Hi everyone,
On the giveaway stuff, I have begun reaching out to a couple of the nonprofits. I will give an extension of another week for people to turn off their pledges to this newsletter as I try to figure out which nonprofit to pledge to.
Also worth mentioning that two weeks from now the newsletter will be on break due to proximity around the holidays.
In terms of content, this is a really jam-packed week! In this edition, we delve into a groundbreaking study on a synbiotic preparation (SIM01) for Long Covid treatment in Hong Kong. We also shed light on the incidence and burden of Long Covid in Africa, highlighting the need for further attention and research in this region. Our featured articles cover a wide range of topics, including the blood-brain barrier breakdown in Covid-19 ICU survivors, dysregulated platelet function in Long Covid, and the potential of Poincaré plot in predicting the curative effect of metoprolol for pediatric postural orthostatic tachycardia syndrome.
Media
SUMMARY:
During 2021–2022, 1.3% of adults had myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Women were more likely than men to have ME/CFS.
The percentage of adults with ME/CFS varied by age.
The percentage of adults with ME/CFS varied by race and Hispanic origin.
The percentage of adults with ME/CFS decreased with increasing family income.
My Take:
This is an extremely important piece, 1.3% might seem low but this is over 4 million people!
DEFINITIONS:
Synbiotic preparation: a combination of probiotics and prebiotics that work together to promote a healthy gut microbiome.
SUMMARY:
This study assessed the effectiveness of a synbiotic preparation (SIM01) in alleviating symptoms of post-acute COVID-19 syndrome (PACS) in Hong Kong.
The trial enrolled 463 patients with PACS and randomly assigned them to receive SIM01 or placebo for 6 months.
At the 6-month follow-up, significantly higher proportions of the SIM01 group experienced alleviation of fatigue, memory loss, difficulty in concentration, gastrointestinal upset, and general unwellness compared to the placebo group.
The study suggests that SIM01 could be a safe and promising treatment for PACS and further exploration of its beneficial effects in other chronic or post-infection conditions is warranted.
My Take:
Further research is needed to explore the potential benefits of SIM01 in other chronic or post-infection conditions.
DEFINITIONS:
Post-traumatic stress disorder (PTSD): A psychiatric disorder that can occur in individuals who have experienced or witnessed a traumatic event, such as the COVID-19 pandemic.
SUMMARY:
This meta-analysis examines long-term COVID-19 effects in the WHO African Region.
The incidence of any long COVID symptomatology was 48.6%, with psychiatric conditions being the most frequent, particularly post-traumatic stress disorder reaching a cumulative incidence of 25%.
Higher age and hospitalization were associated with a higher frequency of long COVID symptoms.
Long COVID poses a significant burden in Africa, particularly concerning psychiatric conditions.
Article: Geriatricians, Look Out for Patients With Long COVID
SUMMARY:
Long COVID, an often debilitating condition, has left doctors scrambling to find treatments and diagnostic tools.
Patients residing in nursing homes may exhibit signs of Long Covid that are missed.
A recent study found that patients in two nursing homes who were infected with SARS-CoV-2 struggled with cognitive issues and were more dependent on the staff for an average of 9 months after infection.
Survivors of COVID-19 continued to experience its effects for an average of 9 months, and 30% of those infected died prior to the 1-year follow-up.
Most participants in the study were women who were aged over 80 years and identified as White and non-Hispanic, with half diagnosed with dementia and every participant having multiple chronic conditions.
Article: Wide Regional Variation in Diagnosis of Long COVID
SUMMARY:
In the year after a SARS-CoV-2 infection, about 5% of patients receive a diagnosis of post–COVID-19 condition (PCC), according to data from the Veterans Affairs health system.
But the rate varies substantially by region, ranging from less than 4% in one area to more than 24% in another.
