Search Results (5,408)

SARS-CoV-2 infection triggers a strong inflammatory response, and persistent symptoms after recovery are thought to reflect prolonged systemic dysregulation. However, mechanisms underlying long COVID remain unclear. This study evaluated longitudinal changes in cytokine hematological and biochemical parameters up to nine months after hospitalization for COVID-19 and examined their relationship with persistent symptoms, vaccination status, and the occurrence of comorbidities. Long COVID patients showed sustained elevations in IL-2, IL-6, IL-10, IL-17A, CXCL9, TNF-α, and IFN-γ compared with healthy controls, exhibiting heterogeneous temporal trajectories. Specifically, levels of IL-2, IL-10, TNF-α, and creatinine continued to increase over time, whereas IFN-γ, LDH, CCL2, CXCL9, and CXCL10 declined. Other parameters exhibited greater variability without a uniform longitudinal pattern. IL-6 demonstrated consistently high diagnostic performance in distinguishing individuals after COVID-19 from healthy controls (AUC > 0.82). Aging substantially affects cytokine profiles and systemic inflammatory status; therefore, residual age-related confounding cannot be fully excluded despite statistical adjustment. Although symptoms such as fatigue, cough, and dyspnea were still reported at nine months, no stable associations were identified between cytokine concentrations and clinical manifestations. These findings indicate that while immune alterations persist long after acute infection, systemic cytokine measurements alone may be insufficient to explain the presence or persistence of symptoms. The results suggest that long COVID reflects multifactorial processes extending beyond systemic inflammation and highlight the need for further research into mechanisms driving long-term long COVID sequelae. Full article

Background: Carotid atherosclerosis is a recognised manifestation of systemic vascular disease, and its association with coronary artery disease (CAD) has been well described. However, previous studies have largely been conducted under conventional diagnostic conditions and have focused on carotid plaque, intima–media thickness, or simple present-versus-absent stenosis classifications, rather than duplex-derived haemodynamic markers across the spectrum of angiographic CAD burden. The COVID-19 pandemic and post-pandemic period changed referral patterns and created more variable cardiovascular presentations, including symptoms that could resemble or mask obstructive CAD. Therefore, we investigated whether the established association between carotid stenosis severity and CAD burden remains detectable in a diagnostically heterogeneous real-world cohort, and whether routinely available carotid duplex haemodynamic parameters provide a clinically relevant signal in this setting. Methods: This single-centre, cross-sectional study was performed as a carotid-focused secondary analysis of the BG Study cohort. We included 902 consecutive patients who underwent invasive coronary angiography between 2021 and 2023 and carotid duplex ultrasonography during the same hospitalisation. CAD burden was defined according to the number of major coronary vessels with ≥70% diameter stenosis and classified as no CAD, one-vessel, two-vessel, or three-vessel disease. Carotid duplex parameters included peak systolic velocities of the common, internal, and external carotid arteries, as well as ICA stenosis severity graded according to NASCET criteria. Associations with CAD burden were assessed using a staged statistical approach combining χ² tests, Kruskal–Wallis tests with post hoc pairwise comparisons, Spearman correlation, inverse probability weighting, and ordered logistic regression. Results: The prevalence of measured ICA stenosis of any grade and severe ICA stenosis increased with greater CAD burden (both p < 0.001). Median PSV values of the bilateral ICAs and ECAs differed significantly across CAD groups on global intergroup testing. Post hoc pairwise analyses showed that significant corrected differences were concentrated between patients without CAD and those with multivessel or three-vessel CAD, particularly for ICA stenosis measures and bilateral ECA PSV. Spearman analysis demonstrated weak but statistically significant correlations between carotid parameters and CAD burden (ρ = 0.085–0.134). After inverse probability weighting, covariate balance was achieved, with all post-IPW standardised mean differences being <0.01. In ordered logistic regression (OLR) analysis, patient-reported history of carotid stenosis (OR 2.25, 95% CI 1.38–3.67; p < 0.001), right external carotid artery PSV per 10 cm/s (OR 1.31, 95% CI 1.09–1.57; p = 0.004), left ICA PSV per 10 cm/s (OR 1.17, 95% CI 1.01–1.36; p = 0.034), and left ICA stenosis per 10% (OR 1.24, 95% CI 1.11–1.39; p < 0.001) were independently associated with higher CAD burden. Exploratory ratio-based analyses showed that the ECA/CCA PSV ratio was associated with CAD presence and higher CAD burden, whereas the ICA/CCA ratio showed weaker associations; neither ratio-based index outperformed absolute ECA PSV. Conclusions: In this carotid-focused secondary analysis of a pandemic-era angiography cohort, carotid stenosis severity and duplex-derived haemodynamic parameters were independently but modestly associated with increasing angiographic CAD burden. These findings support carotid duplex markers as adjunctive indicators of systemic atherosclerotic burden rather than standalone tools for CAD detection or treatment decision-making. Future validation in vascular surgery populations is warranted to determine whether routinely available carotid duplex parameters can contribute to targeted cardiovascular risk recognition before major vascular procedures. Full article

