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      Long-COVID postural tachycardia syndrome: an American Autonomic Society statement

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          Abstract

          COVID-19 is a global pandemic that has had a devastating effect on the health and economy of much of human civilization. While the acute impacts of COVID-19 were the initial focus of concern, it is becoming clear that in the wake of COVID-19, many patients are developing chronic symptoms that have been called Long-COVID. Some of the symptoms and signs include those of postural tachycardia syndrome (POTS). Understanding and managing long-COVID POTS will require a significant infusion of health care resources and a significant additional research investment. In this document from the American Autonomic Society, we outline the scope of the problem, and the resources and research needed to properly address the impact of Long-COVID POTS.

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          Most cited references13

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          SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor

          Summary The recent emergence of the novel, pathogenic SARS-coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread pose a global health emergency. Cell entry of coronaviruses depends on binding of the viral spike (S) proteins to cellular receptors and on S protein priming by host cell proteases. Unravelling which cellular factors are used by SARS-CoV-2 for entry might provide insights into viral transmission and reveal therapeutic targets. Here, we demonstrate that SARS-CoV-2 uses the SARS-CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming. A TMPRSS2 inhibitor approved for clinical use blocked entry and might constitute a treatment option. Finally, we show that the sera from convalescent SARS patients cross-neutralized SARS-2-S-driven entry. Our results reveal important commonalities between SARS-CoV-2 and SARS-CoV infection and identify a potential target for antiviral intervention.
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            Is Open Access

            Cell entry mechanisms of SARS-CoV-2

            Significance A key to curbing SARS-CoV-2 is to understand how it enters cells. SARS-CoV-2 and SARS-CoV both use human ACE2 as entry receptor and human proteases as entry activators. Using biochemical and pseudovirus entry assays and SARS-CoV as a comparison, we have identified key cell entry mechanisms of SARS-CoV-2 that potentially contribute to the immune evasion, cell infectivity, and wide spread of the virus. This study also clarifies conflicting reports from recent studies on cell entry of SARS-CoV-2. Finally, by highlighting the potency and the evasiveness of SARS-CoV-2, the study provides insight into intervention strategies that target its cell entry mechanisms.
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              The face of postural tachycardia syndrome – insights from a large cross‐sectional online community‐based survey

              Abstract Background Patients with postural tachycardia syndrome (POTS) experience chronic symptoms of orthostatic intolerance. There are minimal data detailing the demographics, clinical features and clinical course of this condition. This online, community‐based survey highlights patients’ experience with POTS. It consists of the largest sample of POTS patients reported to date. Objectives To describe the demographics, past medical history, medications, treatments and diagnostic journey for patients living with POTS. Methods Postural tachycardia syndrome patients completed an online, community‐based, cross‐sectional survey. Participants were excluded if they had not received a diagnosis of POTS from a physician. The questions focused on the patient experience and journey, rather than physiological responses. Results The final analysis included 4835 participants. POTS predominantly affects white (93%) females (94%) of childbearing age, with approximately half developing symptoms in adolescence (mode 14 years). POTS is a chronic multisystem disorder involving a broad array of symptoms, with many patients diagnosed with comorbidities in addition to POTS. POTS patients often experience lengthy delays [median (interquartile range) 24 (6–72) months] and misdiagnosis, but the diagnostic delay is improving. POTS patients can present with a myriad of symptoms most commonly including lightheadedness (99%), tachycardia (97%), presyncope (94%), headache (94%) and difficulty concentrating (94%). Conclusions These data provide important insights into the background, clinical features and diagnostic journey of patients suffering from POTS. These data should serve as an essential step for moving forward with future studies aimed at early and accurate diagnoses of these patients leading to appropriate treatments for their symptoms.
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                Author and article information

                Contributors
                satish.raj@ucalgary.ca
                Journal
                Clin Auton Res
                Clin Auton Res
                Clinical Autonomic Research
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0959-9851
                1619-1560
                19 March 2021
                : 1-4
                Affiliations
                [1 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Department of Cardiac Sciences, , Libin Cardiovascular Institute, University of Calgary, ; GAC70 HRIC Bldg, 3280 Hospital Dr. NW, Calgary, AB T2N 4Z6 Canada
                [2 ]GRID grid.412807.8, ISNI 0000 0004 1936 9916, Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Center, , Vanderbilt University Medical Center, ; Nashville, TN USA
                [3 ]GRID grid.29857.31, ISNI 0000 0001 2097 4281, Department of Neural and Behavioral Sciences, , Pennsylvania State University College of Medicine, ; Hershey, PA USA
                [4 ]GRID grid.170205.1, ISNI 0000 0004 1936 7822, Department of Neurology, NorthShore University Health System, Pritzker School of Medicine, , University of Chicago, ; Chicago, IL USA
                [5 ]GRID grid.61971.38, ISNI 0000 0004 1936 7494, Department of Biomedical Physiology and Kinesiology, , Simon Fraser University, ; Burnaby, BC Canada
                [6 ]GRID grid.134936.a, ISNI 0000 0001 2162 3504, Department of Nutrition and Exercise Physiology, , University of Missouri, ; Columbia, MO USA
                [7 ]GRID grid.267308.8, ISNI 0000 0000 9206 2401, Division of Cardiology, Department of Pediatrics, , University of Texas Health Sciences Center at Houston, ; Houston, TX USA
                [8 ]GRID grid.412807.8, ISNI 0000 0004 1936 9916, Department of Neurology, Autonomic Dysfunction Center, , Vanderbilt University Medical Center, ; Nashville, TN USA
                [9 ]Cardiology Division, Wellstar Healthcare System, Atlanta, GA USA
                [10 ]GRID grid.267313.2, ISNI 0000 0000 9482 7121, Department of Neurology, , UT Southwestern Medical Center, ; Dallas, TX USA
                Author information
                http://orcid.org/0000-0002-5890-3785
                Article
                798
                10.1007/s10286-021-00798-2
                7976723
                33740207
                4188afa1-6072-4394-9d1b-026284ec90c2
                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 20 February 2021
                : 10 March 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100006108, National Center for Advancing Translational Sciences;
                Award ID: UL1 TR000445
                Categories
                Review Article

                Medicine
                covid ,long covid,postural tachycardia syndrome,position statement
                Medicine
                covid , long covid, postural tachycardia syndrome, position statement

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