Post-COVID Conditions

 

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Post-COVID Conditions

Although most people with COVID-19 get better within weeks of illness, some people experience post-COVID conditions. Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience more than four weeks after first being infected with the virus that causes COVID-19. Even people who did not have symptoms when they were infected can have post-COVID conditions. These conditions can have different types and combinations of health problems for different lengths of time.

Types of Post-COVID Conditions

Long COVID

Long COVID is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms:

·       Tiredness or fatigue

·       Difficulty thinking or concentrating (sometimes referred to as “brain fog”)

·       Headache

·       Loss of smell or taste

·       Dizziness on standing

·       Fast-beating or pounding heart (also known as heart palpitations)

·       Chest pain

·       Difficulty breathing or shortness of breath

·       Cough

·       Joint or muscle pain

·       Depression or anxiety

·       Fever

·       Symptoms that get worse after physical or mental activities

Multiorgan Effects of COVID-19

Multiorgan effects can affect most, if not all, body systems including heart, lung, kidney, skin, and brain functions. Multiorgan effects can also include conditions that occur after COVID-19, like multisystem inflammatory syndrome (MIS) and autoimmune conditions. MIS is a condition where different body parts can become swollen. Autoimmune conditions happen when your immune system attacks healthy cells in your body by mistake, causing painful swelling in the affected parts of the body.

It is unknown how long multiorgan system effects might last and whether the effects could lead to chronic health conditions.

Post-acute COVID-19 syndrome

 

Fig. 1: Timeline of post-acute COVID-19.

Acute COVID-19 usually lasts until 4 weeks from the onset of symptoms, beyond which replication-competent SARS-CoV-2 has not been isolated. Post-acute COVID-19 is defined as persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. The common symptoms observed in post-acute COVID-19 are summarized.

 

Fig. 2: Interdisciplinary management in COVID-19 clinics.

Multidisciplinary collaboration is essential to provide integrated outpatient care to survivors of acute COVID-19 in COVID-19 clinics. Depending on resources, prioritization may be considered for those at high risk for post-acute COVID-19, defined as those with severe illness during acute COVID-19 and/or requirement for care in an ICU, advanced age and the presence of organ comorbidities (pre-existing respiratory disease, obesity, diabetes, hypertension, chronic cardiovascular disease, chronic kidney disease, post-organ transplant or active cancer). The pulmonary/cardiovascular management plan was adapted from a guidance document for patients hospitalized with COVID-19 pneumonia76. HRCT, high-resolution computed tomography; PE, pulmonary embolism.

 

Box 1 Summary of post-acute COVID-19 by organ system

Pulmonary

• Dyspnea, decreased exercise capacity and hypoxia are commonly persistent symptoms and signs
• Reduced diffusion capacity, restrictive pulmonary physiology, and ground-glass opacities and fibrotic changes on imaging have been noted at follow-up of COVID-19 survivors
• Assessment of progression or recovery of pulmonary disease and function may include home pulse oximetry, 6MWTs, PFTs, high-resolution computed tomography of the chest and computed tomography pulmonary angiogram as clinically appropriate

Hematologic

• Thromboembolic events have been noted to be <5% in post-acute COVID-19 in retrospective studies
• The duration of the hyperinflammatory state induced by infection with SARS-CoV-2 is unknown
• Direct oral anticoagulants and low-molecular-weight heparin may be considered for extended thromboprophylaxis after risk–benefit discussion in patients with predisposing risk factors for immobility, persistently elevated D-dimer levels (greater than twice the upper limit of normal) and other high-risk comorbidities such as cancer

Cardiovascular

• Persistent symptoms may include palpitations, dyspnea and chest pain
• Long-term sequelae may include increased cardiometabolic demand, myocardial fibrosis or scarring (detectable via cardiac MRI), arrhythmias, tachycardia and autonomic dysfunction
• Patients with cardiovascular complications during acute infection or those experiencing persistent cardiac symptoms may be monitored with serial clinical, echocardiogram and electrocardiogram follow-up

Neuropsychiatric

• Persistent abnormalities may include fatigue, myalgia, headache, dysautonomia and cognitive impairment (brain fog)
• Anxiety, depression, sleep disturbances and PTSD have been reported in 30–40% of COVID-19 survivors, similar to survivors of other pathogenic coronaviruses
• The pathophysiology of neuropsychiatric complications is mechanistically diverse and entails immune dysregulation, inflammation, microvascular thrombosis, iatrogenic effects of medications and psychosocial impacts of infection

