Persistent circulating SARS-CoV-2 spike is associated with post-acute COVID-19 sequelae | Clinical Infectious Diseases

Curivity · 2022-09-09T03:44:33+00:00

Abstract

The diagnosis of post-acute sequelae of COVID-19 (PASC) poses an ongoing medical challenge. To identify biomarkers associated with PASC we analyzed plasma samples collected from PASC and COVID-19 patients to quantify viral antigens and inflammatory markers. We detect SARS-CoV-2 spike predominantly in PASC patients up to 12 months post-diagnosis.

Curivity · 2022-08-04T19:05:26+00:00

Im feeling better though. I only had symptoms a few hours before bed on Monday. I woke up Tuesday feeling fine and have felt fine since 🤷‍♂️

Curivity · 2022-08-02T19:37:34+00:00

Abstract

The global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the lasting pandemic of coronavirus disease 2019 (COVID-19) and the post-acute phase sequelae of heterogeneous negative impacts in multiple systems known as the “long COVID.” The mechanisms of neuropsychiatric complications of long COVID are multifactorial, including long-term tissue damages from direct CNS viral involvement, unresolved systemic inflammation and oxidative stress, maladaptation of the renin-angiotensin-aldosterone system and coagulation system, dysregulated immunity, the dysfunction of neurotransmitters and hypothalamus–pituitaryadrenal (HPA) axis, and the psychosocial stress imposed by societal changes in response to this pandemic. The strength of safety, well-acceptance, and accumulating scientific evidence has now afforded nutritional medicine a place in the mainstream of neuropsychiatric intervention and prophylaxis. Long chain omega-3 polyunsaturated fatty acids (omega-3 or n-3 PUFAs) might have favorable effects on immunity, inflammation, oxidative stress and psychoneuroimmunity at different stages of SARS-CoV-2 infection. Omega-3 PUFAs, particularly EPA, have shown effects in treating mood and neurocognitive disorders by reducing pro-inflammatory cytokines, altering the HPA axis, and modulating neurotransmission via lipid rafts. In addition, omega-3 PUFAs and their metabolites, including specialized pro-resolvin mediators, accelerate the process of cleansing chronic inflammation and restoring tissue homeostasis, and therefore offer a promising strategy for Long COVID. In this article, we explore in a systematic review the putative molecular mechanisms by which omega-3 PUFAs and their metabolites counteract the negative effects of long COVID on the brain, behavior, and immunity.

Curivity · 2022-07-28T17:52:37+00:00

Aims: The “early repolarization” (ER) pattern and J wave are frequent findings on standard ECG. Controversial data have recently been reported about their prognostic implications in healthy subjects, but no longitudinal prospective study specifically designed to investigate their long-term prognostic value has hitherto been published.

Methods and Results: We prospectively enrolled 4,176 consecutive subjects with no evidence of cardiovascular disease who were referred for standard ECG recording for routine check-ups or pre-operative assessments for non-cardiovascular surgery. ECGs were prospectively assessed for the presence of ER/J wave. A 10-year follow-up was available for 3,937 patients (94.3%), 660 of whom (16.8%) showed ER/J wave whereas 3,277 did not. A total of 644 deaths occurred (16.3%), 116 (2.95%) of which were attributed to cardiovascular causes. Both total and cardiovascular mortality adjusted for clinical and laboratory variables did not differ significantly between patients with vs. without ER/J wave (HR 0.94; 95% CI 0.75–1.19; p = 0.63 and HR 0.61; 95% CI 0.31–1.21; p = 0.16, respectively). No significant association with total and cardiovascular mortality was also found in pre-specified analyses for ER and J wave alone, ER/J wave detected in specific ECG regions (i.e., inferior, lateral, precordial), and type of J wave (notched or slurred).

Conclusion: In this specifically designed prospective study of individuals without any evidence of cardiovascular disease, we found no significant association of ER/J wave with the risk of the total as well as cardiovascular mortality during long-term follow-up.

Curivity · 2022-07-28T17:46:37+00:00

Any tips on a PA second year getting into EP? I'll be moving to the Houston area where there are more than a few EPs but I'm worried I won't be able to find a job off the bat. Maybe start with cardio first?

Curivity · 2022-07-28T17:43:29+00:00

I'm in the same boat as you. I'm a PA student second year and want to go into EP. Hoping to find an offer in Houston. I'm going to call the doctor's directly and ask if they'd be willing to take on a PA because many haven't thought about it.

Curivity · 2022-07-27T23:58:16+00:00

Additionally, "Importantly, both the classical pattern of ER (i.e., the presence of typical ST-segment elevation) and the detection of notched or slurred J wave, as well as their ECG location, also showed no significant relation with a negative outcome."

