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    Home > Active Ingredient News > Blood System > Nature medicine: Pay attention to COVID-19 post-acute syndrome

    Nature medicine: Pay attention to COVID-19 post-acute syndrome

    • Last Update: 2021-04-14
    • Source: Internet
    • Author: User
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    SARS-CoV-2 is the pathogen that caused the COVID-19 pandemic, leading to a global medical crisis and a shortage of health resources.
    As the
    number of people recovering from COVID-19 grows, it is vital to understand the health care issues around them.
    COVID-19 is now recognized as a multi-organ disease with a wide range of manifestations.
    Similar to the
    post- acute viral syndrome described by survivors of other highly virulent coronavirus epidemics , there are more and more reports of sustained and long-term effects after acute COVID-19 .
    Patient advocacy groups
    ( many of whom claim to be long-distance transporters ) help recognize post - acute COVID-19 , a syndrome characterized by persistent symptoms and / or delayed or long-term complications 4 weeks after the onset of symptoms .
    Ani Nalbandian et al .
    conducted a comprehensive review of the current literature
    on acute COVID-19 , its pathophysiology and its organ-specific sequelae, and the article was published in the journal Nature Medicine .
    Finally, this article discusses the relevant considerations of multidisciplinary care for COVID-19 survivors, and proposes a framework for identifying high- risk groups after the acute phase of COVID-19 and treating them through specialized COVID-19 clinics.
    Coordinate
    management .

    SARS-CoV-2 led to 19 COVID- COVID 19- pandemic pathogens, leading global medical crises and health resource constraints.
    As the
    number of people recovering from COVID-19 grows, it is vital to understand the health care issues around them.
    COVID-19 is now recognized as a multi-organ disease with widespread manifestations.
    Similar to the
    post- acute viral syndrome described by survivors of other highly virulent coronavirus epidemics , there are more and more reports of sustained and long-term effects after acute COVID-19 .
    Patient advocacy groups
    ( many of whom claim to be long-distance transporters ) help recognize post - acute COVID-19 , a syndrome characterized by persistent symptoms and / or delayed or long-term complications 4 weeks after the onset of symptoms .
    Ani Nalbandian et al .
    conducted a comprehensive review of the current literature
    on acute COVID-19 , its pathophysiology and its organ-specific sequelae, and the article was published in the journal Nature Medicine .
    Finally, this article discusses the relevant considerations of multidisciplinary care for COVID-19 survivors, and proposes a framework for identifying high- risk groups after the acute phase of COVID-19 and treating them through specialized COVID-19 clinics.
    Coordinated
    management
    .
    management

    The scientific and clinical evidence for the subacute and long-term effects of COVID-19 is evolving, and it can affect multiple organ systems.
    Early reports showed the residual effects of
    SARS-CoV-2 infection , such as fatigue, dyspnea, chest pain, cognitive impairment, arthralgia, and decreased quality of life.
    Cell damage, a powerful innate
    immune response that produces inflammatory cytokines, and
    the procoagulant state induced by SARS-CoV-2 infection may all contribute to these sequelae.
    Survivors of previous coronavirus infections, including
    the SARS epidemic in 2003 and the Middle East Respiratory Syndrome (MERS) epidemic in 2012 , all showed similar persistent symptoms, exacerbating concerns about the severe clinical sequelae of COVID-19 .
    The article defines post-acute viral syndrome as the onset of SARS-CoV-2 infection with persistent symptoms and / or delayed or long-term complications more than 4 weeks.

    The scientific and clinical evidence for the subacute and long-term effects of COVID-19 is evolving, and it can affect multiple organ systems.
    Early reports showed the residual effects of
    SARS-CoV-2 infection , such as fatigue, dyspnea, chest pain, cognitive impairment, arthralgia, and decreased quality of life.
    Powerful innate cell damage An inflammatory cytokine production of
    immune reactions and
    infections immune SARS-CoV-2 infection induces a procoagulant state may cause these effects.
    Survivors of previous coronavirus infections, including
    the SARS epidemic in 2003 and the Middle East Respiratory Syndrome (MERS) epidemic in 2012 , all showed similar persistent symptoms, exacerbating concerns about the severe clinical sequelae of COVID-19 .
    In this paper, the acute post-viral syndrome is defined as the acute syndrome is defined as a virus of SARS-CoV-2 of SARS-CoV-2 infection and the onset of persistent symptoms of infection and the onset of persistent symptoms / / or delays or long-term complications than or delayed or long-term complications Chaoguo 4 4 weeks.
    week.

