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ହାଇଡ୍ରାଟିଡିଫର୍ମ ମୋଲ ପାଇଁ ସୂଚନା |

Long COVID 'May Be Four Syndromes'

The condition commonly called 'long COVID' may not be one syndrome but possibly up to four different syndromes, according to a new review.

The finding comes from a dynamic themed review of available scientific evidence published by the National Institute for Health Research (NIHR).

The paper, Living with COVID19 draws on the latest expert consensus and published evidence, as well as the experience of patients.

It formed the first output from the NIHR Centre for Engagement and Dissemination (NIHR CED) which is working towards a real-time knowledge base in what is an emerging field.

It is estimated that as many as 60,000 people in the UK may have long COVID.

Long COVID 'May Be a Catch All Term'

The review found clear consistencies for a wide range of recurring symptoms among people who had been hospitalised because of COVID-19, as well as those who had COVID-19 in the community.

Those who experienced ongoing COVID had problems with the respiratory system, the brain, cardiovascular system and heart, kidneys, the gut, the liver, and even skin.

The authors said that such a wide range of symptoms created diagnostic uncertainty.

"We believe that the term 'long COVID' is being used as a catch-all for more than one syndrome, possibly up to four," said Dr Elaine Maxwell, the review's author.

She told a briefing hosted by the Science Media Centre (SMC) that while some patients experience "classic post-critical illness symptoms", others reported "fatigue and brain fog in a way that's consistent with post viral fatigue syndrome".

A third group experienced "permanent organ damage caused by the virus", while another significant group "describe a rollercoaster of symptoms that move around the body and do not steadily progress towards recovery".

"We believe that the lack of distinction between these syndromes may explain the challenges people are having in being believed, and accessing services," said Dr Maxwell.

Patients who were unable to have their symptoms addressed and treated in the absence of an agreed definition of ongoing COVID, particularly those who were not hospitalised and never formerly diagnosed, may in turn go on to encounter a psychological impact, the review said.

Ongoing COVID 'Can Last for Months'

Another notable feature of ongoing COVID was a wide spectrum in how long patients reported feeling unwell.

"People asking for help and advice now are being told that they should recover within 2 to 3 weeks," said Dr Maxwell, "but we heard from people who are still unable to work, study, or care for dependents 7 months after their initial infection."

As part of the study, the NIHR CED held a focus group with 14 members of the Long COVID Facebook group, whose members include post-hospitalised and non-hospitalised people.

EFFECTIVE LIFESTYLE MODIFICATION in HYPERTESION

 

PERSISTENT NIGHT SWEATS: NEVER TO BE IGNORED.

 

Night sweats are a nonspecific symptom that patients commonly experience but rarely discuss with their physicians without prompting. Although many life-threatening causes such as malignancies or infections have been described, most patients who report persistent night sweats in the primary care setting do not have a serious underlying disorder. Conditions commonly associated with night sweats include menopause, mood disorders, gastroesophageal reflux disease, hyperthyroidism, and obesity. If a clinical diagnosis is apparent based on the initial history and physical examination, specific treatment for four to eight weeks may be offered. When the history and physical examination do not reveal a specific cause, physicians should proceed with a systematic and cost-conscious strategy that uses readily available laboratory and imaging studies, such as a complete blood count, tuberculosis testing, thyroid-stimulating hormone levels, HIV testing, C-reactive protein level, and chest radiography. Additional tests that could be considered selectively include computed tomography of the chest and/or abdomen, bone marrow biopsy, polysomnography, and/or additional laboratory studies if indicated. If these results are normal, and no additional disorders are suspected, reassurance and continued monitoring are recommended. The presence of night sweats alone does not indicate an increased risk of death.

 

Night sweats are a common experience, with a prevalence of up to 41% among primary care patients. The definition of night sweats varies and generally does not require that the symptom be bothersome to the patient. One definition suggested in a 2010 study was “sweating at night even when it is not excessively hot in your bedroom.”3 New evidence from the primary care setting has been published.

A systematic review found that the cross-sectional prevalence of night sweats ranges from 10% to 41% in the primary care setting, with the highest prevalence occurring in patients between 41 and 55 years of age.

In a study of school-aged children in China, 12% reported having weekly night sweats during the past year. When present, night sweats were associated with obstructive sleep apnea, insomnia, anxiety, and respiratory and atopic symptoms.

A cohort study of 1,534 patients older than 65 years found that after seven years, patients who reported having night sweats were not more likely to die or to die earlier than patients who did not report them.

INFECTIONS IN PREGNANCY – CYTOMEGALOVIRUS

 

CAUSATIVE ORGANISM:

Cytomegalovirus (CMV) or herpesvirus type 5(HHV-5). Family: Herpesviridae

TRANSMISSION:

CMV is transmitted through exposure to bodily fluids. Such as Urine, Feces, Blood, Semen, Urogenital secretions, Breast milk, urine. Vertical (Transplacental), Blood Transfusion, Organ Transplant.

RISK FACTORS:  

Higher socioeconomic class (less likely to have immunity through childhood infection), immunosuppression (e.g. HIV).

EPIDEMIOLOGY:

CMV is ubiquitous, 50% adults develop immunity in pregnant women. 1% of seronegative pregnant women will contract CMV antenatally.

