IntroductionSince the World Health Organization declared the COVID-19 global pandemic in early March 2020, over 153 million coronavirus cases and 3.2 million deaths were reported worldwide. 1 The effective and rapid roll-out of the COVID-19 vaccine in the UK and other parts of the world has brought hope that the pandemic is coming to an end. 2,3 Unfortunately, the long-term devastating effects of COVID-19 are here to stay. There has been increasing attention recently about the longterm sequel of COVID-19 called 'Long COVID' or post COVID-19 syndrome. Long COVID or post COVID-19 syndrome has been defi ned as 'signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis'. 4 The epidemiology, clinical characteristics, pathogenesis, and complications of patients with acute COVID-19 have been explicitly described, but the long-term consequences and predictors of the illness remain largely unclear.A recent study showed that multiple acute COVID-19 symptoms during the fi rst week of illness predicted long COVID. 5 Other studies have reported consequences of COVID-19 infection up to 6 months. 6,7 Thus, we conducted an observational study with the aim to describe the long COVID symptoms at 3, 6 and 9 months and to determine the risk factors predisposing the development of long COVID following patient hospital discharge. MethodsWe included all patients with confi rmed COVID-19 admitted to a district general hospital, in the UK, between 15 February 2020 and 31 July 2020. All patients tested positive on admission for SARS-CoV-2 on a reverse transcriptase polymerase chain reaction assay after a nasopharyngeal swab. Four of the authors contacted all patients via telephone after hospital discharge between 5 January 2021 and 22 January 2021. We carried out a cross-sectional survey of patients using a standardised questionnaire. Subsequently, we assessed patients' presence and severity of long COVID symptoms at 9 months after their hospital discharge following hospital admissions with acute COVID-19 illness. During the same telephone survey, all patients interviewed were asked to recollect their symptoms for long COVID at 3 and 6 months. Patients who did not answer our initial telephone calls were re-contacted at least three times. Patients who had diffi culty hearing, dementia, care home residents, and those unwilling to participate were excluded.Background Studies to evaluate long COVID symptoms and their risk factors are limited. We evaluated the presence of long COVID and its risk factors in patients discharged from a hospital with COVID-19 illness.Methods This observational study included 271 COVID-19 patients admitted between February and July 2020 in a hospital in the UK. The primary outcome measure was to assess the duration and severity of long COVID and its predictors at 3, 6 and 9 months. Logistic regression was performed to assess the potential risk factors for long COVID.Results Out of 89 patients interviewed, ...
Background The British Thoracic Society (BTS) recommends that all patients admitted with COVID-19 pneumonia should have a chest X-ray (CXR) and clinical follow-up at 6 or 12 weeks, depending on the disease severity. Little data is available on long-term CXR follow-up for moderate and severe COVID-19 pneumonia. This study aims to evaluate compliance with clinico-radiological follow-up of patients recovering from COVID-19 pneumonia at a local hospital in the UK, as per the BTS guidance, and to analyse radiological changes at clinical follow-up at 12 weeks, in order to risk-stratify and improve patient outcomes. Methods This is a single-centre retrospective audit of 255 consecutive COVID-19 positive patients admitted to a local hospital in the UK over 5 months between May and October 2020. All CXRs and clinic follow-up at 12 ± 8 weeks were checked on an electronic database. Results Over one in two (131/255) patients had CXR evidence of COVID-19 pneumonia during the initial hospital admission. Half of the patients (60/131) died before CXR or clinic follow-up. Fifty-eight percent (41/71) of the surviving patients had a follow-up CXR, and only two developed respiratory complications- one had residual lung fibrosis, another a pulmonary embolism. Eighty-eight percent (36/41) of the patients had either resolution or improved radiological changes at follow-up. Most patients who had abnormal follow-up CXR were symptomatic (6/8), and many asymptomatic patients at follow-up had a normal CXR (10/12). Conclusions Although there were concerns about interstitial lung disease (ILD) incidence in patients with COVID-19 pneumonia, most of our patients with COVID-19 pneumonia had no pulmonary complications at follow-up with CXR. This emphasises that CXR, a cost-effective investigation, can be used to risk-stratify patients for long term pulmonary complications following their COVID-19 pneumonia. However, we acknowledge the limitations of a low CXR and clinic follow-up rate in our cohort.
Background/Aims There are sporadic reports about the development of new rheumatic immune-mediated inflammatory diseases (R-IMIDs) in adults after receiving SARS-CoV-2 vaccines. This systematic review (SR) aimed to critically review and summarize the clinical profile, patient demographics, treatment, and prognosis of new-onset R-IMIDs following SARS-CoV-2 vaccination. Methods We retrieved English-language articles (Case reports and series and observational studies) on new-onset R-IMIDs following SARS-CoV-2 vaccination, published until June 2022, from standard databases (MEDLINE, Embase, Cochrane). The search strings used during the literature search incorporated ‘SARS-CoV-2 vaccination’ (along with related MeSH terms) and various key terms for R-IMIDs [which included (but was not limited to) inflammatory arthritis, connective tissue disease (CTD), vasculitis, systemic lupus erythematosus, Sjogren’s syndrome, sarcoidosis, systemic sclerosis, idiopathic inflammatory myositis, anti-synthetase syndrome, Adult-onset Stills disease (AOSD), giant cell arteritis (GCA), and polymyalgia rheumatica (PMR)]. The protocol was registered in PROSPERO (CRD42022318561). Results Of the total 2179 articles retrieved, 1986 articles were excluded following the title-abstract screening, and 107 articles that did not meet inclusion criteria. We included the remaining 86 articles (130 cases) upon full-text screening. Furthermore, we added four articles (six cases) based on a manual search, comprising 90 articles (136 cases) for final analysis. These 136 new R-IMID cases were reported from 27 different countries. Of these, more than one-third of the cases were reported from three countries (viz., Italy, Japan, and the USA). The patients had a mean age of 57 (range:17-90) years, and the majority were females (63.0%). Most patients developed R-IMIDs after receiving Pfizer-BioNTech vaccine (76; 55%), followed by Oxford AstraZeneca vaccine (35; 25%). The mean duration between SARS-CoV-2 vaccination and R-IMIDs development was 9.2 (range:1-90) days. The second dose of the vaccine resulted in more R-IMIDs (74;54%) than the first (53;39%). CTDs (34; 25%) and small vessel vasculitis (33; 24%) were the commonest R-IMID manifestations, followed by inflammatory arthritis and AOSD, each in 13 (9.5%) cases. Nearly half of the patients with CTDs had Idiopathic Inflammatory Myositis. PMR and GCA accounted for 16 (11.7%) and 5 (3.6%) cases, respectively. However, no cases of axial spondylarthritis were reported. Most (118; 86%) R-IMID patients were treated with corticosteroids, with a small number receiving steroid-sparing drugs, such as methotrexate, rituximab and cyclophosphamide. Most (125; 91%) went into either disease remission or improvement following the treatment. Only three patients were admitted to the intensive care unit (ICU) to manage their disease; One of them died due to fatal myositis and rhabdomyolysis; two surviving ICU patients had ANCA-associated vasculitis with lung involvement. Conclusion Although rare, this SR highlights the emergence of de novo R-IMIDs following SARS-CoV-2 vaccination. We cannot confirm the causality between the vaccination and the onset of R-IMID. However, further research is warranted in this area. Disclosure A. Nune: None. K. Bora: None. K.P. Iyengar: None. B. Barman: None. V. Durkowski: None. S. Venkatachalam: None. S. Bilgrami: None. L. Ottewell: None. C. Manzo: None.
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