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      Musculoskeletal symptoms and related factors in postacute COVID‐19 patients


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          There is a lack of an overview of the factors associated with postacute COVID‐19 musculoskeletal symptoms. The aims of this study were as follows: 1‐ to evaluate the most frequent admission symptoms and the frequency of musculoskeletal symptoms in postacute COVID‐19 patients; and 2‐ to determine the related factors with the postacute COVID‐19 musculoskeletal symptoms.


          A total of 280 postacute COVID‐19 patients (183 females, 97 males) were enrolled and divided into two groups: 1‐ patients whose musculoskeletal symptoms initiated with or were aggravated by COVID‐19 (n = 240); and 2‐ patients whose musculoskeletal symptoms did not change with COVID‐19 (n = 40). The variables were demographic and treatment data, symptoms on admission, postacute COVID‐19 symptoms, laboratory results (complete blood count, erythrocyte sedimentation rate, C‐reactive protein, ferritin and d‐dimer), chest computed tomography findings and symptoms during acute COVID‐19.


          Most of the patients have fatigue (71.8%), spine pain (70.7%) and myalgia (60.7%). The most common pain region was the back (30.4%). The frequency of dyspnoea was 30%, cough 18.5% and chest pain 10.7%. Having any chronic disease ( P = .031), the duration of hospital stay ( P = .016), frequency of back pain during acute COVID‐19 ( P = .018), tomography findings and d‐dimer ( P = .035) levels were significantly higher, and lymphocyte ( P = .024) levels were significantly lower in the patients whose symptoms began with or were aggravated by COVID‐19.


          Back pain was the most frequent symptom on admission. The most common postacute COVID‐19 musculoskeletal symptoms were fatigue, spine pain and myalgia. Lower lymphocyte and higher d‐dimer levels, the presence of COVID‐19 findings in tomography and back pain during acute COVID‐19 infection, higher duration of hospital stay and having chronic diseases were related to post‐COVID‐19 musculoskeletal symptoms.

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          6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

          Background The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. Methods We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences. Findings In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up. Interpretation At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery. Funding National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.
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            Persistent Symptoms in Patients After Acute COVID-19

            This case series describes COVID-19 symptoms persisting a mean of 60 days after onset among Italian patients previously discharged from COVID-19 hospitalization.
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              Extrapulmonary manifestations of COVID-19

              Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. Given that ACE2, the entry receptor for the causative coronavirus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thromboinflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19. Here we review the extrapulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for all organ systems involved.

                Author and article information

                Int J Clin Pract
                Int J Clin Pract
                International Journal of Clinical Practice
                John Wiley and Sons Inc. (Hoboken )
                18 August 2021
                18 August 2021
                : e14734
                [ 1 ] Physical Medicine and Rehabilitation Eskisehir City Hospital Eskisehir Turkey
                [ 2 ] Internal Medicine Eskisehir City Hospital Eskisehir Turkey
                [ 3 ] Family Medicine Eskisehir City Hospital Eskisehir Turkey
                [ 4 ] Department of Biostatistics Eskişehir Osmangazi University Eskişehir Turkey
                Author notes
                [*] [* ] Correspondence

                Fulya Bakılan, Physical Medicine and Rehabilitation, Eskişehir City Hospital, Eskisehir, Turkey.

                Email: fulyabakilan@ 123456gmail.com

                Author information
                © 2021 John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                : 18 June 2021
                : 10 August 2021
                Page count
                Figures: 0, Tables: 5, Pages: 8, Words: 9631
                Original Paper
                Original Papers
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