    Post - acute COVID-19 timeline.
    Acute
    COVID-19 usually lasts for 4 weeks from the onset of symptoms .
    After more than
    4 weeks, SARS-CoV-2 , which has the ability to replicate, has not been isolated.
    Post
    - acute COVID-19 is defined as persistent symptoms and / or delayed or long-term complications from the onset of symptoms for more than 4 weeks .

    Post - acute COVID-19 timeline.
    Acute
    COVID-19 usually lasts for 4 weeks from the onset of symptoms .
    After more than
    4 weeks, SARS-CoV-2 , which has the ability to replicate, has not been isolated.
    Post
    - acute COVID-19 is defined as persistent symptoms and / or delayed or long-term complications from the onset of symptoms for more than 4 weeks .
    Post - acute COVID-19 timeline.
    Acute
    COVID-19 usually lasts for 4 weeks from the onset of symptoms .
    After more than
    4 weeks, SARS-CoV-2 , which has the ability to replicate, has not been isolated.
    Post
    - acute COVID-19 is defined as persistent symptoms and / or delayed or long-term complications from the onset of symptoms for more than 4 weeks .

    Based on recent studies, is further divided into two categories : (1) sub-acute or persistent COVID-19 symptoms , including acute COVID-19 after 4--12 weeks abnormal signs and symptoms ; (2) chronic or 19 COVID- after synthesis Signs , including symptoms and abnormalities that persist or appear 12 weeks after the onset of acute COVID-19 , cannot be attributed to other diagnoses .
    Here, this review summarizes the epidemiology and organ-specific sequelae after acute COVID-19 , and puts forward the management considerations of COVID-19 clinics for interdisciplinary comprehensive care of these patients.

    Based on recent studies, is further divided into two categories : (1) sub-acute or persistent subacute or persistent COVID-19 COVID-19 symptoms symptoms , including acute COVID-19 after 4--12 weeks symptoms and abnormalities ; ( 2) chronic or chronic or COVID-19 COVID-19 syndrome after the syndrome , including acute COVID-19 attack 12 weeks after the occurrence of symptoms and persistent abnormal or can not be attributed to other diagnosis .
    Here, this review summarizes the
    epidemiology and organ-specific sequelae after the acute diagnosis of COVID-19 , and proposes management considerations for the interdisciplinary comprehensive care of these patients in COVID-19 clinics.

    Summary of the pathological changes of various organ systems in COVID-19 post-acute syndrome

    Summary of changes in various organ systems of COVID-19 post-acute syndrome Summary of changes in various organ systems of COVID-19 post-acute syndrome

    lung

    Pulmonary lung

    Difficulty breathing , decreased exercise capacity and hypoxia are common and persistent symptoms and signs

    Difficulty breathing , decreased exercise capacity and hypoxia are common and persistent symptoms and signs

    • During the follow-up of COVID-19 survivors, it was found that the spreading ability was weakened , the lung physiology was restricted, and the ground glass shadow and fibrosis were affected.

    • During the follow-up of COVID-19 survivors, it was found that the spreading ability was weakened , the lung physiology was restricted, and the ground glass shadow and fibrosis were affected.

    progression of lung disease and functional recovery assessment may include family or pulse oximeter, 6 MWTS , PFTs , high resolution chest CT , pulmonary vascular CT angiography.

    progression of lung disease and functional recovery assessment may include family or pulse oximeter, 6 MWTS , PFTs , high resolution chest CT , pulmonary vascular vascular CT angiography.

    Blood system

    Blood system blood system

    A retrospective study found that acute COVID-19 there after thrombotic embolic event rate of <5%

    A retrospective study found that acute COVID-19 there after thrombosis incidence of thromboembolic events thrombotic <5%

    The duration of the hyperinflammatory state caused by SARS-CoV-2 infection is unknown

    The duration of the hyperinflammatory state caused by SARS-CoV-2 infection is unknown

    After discussing the risk - benefit of patients who are susceptible to immobility, d- dimer levels that continue to rise ( more than twice the upper limit of normal ), and other high-risk comorbidities ( such as cancer ) , direct oral anticoagulants may be considered And low molecular weight heparin is used for thrombosis prevention .