CLINICAL FINDINGS and COMPLICATIONS: 

o   Congenital- 90% infected infants appear normal, later 20% develop sensory nerve hearing loss, psychomotor mental retardation, or both. The infants with symptomatic illness (about 0.1% of all births) show congenital defects or disorders (jaundice, anemia, hepatosplenomegaly, thrombocytopenia, low birth weight, microcephaly, and chorioretinitis).

o   Perinatal- Almost all of these perinatally infected infants have no discernible illness unless the baby is premature or immunocompromised. CMV can also be efficiently transmitted from mother to child by breast milk, but these postpartum infections are also usually benign.

o   Post neonatal- CMV infections during childhood and adulthood are totally asymptomatic. CMV may cause a mononucleosis-like syndrome.

o   Adults: Persons having AIDS, latent CMV may be reactivated and cause very serious disease. interstitial pneumonia (90% mortality), chorioretinitis, gastroenteritis, neurologic and other organs involvements.

SIGNS:

Often no clinical signs, may find lymphadenopathy.

PATHOLOGY/PATHOGENESIS:

Incubation period 1–2 months.

Cytomegalovirus infects epithelial cells and leukocytes. In vitro, CMV DNA can be demonstrated in monocytes showing no cytopathology, indicating a restricted growth potential in these cells. In addition to nuclear inclusions (“owl eye cells”), CMV produces perinuclear cytoplasmic inclusions and enlargement of the cell (cytomegaly), a property which gives the virus its name. Following primary infection can remain dormant and then reactivate (e.g. in immunosuppression).

 

INVESTIGATIONS

Bloods: CMV IgM (current infection)/IgG (immunity).

USS: Fetal anomaly scan.

Other: Amniocentesis for CMV PCR (6–9 weeks after primary infection).

MANAGEMENT:

No treatment to prevent transmission to fetus. May offer termination of pregnancy if evidence of CNS damage. Ganciclovir, a nucleoside analog of acyclovir (INN: Aciclovir), inhibits CMV replication and reduces the severity of CMV syndromes, such as retinitis and gastrointestinal disease. When given with hyper immune globulin, ganciclovir is thought to reduce the mortality. Neonatal gancyclovir can attenuate audiological complications.

PROGNOSIS:

Rate of transmission to the fetus is 40%. Of these, only 10% will develop the congenital Syndrome. Ninety percent of babies who are symptomatic at birth will have later neuro-developmental problems.

INFECTIONS IN PREGNANCY – HERPES SIMPLEX

CAUSATIVE ORGANISM:  Herpes Simplex Virus (HSV).

TRANSMISSION:   

    By physical contact, sexual contact, vertical.

RISK FACTORS: 

    Unprotected sex, immunosuppression (e.g. HIV), other STIs.

EPIDEMIOLOGY: 

    Herpes simplex infects 2% of pregnant women.

SYMPTOMS: 

    Burning sensation, pain, pruritis, dysuria (note: may be asymptomatic).

SIGNS: 

    Clusters of vesicles with surrounding erythema, can progress to ulcerated lesions which crust over, may be associated with local lymphadenopathy.

PATHOLOGY/PATHOGENESIS

DNA virus (herpes family), two types – HSV-1 is transmitted by oral-to-oral contact to cause oral herpes (which can include symptoms known as “cold sores”), but can also cause genital herpes.HSV-2 is a sexually transmitted infection that causes genital herpes. Both HSV-1 and HSV-2 infections are lifelong. Dormant period: Following primary infection, HSV remains dormant in nerve ganglia and can be reactivated to form recurrent lesions. Spread to neonate: Mainly direct contact with infected maternal secretions (but transplacental transmission possible), risk of neonatal transmission at vaginal delivery – 41% with primary lesions, 2% with recurrent lesions.

INVESTIGATIONS:

Usually diagnosed clinically. Microbiology: Swabs for viral culture/PCR, STI screen. Bloods: HSV antibody (primary infection in third trimester).

MANAGEMENT

Antenatal: Aciclovir (200 mg 5 times daily for 5 days) in primary infection. Treatment with acyclovir and valacyclovir by 36 weeks of pregnancy to term reduces the frequency of clinical manifestations, vertical transmission, elimination of the virus during birth by reducing the percentage of caesarean

Delivery with primary HSV: If within 6 weeks of likely delivery, advise Caesarean section. If opts for vaginal delivery, give IV aciclovir intrapartum, avoid prolonged ruptured membranes/FSE/FBS.

Delivery with recurrent HSV: Does not necessitate Caesarean section. Women may opt for Caesarean if lesions detected at onset of labour – can offer daily aciclovir from 36/40 to reduce likelihood of lesions.

COMPLICATIONS

Maternal: Disseminated herpes (encephalitis, hepatitis, disseminated skin lesions) rare but not uncommon in pregnancy.

Neonatal: It affects skin/eyes/mouth, CNS or multiple organs. The risk of neonatal infection varies from 30% to 50% for late onset HSV infections (last trimester), whereas early pregnancy infection carries a risk of about 1%. When primary HSV infection occurs during late pregnancy

PROGNOSIS:

•  HSV disease localized to the skin, eye, and/or mouth (SEM); this syndrome is associated with a low mortality but it has a significant morbidity, and it may progress to encephalitis or disseminated disease if left untreated;
• HSV encephalitis with or without skin, eye, and/or mouth involvement which causes neurologic morbidity among the majority of survivors; 
• Disseminated HSV which manifests as severe multiorgan dysfunction (including central nervous system, liver, lung, brain, adrenals, skin, eye, and/or mouth) and has a mortality risk that exceeds 80% in absence of therapy