Renal

• Resolution of AKI during acute COVID-19 occurs in the majority of patients; however, reduced eGFR has been reported at 6 months follow-up
• COVAN may be the predominant pattern of renal injury in individuals of African descent
• COVID-19 survivors with persistent impaired renal function may benefit from early and close follow-up in AKI survivor clinics

Endocrine

• Endocrine sequelae may include new or worsening control of existing diabetes mellitus, subacute thyroiditis and bone demineralization
• Patients with newly diagnosed diabetes in the absence of traditional risk factors for type 2 diabetes, suspected hypothalamic–pituitary–adrenal axis suppression or hyperthyroidism should undergo the appropriate laboratory testing and should be referred to endocrinology

Gastrointestinal and hepatobiliary

• Prolonged viral fecal shedding can occur in COVID-19 even after negative nasopharyngeal swab testing
• COVID-19 has the potential to alter the gut microbiome, including enrichment of opportunistic organisms and depletion of beneficial commensals

Dermatologic

• Hair loss is the predominant symptom and has been reported in approximately 20% of COVID-19 survivors

Ayurvedic treatment may be helpful to reduce post covid complications:-

1-    Dashmool Kwath

2-    Dashmoolarishta

3-    Sansamni vati

4-    Arjun kwath

5-    Breathing exercise

6-    Chandraprabha vati

7-    Arogyavardhini vati

8-    Chawanprash awleh

9-    Kaishor Guggulu

10- Shnehan

11- Prawal pisti

12- Drakhcha awleha

13- Golden milk

14- Tulsi

15- Adrak

16- Swarn malti basant rash

17- Lukewarm water

18- Vitamin -A

19- Laghu aahar

20- Mild exercise

 

Parkinson's disease

Parkinson's disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination. Parkinson's symptoms usually begin gradually and get worse over time. As the disease progresses, people may have difficulty walking and talking.

Both men and women can have Parkinson’s disease. However, the disease affects about 50 percent more men than women.

One clear risk factor for Parkinson's is age. Although most people with Parkinson’s first develop the disease at about age 60, about 5 to 10 percent of people with Parkinson's have "early-onset" disease, which begins before the age of 50. Early-onset forms of Parkinson's are often, but not always, inherited, and some forms have been linked to specific gene mutations.

What Causes Parkinson's Disease?

Parkinson's disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson's. Scientists still do not know what causes cells that produce dopamine to die.

People with Parkinson's also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson's, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.

Many brain cells of people with Parkinson's contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinson’s disease and Lewy body dementia.

Although some cases of Parkinson's appear to be hereditary, and a few can be traced to specific genetic mutations, in most cases the disease occurs randomly and does not seem to run in families. Many researchers now believe that Parkinson's disease results from a combination of genetic factors and environmental factors such as exposure to toxins.

Symptoms of Parkinson’s Disease

Parkinson's disease has four main symptoms:

•           Tremor (trembling) in hands, arms, legs, jaw, or head

•           Stiffness of the limbs and trunk

•           Slowness of movement

•           Impaired balance and coordination, sometimes leading to falls

Other symptoms may include depression and other emotional changes; difficulty swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.

Symptoms of Parkinson’s and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson's as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.

Early symptoms of Parkinson's disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson's. They may see that the person's face lacks expression and animation, or that the person does not move an arm or leg normally.

People with Parkinson's often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.

Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.

Many people with Parkinson’s note that prior to experiencing stiffness and tremor, they had sleep problems, constipation, decreased ability to smell, and restless legs.

Diagnosis of Parkinson’s Disease

A number of disorders can cause symptoms similar to those of Parkinson's disease. People with Parkinson's-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson's, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson's. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.

There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson's disease. Diagnosis is based on a person's medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson's disease.

Treatment of Parkinson’s Disease

Although there is no cure for Parkinson's disease, medicines, surgical treatment, and other therapies can often relieve some symptoms.

Medicines for Parkinson's Disease

Medicines prescribed for Parkinson's include:

•           Drugs that increase the level of dopamine in the brain

•           Drugs that affect other brain chemicals in the body

•           Drugs that help control nonmotor symptoms

The main therapy for Parkinson's is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain's dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy—such as nausea, vomiting, low blood pressure, and restlessness—and reduces the amount of levodopa needed to improve symptoms.