    After discussing the risk - benefit of patients who are susceptible to immobility, d- dimer levels that continue to rise ( more than twice the upper limit of normal ), and other high-risk comorbidities ( such as cancer ) , direct oral anticoagulants may be considered And low molecular weight heparin is used for thrombosis prevention .
    prevention

    Cardiovascular

    Cardiovascular Cardiovascular Cardiovascular

    Persistent symptoms may include palpitations, difficulty breathing, chest pain

    Persistent symptoms may include palpitations, difficulty breathing, chest pain

    Long-term sequelae may include increased cardiovascular metabolic demands, myocardial fibrosis or scars ( can be detected by cardiac MRI ) , arrhythmia , tachycardia, and autonomic dysfunction

    Long-term sequelae may include increased cardiovascular metabolic requirements, myocardial fibrosis or scars ( can be detected by cardiac MRI ) , arrhythmia , tachycardia, and autonomic dysfunction arrhythmia

    •Patients with cardiovascular complications or persistent cardiac symptoms during acute infection can be monitored through clinical follow-up, echocardiography and ECG follow-up

    •Patients with cardiovascular complications or persistent cardiac symptoms during acute infection can be monitored through clinical follow-up, echocardiography and ECG follow-up

    Neuropsychiatric

    Neuropsychiatric Neuropsychiatric

    • Persistent abnormalities may include fatigue, myalgias, headaches, neurological abnormalities and cognitive impairment

    • Persistent abnormalities may include fatigue, myalgias, headaches, neurological abnormalities and cognitive impairment

    Similar to other pathogenic coronavirus survivors, in 30-40% of COVID-19 survivors, anxiety, depression, sleep disorders and post-traumatic stress disorder

    Similar to other pathogenic coronavirus survivors, in 30-40% of COVID-19 survivors, anxiety, depression, sleep disorders and post-traumatic stress disorder

    • pathophysiology of neuropsychiatric complications are diverse , by immune disorders, inflammation, microvascular thrombosis , influence iatrogenic effects of drugs and psychological factors

    • pathophysiology of neuropsychiatric complications are diverse , by immune disorders, inflammation, microvascular thrombosis , influence iatrogenic effects of drugs and psychological factors

    kidney

    Kidney Kidney

    Most COVID-19 patients were cured of acute kidney injury in the acute phase, but an article reported that eGFR was lowered during a 6 -month follow-up .

    Most COVID-19 patients were cured of acute kidney injury in the acute phase, but an article reported that eGFR was lowered during a 6 -month follow-up .

    • COVID-19- related nephropathy ( COVAN ) may be the main mode of kidney injury in African-American patients.

    • COVID-19- related nephropathy ( COVAN ) may be the main mode of kidney injury in African-American patients.

    Survivors of COVID-19 with persistent renal impairment may benefit from early and close clinical follow-up of AKI survivors.

    Survivors of COVID-19 with persistent renal impairment may benefit from early and close clinical follow-up of AKI survivors.

    endocrine

    Endocrine Endocrinology

    Endocrine sequelae may include deterioration of new or existing diabetes control, subacute thyroiditis and osteoporosis .

    Endocrine sequelae may include deterioration of new or existing diabetes control, subacute thyroiditis and osteoporosis .
    Diabetic osteoporosis

    • newly diagnosed with diabetes if not 2 traditional risk factors for diabetes, suspected hypothalamic - pituitary - adrenal axis suppression or hyperthyroidism should receive appropriate laboratory tests, and should be referred to the Department of Endocrinology.

    • newly diagnosed with diabetes if not 2 traditional risk factors for diabetes, suspected hypothalamic - pituitary - adrenal axis suppression or hyperthyroidism should receive appropriate laboratory tests, and should be referred to the Department of Endocrinology.

    Gastrointestinal, liver and gallbladder

    Gastrointestinal, liver and gallbladder gastrointestinal, liver and gallbladder

    Even after a nasopharyngeal swab test is negative, prolonged viral fecal shedding may occur in COVID-19 .

    Even after a nasopharyngeal swab test is negative, prolonged viral fecal shedding may occur in COVID-19 .

    • COVID-19 may change the gut microbiota, including the abundance of opportunistic microorganisms and the depletion of beneficial symbionts.

