 61 patients admitted to Rigshospitalet, Copenhagen University Hospital in Denmark, nearly half (45.9%) of the patients had persistent central and peripheral nervous system complications.14

“Many patients actually still have affected cognitive ability. The average MOCA [Montreal Cognitive Assessment] score was 22 out of 30. Particularly, patients [who] were discharged from the intensive care unit had 19.5 out of 30, so they’re affected cognitively,” described Dr Michael E. Benros, professor of immuno-psychiatry in the Department of Immunology and Microbiology at the University of Copenhagen.

Dr Kondziella added, “There are 3 main ways by which COVID-19 might affect the nervous system. First, the virus itself has some sort of neurotropism. That means the virus crosses the blood-brain barrier and enters the brain, where it damages the tissue directly. The other option is that there is an autoimmune response by which cross-reaction toward the virus particles induces a neuroinflammatory pathway in the brain. We did find that in our study to a relatively lesser extent, compared to the third category, which is peripheral nervous system damage not directly caused by the virus or by autoimmune responses, but more because of treatment-related disorders.”

Because many of these nervous system manifestations were attributed to treatment-related complications (n=34 vs unresolved [n=4] vs para/postinfectious [n=3]),14 many of the younger, fitter patients likely will improve over time with rehabilitation after several months, predicted Dr Benros. However, patients who experience stroke or other thrombotic events may experience life-long COVID-19 complications.

Psychiatry

The neurologic presentations observed among patients with COVID-19 may have psychiatric consequences. “Symptoms from long-term COVID-19 are commonly fatigue, headache, insomnia, and brain fog,” stated Dr Samoon Ahmad, professor in the Department of Psychiatry at New York University Grossman School of Medicine and Unit Chief of Inpatient Psychiatry at Bellevue Hospital Center. “However, we don’t know whether these symptoms are neurologic or caused by depression.”

Dr Ahmad explained that approximately 30% of patients who recovered from COVID-19 went on to develop post-traumatic stress disorder (PTSD).19,20 Symptoms of PTSD also have been reported in multiple studies of highly exposed individuals working in the healthcare sector.21

The observation of PTSD among healthcare workers is important because it brings to the forefront the fact that by no means do you need to be infected with the virus to be experiencing psychiatric consequences from SARS-CoV-2.

Dr Ahmad expounded, “Using data from 2019, on average we see that around 8% of people have anxiety disorders, and 6% [have] depressive disorders. If you look at the most recent data in a similar population, it is mind-boggling because rates of anxiety and depression have fluctuated between 34% and 42%. It’s just remarkable that during the pandemic, about 4 in 10 adults have reported symptoms of anxiety or depressive disorders.”

Dr Ahmad commented that the extent of the psychiatric consequences from the pandemic are likely far from being realized. Future research is needed to focus on the long-term psychiatric effects among patients who have recovered from severe illness, healthcare workers who were exposed to traumatic situations, the general public who experienced increased loneliness or the loss of loved ones, and children who were isolated because of the suspension of schools.

Future Perspectives

The need for ongoing collection of highly robust data and for the streamlining of definitions, data collection strategies, and patient stratification such that more consistent data become available is apparent. A more collaborative approach to conducting SARS-CoV-2 research would not only improve understanding but allow for more precise communication with the general public, which is imperative for successful vaccination campaigns and COVID-19 rule compliance.

In the meantime, Dr Püntmann implores fellow clinicians not to ignore the exercise intolerance that persists for weeks or months after infection among some COVID-19 patients. They may offer advice to patients to slow down for 3 to 6 months and not try to push themselves back to their former fitness too early. “By [not] doing that, they can make the symptoms a lot worse and slow down their recovery. This may feel very counterintuitive, especially to the young and fit patients because they are used to getting fit as soon as possible after a flu or a cold. Recovery after COVID-19 is a different, much more protracted process.”

The other largely protracted process will be to overcome the long-term stress associated with the pandemic. “In the short term it is easy to put mental health concerns on the back burner. This sort of constant stress will eventually have an impact on mental health in general,” cautioned Dr Ahmad. “At a certain point, people just reach their breaking point.” He stated that there is a great need for large-scale improved access to basic mental health support, such that everyone can be armed with basic tools to reduce stress and develop healthy routines.

References

1. World Health Organization. Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19). Published February 16-24, 2020. Accessed June 1, 2021. http://who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

2. Guérin C, Albert RK, Beitler J, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020;46(12):2385-2396. doi:10.1007/s00134-020-06306-w

3. Weinreich DM, Sivapalasingam S, Norton T, et al. REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19. N Engl J Med. 2021;384(3):238-251. doi:10.1056/NEJMoa2035002

4. Ella R, Vadrevu KM, Jogdand H, et al. Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: a double-blind, randomised, phase 1 trial. Lancet Infect Dis. 2021;21(5):637-646. doi:10.1016/S1473-3099(20)30942-7

5. Voysey M, Clemens SAC, Madhi SA, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269):99-111. doi:10.1016/S0140-6736(20)32661-1

6. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403-416. doi:10.1056/NEJMoa2035389