People with Parkinson's should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.

Other medicines used to treat Parkinson’s symptoms include:

•           Dopamine agonists to mimic the role of dopamine in the brain

•           MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain

•           COMT inhibitors to help break down dopamine

•           Amantadine, an old antiviral drug, to reduce involuntary movements

•           Anticholinergic drugs to reduce tremors and muscle rigidity

Deep Brain Stimulation

For people with Parkinson’s who do not respond well to medications, deep brain stimulation, or DBS, may be appropriate. DBS is a surgical procedure that surgically implants electrodes into part of the brain and connects them to a small electrical device implanted in the chest. The device and electrodes painlessly stimulate the brain in a way that helps stop many of the movement-related symptoms of Parkinson's, such as tremor, slowness of movement, and rigidity.

 

Ankylosing spondylitis

 

Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the small bones in your spine (vertebrae) to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply.

Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation also can occur in other parts of your body — most commonly, your eyes.

There is no cure for ankylosing spondylitis, but treatments can lessen your symptoms and possibly slow progression of the disease.

Symptoms

Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular intervals.

The areas most commonly affected are:

•           The joint between the base of your spine and your pelvis

•           The vertebrae in your lower back

•           The places where your tendons and ligaments attach to bones, mainly in your spine, but sometimes along the back of your heel

•           The cartilage between your breastbone and ribs

•           Your hip and shoulder joints

Causes

Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at a greatly increased risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition.

Risk factors

•           Your sex. Men are more likely to develop ankylosing spondylitis than are women.

•           Your age. Onset generally occurs in late adolescence or early adulthood.

•           Your heredity. Most people who have ankylosing spondylitis have the HLA-B27 gene. But many people who have this gene never develop ankylosing spondylitis.

Complications

In severe ankylosing spondylitis, new bone forms as part of the body's attempt to heal. This new bone gradually bridges the gap between vertebrae and eventually fuses sections of vertebrae. Those parts of your spine become stiff and inflexible. Fusion can also stiffen your rib cage, restricting your lung capacity and function.

Other complications might include:

•           Eye inflammation (uveitis). One of the most common complications of ankylosing spondylitis, uveitis can cause rapid-onset eye pain, sensitivity to light and blurred vision. See your doctor right away if you develop these symptoms.

•           Compression fractures. Some people's bones thin during the early stages of ankylosing spondylitis. Weakened vertebrae can crumble, increasing the severity of your stooped posture. Vertebral fractures can put pressure on and possibly injure the spinal cord and the nerves that pass through the spine.

•           Heart problems. Ankylosing spondylitis can cause problems with your aorta, the largest artery in your body. The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function.

 

 

Women Need 400 micrograms of Folic Acid Every Day

CDC urges every woman who could become pregnant to get 400 micrograms (400 mcg) of folic acid every day.

The B vitamin folic acid helps prevent birth defects. If a woman has enough folic acid in her body before and while she is pregnant, her baby is less likely to have a major birth defect of the brain or spine.

What Is Folic Acid?

Folic acid is a B vitamin. Our bodies use it to make new cells. Everyone needs folic acid. But for women who can get pregnant, it is really important! If a woman has enough folic acid in her body before she is pregnant, it can help prevent major birth defects of her baby’s brain and spine. These birth defects are neural tube defects or NTDs. Women need to take folic acid every day, starting before they are pregnant to help prevent NTDs.

 

How Much Folic Acid Is Needed To Prevent Neural Tube Defects?

CDC and the US Public Health Service urge every woman who could become pregnant to get 400 micrograms (400 mcg) of synthetic folic acid every day.

One easy way a woman can be sure she is getting enough folic acid is to take a vitamin that has folic acid in it every day. Most vitamins sold in the United States have the recommended daily amount of folic acid (400 mcg) that women need to prevent neural tube defects. Vitamins can be found at most local pharmacy, grocery, or discount stores.

You can get your vitamin with folic acid in one of several ways. You can take a multivitamin or a small, single supplement of folic acid. These days, multivitamins with folic acid come in chewable chocolate or fruit flavors, liquids, and large oval or smaller round pills. Many stores offer a single folic acid supplement for just pennies a day.