    • COVID-19 may change the gut microbiota, including the abundance of opportunistic microorganisms and the depletion of beneficial symbionts.

    dermatology

    Dermatology Dermatology

    •Hair loss is the main symptom, and it is reported that about 20% of COVID-19 survivors have hair loss.

    •Hair loss is the main symptom, and it is reported that about 20% of COVID-19 survivors have hair loss.

    Children's Multiple System Inflammatory Syndrome ( MIS-C )

    Children's Multiple System Inflammatory Syndrome ( Children's Multiple System Inflammatory Syndrome (Children MIS-C MIS-C ) )

    •Diagnostic criteria: age <21 years, fever, elevated inflammatory markers, multiple organ dysfunction, current or recent infection with SARS-CoV-2 , other reasonable diagnoses are excluded.

    •Diagnostic criteria: age <21 years, fever, elevated inflammatory markers, multiple organ dysfunction, current or recent infection with SARS-CoV-2 , other reasonable diagnoses are excluded.

    • Usually affects children over 7 years of age and disproportionately affects African, Afro-Caribbean or Hispanic ancestry.
    • Cardiovascular
    ( coronary artery aneurysm ) and neurological ( headache, encephalopathy, stroke, and epilepsy ) complications may occur.

    • Usually affects children over the age of 7 and disproportionately affects African, Afro-Caribbean, or Hispanic ancestry.
    • cardiovascular
    ( coronary artery aneurysms ) and neurological ( headache, encephalopathy, stroke and epilepsy seizures ) complications may occur.

    The sequelae of multiple organs beyond the acute phase of COVID-19 infection have received more and more attention with the increase of data and clinical experience in this time frame.
    The necessary active future research includes identifying and characterizing the main clinical, serological, imaging and epidemiological characteristics of
    COVID-19 in the acute, subacute and chronic phases of the disease, which will help us better understand this new disease Natural history and pathophysiology.
    Active and future clinical research, including prospective cohorts and clinical trials, as well as frequent reviews of emerging evidence by working groups and task forces, are essential for building a strong knowledge base and providing information for clinical practice in this field important.
    Currently,
    medical professionals who care for survivors of acute COVID-19 play a key role in identifying, carefully recording, investigating, and managing emerging or new symptoms, as well as tracking organ-specific complications that occur during acute illness.
    Equally important, clinicians must provide information in an accessible form, including clinical research and other resources for participation, such as patient advocacy and support groups.

    The sequelae of multiple organs beyond the acute phase of COVID-19 infection have received more and more attention with the increase of data and clinical experience in this time frame.
    The necessary active future research includes identifying and characterizing the main clinical, serological, imaging and epidemiological characteristics of
    COVID-19 in the acute, subacute and chronic phases of the disease, which will help us better understand this new disease Natural history and pathophysiology.
    Active and future clinical research, including prospective cohorts and clinical trials, as well as frequent reviews of emerging evidence by working groups and task forces, are essential for building a strong knowledge base and providing information for clinical practice in this field important.
    Currently,
    medical professionals who care for survivors of acute COVID-19 play a key role in identifying, carefully recording, investigating, and managing emerging or new symptoms, as well as tracking organ-specific complications that occur during acute illness.
    Equally important, clinicians must provide information in an accessible form, including clinical research and other resources for participation, such as patient advocacy and support groups.

    Interdisciplinary management of COVID-19 .
    Multidisciplinary collaboration is essential to provide comprehensive outpatient care for acute COVID-19 survivors in
    COVID-19 clinics .
    According to the resource situation, priority can be given to the high-risk population of COVID-19 after acute COVID-19 , which is defined as those who suffer from serious illness during acute COVID-19 and / or need to receive care in the intensive care unit, the elderly and the presence of organ comorbidities ( previous People with respiratory disease, obesity, diabetes, high blood pressure, chronic cardiovascular disease, chronic kidney disease, post-organ transplantation or active cancer ) .
    HRCT , high-resolution CT ; PE , pulmonary embolism.