"In the Sunshine Healthcare Network in Florida, the 12-month incidence of U09.9 documentation was 3.39%, whereas in the VA Heart of Texas Healthcare Network it was 24.9%," the diagnostic code for PCC was documented more often in regions with dedicated PCC clinics, the researchers found.
Common symptoms in patients with PCC included shortness of breath (37.1%), fatigue or exhaustion (22.3%), cough (18%), reduced cognitive function or brain fog (6.3%), and change in smell or taste (5.7%).
My Take:
This is why having a biomarker or something close to it is imperative. This is also why having more Long Covid clinics around the country would make such a difference in making diagnoses
Research
Pathologic dysfunction caused by Covid
Article: Blood-brain barrier breakdown in COVID-19 ICU survivors: an MRI pilot study
DEFINITIONS:
Blood-brain barrier (BBB): A selective barrier that separates the blood circulation from the brain tissue and helps protect the brain from toxins and pathogens.
WEPCAST MRI: A non-invasive MRI technique that measures BBB permeability to water without the use of contrast agents.
SUMMARY:
Using a novel MRI technique called water-extraction-with-phase-contrast-arterial-spin-tagging (WEPCAST), researchers have found preliminary evidence of chronic blood-brain barrier (BBB) breakdown in COVID-19 intensive care unit (ICU) survivors.
The study compared COVID-19 ICU survivors (n=7) to age and sex-matched control participants (n=17) and found significantly higher BBB permeability in the COVID-19 survivors, suggesting BBB abnormalities as a contributor to neurological symptoms in long COVID.
My Take:
The observed chronic BBB breakdown in COVID-19 survivors highlights a potential mechanism for long COVID symptoms and cognitive dysfunction.
Article: Dysregulated Platelet Function in Patients with Post-Acute Sequelae of COVID-19 | bioRxiv
DEFINITIONS:
Glycoprotein VI (GPVI) receptor: A platelet surface receptor involved in platelet activation and aggregation.
Thromboxane receptor: A platelet surface receptor involved in platelet aggregation and blood clot formation.
Factor Xa: The activated form of coagulation factor X, which plays a role in the coagulation pathway.
SUMMARY:
26 patients with Post-Acute Sequelae of COVID-19 (PASC) were enrolled in the study to evaluate platelet function and thrombotic potential in patients following recovery from SARS-CoV-2 with PASC symptoms.
PASC patients showed a mild increase in platelet aggregation through the thromboxane receptor and decreased platelet activation through the glycoprotein VI (GPVI) receptor compared to healthy controls.
Thrombosis under shear conditions and Factor Xa activity were reduced in PASC patients.
Plasma from PASC patients activated healthy platelets more potently than plasma from healthy individuals.
My Take:
The study findings suggest that patients with PASC experience dysregulated platelet function and coagulation, which may be driven by a circulating molecule that promotes thrombosis.
SUMMARY:
RNA are involved in modulating the immune response to SARS-CoV-2, the focus has primarily been on miRNAs (microRNAs).
Numerous studies have identified differentially expressed miRNAs in response to SARS-CoV-2 infection, many of which are implicated in regulating immune pathways.
An important example is miR-146a, which is upregulated in COVID-19 patients and acts as a negative regulator of the inflammatory response through targeting genes involved in the nuclear factor kappa B (NF-κB) signaling pathway.
Furthermore, several other miRNAs, such as miR-132, miR-155, and miR-223, have also been shown to play a role in modulating immune responses to viral infections.
In addition to miRNAs, lncRNAs (long non-coding RNAs) have also been implicated in immune regulation during SARS-CoV-2 infection.
For example, the lncRNA NEAT1 has been shown to promote the production of type I interferons, which are critical in the antiviral immune response.Furthermore, circRNAs (circular RNA’s) have recently emerged as potential regulators of immune responses.
Several studies have identified differentially expressed circRNAs in COVID-19 patients, and functional studies have demonstrated their ability to modulate immune signaling pathways.