Another good choice is a store-brand multivitamin, which includes most of the vitamins you need each day. Unless your doctor suggests a special type, you do not need to choose among vitamins for women or active people, or one for people who are on a low carbohydrate diet. A basic multivitamin meets the needs of most women.

Another way to get folic acid is to eat enough breakfast cereal that has been enriched with folic acid every day. Amounts of folic acid in cereals vary, so be sure to check the label on the side of the box to make sure you’re getting an adequate amount.

When Should a Woman Start Taking Folic Acid?

These birth defects of the brain and spine happen in the first few weeks of pregnancy, often before a woman finds out she is pregnant. All women should get in the habit of taking folic acid daily even when they are not planning to get pregnant. For folic acid to help, a woman needs to take it every day, starting before she becomes pregnant.

Folic Acid: All Women, Every Day

You might think that you can get all the folic acid and other vitamins you need from the food you eat each day. But it is hard to eat a diet that has all the nutrients you need every day. Even with careful planning, you might not get all the vitamins you need from your diet alone. That’s why it’s important to take a vitamin with folic acid every day.

Today’s woman is busy. You know that you should exercise, eat right, and get enough sleep. You might wonder how you can fit another thing into your day. But it only takes a few seconds to take a vitamin to get all the folic acid you need.

Folate has many functions in the body:

•           Helps tissues grow and cells work

•           Works with vitamin B12 and vitamin C to help the body break down, use, and create new proteins

•           Helps form red blood cells (helps prevent anemia)

•           Helps produce DNA, the building block of the human body, which carries genetic information

Folate deficiency may cause:

•           Diarrhea

•           Gray hair

•           Mouth ulcers

•           Peptic ulcer

•           Poor growth

•           Swollen tongue (glossitis)

It may also lead to certain types of anemias.

Because it's hard to get enough folate through foods, women thinking about becoming pregnant need to take folic acid supplements. Taking the right amount of folic acid before and during pregnancy helps prevent neural tube defects, including spina bifida. Taking higher doses of folic acid before you get pregnant and during the first trimester may lower your chances of miscarriage.

Folic acid supplements may also be used to treat a lack of folate, and may help with some kinds of menstrual problems and leg ulcers.

•           broccoli.

•           brussels sprouts.

•           leafy green vegetables, such as cabbage, kale, spring greens and spinach.

•           peas.

•           chickpeas and kidney beans.

•           liver (but avoid this during pregnancy)

•           breakfast cereals fortified with folic acid.

 

The following supplements may improve sperm count and male fertility issues.

 

• D-aspartic acid (D-AA). Experts believe this amino acid is related to low sperm count because men with fertility issues have lower levels of it. ...

• Vitamin C. ...

• Vitamin D. ...

• Fenugreek. ...

• Zinc. ...

• Ashwagandha. ...

• Maca root. ...

• Coenzyme Q10

1. Lose weight

Losing weight if you’re overweight is one of the single-most effective things you can do to increase sperm count.

2. Exercise

Even if you don’t need to lose weight, staying active and leading a healthy lifestyle can help boost your sperm count.

3. Take your vitamins

Some types of vitamins, including vitamins D, C, E, and CoQ10, are important for sperm health.

4. Avoid substance abuse

Low sperm counts and unhealthy sperm have been linked

•           heavy drinking, which is defined as drinking two or more alcoholic drinks per day

•           tobacco use of any kind

•           illegal drug use, including cocaine and anabolic steroids

5. Check your environment

Consider changing your clothes and showering as soon as possible if you’ve been exposed to:

•           metals

•           solvents

•           pesticides

•           paint strippers

•           degreasers

•           non-water based glues or paints

•           other endocrine disruptors

6. Have your bike checked

Biking might be related to low sperm count. Bicycling more than five hours per week is associated with lower sperm concentration. Having your bike checked for a proper fit can help.

7. Wear loose, cotton boxers

Keeping your sperm at an adequate temperature and allowing lots of air flow to the scrotum can help cultivate the right environment for healthy sperm. If you don’t feel comfortable wearing boxers, choose cotton briefs instead of synthetic ones. That will still help control air flow and temperature.

Healthy sperm

Sperm count isn’t the only thing that matters when trying to conceive. You also want to have overall healthy sperm.

A male’s reproductive health is defined by three aspects of sperm:

1.         the health of the individual sperm

2.         the amount or concentration of sperm

3.         the volume of the overall sperm