    Interdisciplinary management of COVID-19 .
    Multidisciplinary collaboration is essential to provide comprehensive outpatient care for acute COVID-19 survivors in
    COVID-19 clinics .
    According to the resource situation, priority can be given to the high-risk population of COVID-19 after acute COVID-19 , which is defined as those who suffer from serious illness during acute COVID-19 and / or need care in the intensive care unit, the elderly and the presence of organ comorbidities ( previously People with respiratory disease, obesity, diabetes, high blood pressure, chronic cardiovascular disease, chronic kidney disease, post-organ transplantation or active cancer ) .
    HRCT , high-resolution CT ; PE , pulmonary embolism.
    Interdisciplinary management of COVID-19 .
    Multidisciplinary collaboration is essential
    to provide comprehensive outpatient care for acute COVID-19 survivors in COVID-19 clinics .
    According to the resource situation, priority can be given to the high-risk population of COVID-19 after acute COVID-19 , which is defined as people who suffer from serious illness during acute COVID-19 and / or need care in the intensive care unit, the elderly and the presence of organ comorbidities (
    People with previous respiratory disease, obesity, diabetes, hypertension, chronic cardiovascular disease, chronic kidney disease, post-organ transplantation or active cancer ) .
    HRCT , high-resolution CT ; PE , pulmonary embolism.

    In addition, the care of COVID-19 patients obviously does not end when they are discharged from the hospital.
    Interdisciplinary cooperation is needed to provide comprehensive care for these patients in an outpatient setting.
    Therefore, the healthcare system and hospitals recognize the need to establish specialized
    COVID-19 clinics where experts from multiple disciplines can provide comprehensive care, which is crucial .
    For
    people at high risk of post - acute COVID-19 , follow-up care can be considered as a priority, including those who are severely ill during acute COVID-19 and / or need to be treated in the ICU , and those who are most prone to complications ( such as the elderly) , Patients with multiple organ complications, post-transplant patients , and those with a history of active cancer ) and those with the highest burden of persistent symptoms.

    In addition, COVID-19 COVID 19- patient care is clearly not ended at the time of discharge, it requires cross-disciplinary cooperation, comprehensive care for these patients in an outpatient setting.
    Therefore, the healthcare system and hospitals recognize that the need to establish specialized
    patient care obviously does not end when they are discharged from the hospital, and interdisciplinary cooperation is needed to provide comprehensive care for these patients in an outpatient setting.
    Therefore, the healthcare system and hospitals recognize the need to establish specialized
    COVID-19 COVID-19 clinics, where experts from multiple disciplines can provide comprehensive care, which is crucial for clinics, where experts from multiple disciplines can It is essential to provide comprehensive care .
    For
    people at high risk of post - acute COVID-19 , follow-up care can be considered as a priority, including those who are severely ill during acute COVID-19 and / or need to be treated in the ICU , and those who are most prone to complications ( such as the elderly) , Patients with multiple organ complications, post-transplant patients , and those with a history of active cancer ) and those with the highest burden of persistent symptoms.

    Given the global scale of this pandemic, it is clear that the medical needs of patients with sequelae of COVID-19 will continue to increase in the foreseeable future .
    To meet this challenge, it will be necessary to use the existing outpatient infrastructure, develop a scalable medical model, and conduct interdisciplinary integration to improve the physical and mental health of
    COVID-19 survivors in the long-term .

    Given the global scale of this pandemic, it is clear that in the foreseeable future, COVID-19 COVID-19 medical needs of patients with sequelae will continue to increase.
    To cope with this challenge, it will be necessary to use the existing outpatient infrastructure, develop a scalable medical model, and conduct interdisciplinary integration to improve
    the medical needs of patients with sequelae in the long-term will continue to increase.
    To meet this challenge, the need to use existing clinic infrastructure, the development of scalable medical model, and interdisciplinary integration in order to improve the long-term
    COVID-19 COVID-19 physical and mental health of survivors.
    The physical and mental health of the survivors.

    Original source:

    Original source:

    Nalbandian, Ani et al.
    “Post-acute COVID-19 syndrome.
    ” 
    Nature medicine , 10.
    1038/s41591-021-01283-z.
    22 Mar.
    2021, doi:10.
    1038/s41591-021-01283-z

    Nalbandian, Ani et al.
    “Post-acute COVID-19 syndrome.
    ” 
    Nature medicine , 10.
    1038/s41591-021-01283-z.
    22 Mar.
    2021, doi:10.
    1038/s41591-021-01283-z
    Nalbandian, Ani et al .
    "Post-acute COVID-19 syndrome.
    Nature medicine

     



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