Overall, host ncRNAs (non-coding RNAs) play a significant role in regulating the immune response to SARS-CoV-2 infection, and further research is needed to fully understand their mechanisms of action and potential therapeutic applications.
My Take:
A lot of this went over my head but thought this was worth sharing!
DEFINITIONS:
Post-acute sequelae: Persistent symptoms and complications that individuals experience after recovering from the acute phase of COVID-19 and other viruses.
SUMMARY:
This study compared post-acute sequelae following hospitalization for COVID-19 and influenza.
The study found that patients with COVID-19 had a higher incidence of post-COVID conditions compared to patients with influenza.
Specific symptoms more prevalent in the COVID-19 group included abnormal breathing, abdominal symptoms, fatigue, and cognitive symptoms.
Beyond the post-COVID conditions, patients with COVID-19 also faced an elevated risk of all-cause ED visits, hospitalizations, and mortality following hospital discharge compared to those with influenza.
My Take:
This study provides evidence that hospitalized COVID-19 patients are at a higher risk of long-term complications compared to influenza survivors.
Related Syndromes
DEFINITIONS:
Poincaré plot: A graphical plot that displays all the RR intervals (a specific interval on an ECG) of 24-hour Holter ECG data in one scatterplot and reflects autonomic activity using graphical characteristics.
Holter ECG: A continuous recording of the electrical activity of the heart for 24 hours to monitor the heart's rhythm and rate during daily activities.
Longitudinal axis (L): The length of the Poincaré plot distributed along the 45-degree line. Believed to indicate sympathetic tone.
Transverse axis (T): The vertical distance between lines parallel to the 45-degree line that intersect the boundaries of the Poincaré plot. Related to parasympathetic/vagal activity.
L/T ratio: The ratio between L and T, indicates the balance between sympathetic and parasympathetic systems.
rMSSD: The root mean square of successive heart beat interval differences - a heart rate variability index reflecting parasympathetic activity.
pNN50: The percentage of successive beat intervals that differ by more than 50ms - another heart rate variability metric indicating parasympathetic tone.
SUMMARY:
Poincaré plots and HR variability indexes can help predict the curative effect of metoprolol for pediatric postural orthostatic tachycardia syndrome (POTS).
63 children with POTS were included, 40 of whom responded to metoprolol treatment and 23 who did not.
The L and T values in the Poincaré plots and the rMSSD, pNN50, HF, and TP values of the HR variability data were significantly lower in participants who responded to metoprolol compared to those who did not.
The L/T value of participants who responded to metoprolol was greater than that of non-responders.
A T < 573.9 ms combined with an L/T > 2.9 had the best performance for predicting the effectiveness of metoprolol, with a sensitivity of 85.0%, specificity of 82.6%, and accuracy of 84.1%.
DEFINITIONS:
Mast cell activation syndrome (MCAS): an immune disease characterized by abnormal reactivity of mast cells, leading to multisystemic inflammatory and allergic manifestations.
Hypermobile Ehlers-Danlos syndrome (hEDS): a genetic disorder affecting connective tissue, leading to joint hypermobility, skin fragility, and other symptoms.
SUMMARY:
MCAS is an immune disease characterized by aberrant mast cell reactivity and is associated with various neurologic and psychiatric disorders.
Mast cell chemical mediators can lead to heterogeneous multisystemic inflammatory and allergic manifestations in MCAS.
MCAS is often undiagnosed and patients can suffer for years due to lack of recognition.
MCAS can be comorbid with autonomic disorders, such as POTS, and hypermobile Ehlers-Danlos syndrome (hEDS).
Treatment with mast cell-directed therapy can lead to significant improvements in neuropsychiatric and multisystemic symptoms in patients with MCAS.
Great information, thank you!
Very interesting all the different research paths. Both my daughter and I have long Covid. As a result, and from reading research, I can see my daughter has hEDS. This also explains some gut issues pre long Covid.
It’s very interesting all the different research and if all these are contributory factors. And Covid has thrown a number of our systems out of whack.