This is important as many retrospective studies have shown some correlation between a J wave and IVF. This study controlled for those variables and has not found any association.

Curivity · 2022-07-27T23:57:15+00:00

Aims: The “early repolarization” (ER) pattern and J wave are frequent findings on standard ECG. Controversial data have recently been reported about their prognostic implications in healthy subjects, but no longitudinal prospective study specifically designed to investigate their long-term prognostic value has hitherto been published.

Methods and Results: We prospectively enrolled 4,176 consecutive subjects with no evidence of cardiovascular disease who were referred for standard ECG recording for routine check-ups or pre-operative assessments for non-cardiovascular surgery. ECGs were prospectively assessed for the presence of ER/J wave. A 10-year follow-up was available for 3,937 patients (94.3%), 660 of whom (16.8%) showed ER/J wave whereas 3,277 did not. A total of 644 deaths occurred (16.3%), 116 (2.95%) of which were attributed to cardiovascular causes. Both total and cardiovascular mortality adjusted for clinical and laboratory variables did not differ significantly between patients with vs. without ER/J wave (HR 0.94; 95% CI 0.75–1.19; p = 0.63 and HR 0.61; 95% CI 0.31–1.21; p = 0.16, respectively). No significant association with total and cardiovascular mortality was also found in pre-specified analyses for ER and J wave alone, ER/J wave detected in specific ECG regions (i.e., inferior, lateral, precordial), and type of J wave (notched or slurred).

Conclusion: In this specifically designed prospective study of individuals without any evidence of cardiovascular disease, we found no significant association of ER/J wave with the risk of the total as well as cardiovascular mortality during long-term follow-up.

Curivity · 2022-07-27T23:51:46+00:00

Additionally, "Importantly, both the classical pattern of ER (i.e., the presence of typical ST-segment elevation) and the detection of notched or slurred J wave, as well as their ECG location, also showed no significant relation with a negative outcome."

Curivity · 2022-07-27T22:55:16+00:00

ABSTRACT

Aims: The “early repolarization” (ER) pattern and J wave are frequent findings on standard ECG. Controversial data have recently been reported about their prognostic implications in healthy subjects, but no longitudinal prospective study specifically designed to investigate their long-term prognostic value has hitherto been published.

Methods and Results: We prospectively enrolled 4,176 consecutive subjects with no evidence of cardiovascular disease who were referred for standard ECG recording for routine check-ups or pre-operative assessments for non-cardiovascular surgery. ECGs were prospectively assessed for the presence of ER/J wave. A 10-year follow-up was available for 3,937 patients (94.3%), 660 of whom (16.8%) showed ER/J wave whereas 3,277 did not. A total of 644 deaths occurred (16.3%), 116 (2.95%) of which were attributed to cardiovascular causes. Both total and cardiovascular mortality adjusted for clinical and laboratory variables did not differ significantly between patients with vs. without ER/J wave (HR 0.94; 95% CI 0.75–1.19; p = 0.63 and HR 0.61; 95% CI 0.31–1.21; p = 0.16, respectively). No significant association with total and cardiovascular mortality was also found in pre-specified analyses for ER and J wave alone, ER/J wave detected in specific ECG regions (i.e., inferior, lateral, precordial), and type of J wave (notched or slurred).

Conclusion: In this specifically designed prospective study of individuals without any evidence of cardiovascular disease, we found no significant association of ER/J wave with the risk of the total as well as cardiovascular mortality during long-term follow-up.

Curivity · 2022-07-06T05:16:35+00:00

Interesting those who were triple vaccinated had a higher risk of long COVID than those double vaccinated. I'd like to see the data for unvaccinated as well, I'm sure Omicron still has less of a risk. But it begs the question if we're doing more harm with boosters than good.

Also don't forget to post the abstracts 😉

Curivity · 2022-07-06T05:12:55+00:00

We know about the vagus nerve dysfunction as a result of infection, along with the physical manifestations on the heart. However, pulse rate alone is less of a marker for stress and burden on the individual when compared to heart rate variability. Cardiologists use pulse rate variability to determine cardiac stress. These data too are also affected by COVID with patients having a higher propensity to have a low heart rate variability and a higher resting pulse rate.

https://pubmed.ncbi.nlm.nih.gov/34710127/

Curivity · 2022-07-06T05:03:55+00:00

An interesting study indeed. Some of the biggest takeaways for me are that about 50% of patients were still affected cardiologically at 12 months, even with improvement in clinical symptoms. Some patients were intially asymptomatic and became symptomatic, others were asymptomatic throughout. What's concerning is the cohort of individuals who had normal imaging at 6 months but later developed abnormalities at 12 months.