7. Sadoff J, Le Gars M, Shukarev G, et al. Interim results of a phase 1–2a trial of Ad26.COV2.S Covid-19 vaccine. 2021;NEJMoa2034201. N Engl J Med. doi:10.1056/NEJMoa2034201

8. Carvalho-Schneider C, Laurent E, Lemaignen A, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021;27(2):258-263. doi:10.1016/j.cmi.2020.09.052

9. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-232. doi:10.1016/S0140-6736(20)32656-8

10. Behzad S, Aghaghazvini L, Radmard AR, Gholamrezanezhad A. Extrapulmonary manifestations of COVID-19: radiologic and clinical overview. Clin Imaging. 2020;66:35-41. doi:10.1016/j.clinimag.2020.05.013

11. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 Patients. AJR Am J Roentgenol. 2020;215(1):87-93. doi:10.2214/AJR.20.23034

12. Daher A, Balfanz P, Cornelissen C, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): pulmonary and extrapulmonary disease sequelae. Respir Med. 2020;174:106197. doi:10.1016/j.rmed.2020.106197

13. Puüntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(11):1265-1273. doi:10.1001/jamacardio.2020.3557

14. Nersesjan V, Amiri M, Lebech A-M, et al. Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up. J Neurol. Published online January 13, 202. doi:10.1007/s00415-020-10380-x

15. Lambrecq V, Hanin A, Munoz-Musat E, et al. Association of clinical, biological, and brain magnetic resonance imaging findings with electroencephalographic findings for patients with COVID-19. JAMA Netw Open. 2021;4(3):e211489. doi:10.1001/jamanetworkopen.2021.1489

16. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020;94:55-58. doi:10.1016/j.ijid.2020.03.062

17. Domingues RB, Mendes-Correa MC, de Moura Leite FBV, et al. First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease. J Neurol. 2020;267(11):3154-3156. doi:10.1007/s00415-020-09996-w

18. Boldrini M, Canoll PD, Klein RS. How COVID-19 affects the brain. JAMA Psychiatry. Published online March 26, 2021. doi:10.1001/jamapsychiatry.2021.0500

19. Forte G, Favieri F, Tambelli R, Casagrande M. COVID-19 pandemic in the Italian population: validation of a post-traumatic stress disorder questionnaire and prevalence of PTSD symptomatology. Int J Environ Res Public Health. 2020;17(11):4151. doi:10.3390/ijerph17114151

20. Janiri D, Carfì A, Kotzalidis GD, et al. Posttraumatic stress disorder in patients after severe COVID-19 infection. JAMA Psychiatry. 2021;78(5):567-569. doi:10.1001/jamapsychiatry.2021.0109

21. Tucker P, Czapla CS. Post-COVID stress disorder: another emerging consequence of the global pandemic. Psychiatric Times. 2021;38(1).

This article originally appeared on Infectious Disease Advisor

Coinsmart. Beste Bitcoin-Börse in Europa
Source: https://www.medicalbag.com/home/news/multispecialty-perspectives-on-long-covid-19/

Continue Reading
Aviation3 days ago

Delta Air Lines Flight Diverts To Oklahoma Over Unruly Off-Duty Flight Attendant

Crowdfunding5 days ago

April/May 2021 Top Campaigns

Esports3 days ago

Lost Ark Founders Pack: Everything You Need to Know

Blockchain5 days ago

Crypto Fund Manager Says Bitcoin ETFs to be Approved By 2022

Aviation2 days ago

Spirit Airlines Just Made The Best Argument For Lifting LaGuardia’s Perimeter Rule

Fintech5 days ago

PayPal launches PayPal Rewards Card in Australia

Energy4 days ago

Industrial robots market in the automotive industry | $ 3.97 billion growth expected during 2021-2025 | 17000+ Technavio Research Reports

Cyber Security4 days ago

Data Breach that Impacted Both Audi of America and Volkswagen of America

Cleantech4 days ago

Tesla Model S 420 Plaid Is The Best Car In The World (But Not For Me)

Energy4 days ago

Daiki Axis Co., Ltd. (4245, First Section, Tokyo Stock Exchange) Overview of Operating Performance for the First Three Months Ended March 31, 2021

Blockchain4 days ago

Blockchain technology can help to protect sensitive information

Blockchain4 days ago

Blockchain technology can help to protect sensitive information

Esports5 days ago

V-Union cards officially revealed for the Pokémon TCG, includes Mewtwo, Zacian, and Greninja

Blockchain4 days ago

DCR Technical Analysis: Look for Support Levels of $130.13 and $126.01

Blockchain4 days ago

State-Chartered Banks in Texas to Provide Crypto Custody

CNBC5 days ago

From green energy to cybersecurity, Citi names ‘unstoppable trends’ that investors can jump on

Esports5 days ago

LEC Power Rankings: 2021 Summer Split Preseason

Esports5 days ago

New product details and art shared for Pokémon TCG set Evolving Skies

Crowdfunding4 days ago

Chamber of Digital Commerce Welcomes Zilliqa and Newly Formed Zilliqa Capital as New Members

Blockchain2 days ago

Africa Leading Bitcoin P2P Trading Volume Growth in 2021

Trending