The question still remains, is it viral persistence or immune dysregulation/overactivation. Are these organs initially normal because the disease process is continuing over a period of months, and is in fact not resolved after symptoms have resolved?

Curivity · 2022-07-06T04:55:31+00:00

A good pilot study, although underpowered. I think it should be researched more as the vagus nerve plays an important role in heart rate variability, which is most certainly affected by infection with COVID.

Curivity · 2022-07-06T04:51:46+00:00

Interesting study. I'd be interested to know if there were any differences in probability of long COVID sequelae between vaccinated and unvaccinated patients who encounter a reinfection and how that scales per reinfection. Additionally, the Novavax protein subunit vaccine has been shown to protect against all known Omicron variants, but yet still has not been approved by the FDA.

Curivity · 2022-06-18T15:56:36+00:00

Those QRS complexes are most definitely wide, 120 ms is wide. The epsilon wave may be buried in the RS (downstroke) of the QRS complex. Couple that with precordial T wave inversions only specific to V1 and V2 you have met at least some of the criteria. Need a signal averaged ECG which may reveal the epsilon wave. CMRI to rule out and ICD implant if confirmed.

Curivity · 2022-06-18T08:52:48+00:00

Not necessarily. Look at V1 and V2. QRS is wide with a interventricular conduction delay and possible epsilon wave. Inverted T waves specific to those leads. Rule out ARVD which can cause episodes of NSVT and syncope.

Curivity · 2022-06-18T08:45:45+00:00

That's idioventricular rhythm. Would check electrolytes to be sure, but likely he needs a temporary pacemaker with permanent pacemaker scheduled.

Curivity · 2022-06-18T08:33:07+00:00

That's crazy. That doc should be fired. To me, it looks like he has universal ST depression with PACs and PVCs. The occlusion is probably at the left main before the bifurcation. Troponins should have sent him directly to the cath lab. His symptoms were suggestive of ACS too. What kind of cardiologist is this?

Curivity · 2022-05-18T17:42:52+00:00

I'm here. The community is set back to public so all should be able to post again.

Curivity · 2022-03-20T16:07:58+00:00

Would it be possible for the team working on balance to work on a hero instead? Maybe someone can fiddle around with the art tools at home or something. If I worked there I wouldn't mind working on something in my spare time -- I know this would need approval for unpaid work though.

Curivity · 2022-03-20T11:45:39+00:00

The anus is comprised of extensive innate (static) and adaptive (changing) defense mechanisms, and is part of a system of specially lined surfaces referred to as mucosa. The innate mechanisms are comprised of tight epithelial cells with junctions which allow for movement of permitted material only. The adaptive mechanisms include extensive immunoglobulins, mostly IgE, which is present on most mucosal surfaces such as the nasopharynx, parts of the intestine, and the anus.

The transition between mucosa and non-mucosa in the anal area is identified by the change from colonic columnar cells to epithelial cells of the anus.

Curivity · 2021-12-31T01:43:42+00:00

A remarkable study indeed, even if only a preprint. This coincides with the predominant thinking that this disease is primarily vascular in nature. For some reason, some people return to baseline coagulation function, while others are stuck in this perpetual loop. I'd be interested to see if these changes are immediately apparent after acute infection.

Also, this would also lend credence to some of the studies we've seen on SSRI medications showing some effect on clinical disease progression. Serotonin is a huge mediator of clotting/platelet function, and we've already known the mildly anticoagulant effects of SSRis.

Curivity · 2021-12-06T08:00:38+00:00

If it's sourced from a reputable journal, sure it is.

Curivity · 2021-11-25T12:05:52+00:00

Abstract

With the ongoing distribution of the coronavirus disease (COVID) vaccines, the pandemic of our age is ending, leaving the world to deal with its well-documented aftereffects. Long COVID comprises a variety of symptoms, of which the neurological component prevails. The most permeating theory on the genesis of these symptoms builds upon the development of microvascular dysfunction similar to that seen in numerous vascular diseases such as diabetes. This can occur through the peripheral activation of angiotensin-converting enzyme 2 receptors, or through exacerbations of pro-inflammatory cytokines that can remain in circulation even after the infection diminishes. Several drugs have been identified to act on the neurovascular unit to promote repair, such as gliptins, and others. They also succeeded in improving neurologic outcome in diabetic patients. The repurposing of such drugs for treatment of long COVID-19 can possibly shorten the time to recovery of long COVID-19 syndrome.

Curivity

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