Background and Objectives: Healthcare workers (HCWs) involved in the COVID-19 response are at increased risk of mental health disturbances, including sleep disorders. This study aimed to assess the prevalence and predictors of insomnia among HCWs in Almaty, Kazakhstan. Materials and Methods: A cross-sectional study was conducted between 11 and 26 September 2021, including 553 HCWs. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI). The primary binary outcome was defined as an ISI score ≥ 10, while ISI ≥ 15 was used descriptively to indicate moderate-to-severe insomnia symptoms. Associations were evaluated using chi-square tests and multivariable logistic regression models. Statistical significance was set at p < 0.05. Results: Overall, 38.10% of HCWs with complete ISI data had insomnia symptoms based on the predefined ISI ≥ 10 threshold. In multivariable analysis, Kazakh nationality (AOR = 2.11, 95% CI: 1.05–4.23), advanced education (AOR = 2.03, 95% CI: 1.13–3.65), physician role (AOR = 4.92, 95% CI: 1.25–19.30), and working with COVID-19 patients for >1 year (AOR = 2.28, 95% CI: 1.33–3.89) were significantly associated with increased odds of insomnia. Conclusions: Insomnia symptoms were common among surveyed HCWs during the COVID-19 pandemic and were associated with selected demographic and occupational characteristics, including professional role, education level, and duration of work with COVID-19 patients. These findings highlight the need for targeted mental health interventions and structural support systems for HCWs in Kazakhstan. Full article

Mucormycosis is a rare, invasive fungal infection associated with high mortality. This retrospective study evaluated adult mucormycosis cases followed in our clinic between 2015 and 2025. A total of 13 patients were included, with a mean age of 50.92 ± 20.65 years (range, 20–83), and 10 (76.9%) were male. The most frequent symptom was facial pain (100%). Four (30.8%) of the patients had rhino-sinusitis, and three (23%) had rhino-orbito-cerebral involvement. Seven (53.9%) of the patients had hematological malignancy, three (23%) had diabetes mellitus (DM), two (15.4%) had a history of COVID-19 pneumonia, and one (7.7%) had a history of both DM and COVID-19 pneumonia. All had elevated C-reactive protein levels. Rhizopus spp. grew in nasal/tissue cultures of three (23%) patients, and so did Mucor spp. Surgery was performed in 11 (84.6%) patients, and fungal hyphae were observed in tissue histopathology. All patients showed radiological findings of mucormycosis on imaging. All patients received Liposomal Amphotericin B, and nine (69.2%) patients received sequential posaconazole therapy. Recurrence occurred in two (15.4%) patients. A total of eight (61.5%) patients, including three (23%) patients with intracranial involvement, died. Mucormycosis is a severe infection, especially in patients with hematological malignancies or DM, despite early diagnosis and combined antifungal and surgical treatments. Full article

This study aimed to identify the distinct intrinsic response potential of γδ T cells from COVID-19 patients with different illness severities, to better understand the implication of these cells in COVID-19 disease. Forty-four COVID patients were enrolled at hospitalization and classified as: moderate without oxygen support (MWO₂; N = 15), moderate with oxygen support (MO₂; N = 15), or severe disease requiring mechanical ventilation (SD; N = 14). γδ T cells were characterized ex vivo, isolated from peripheral blood cells, stimulated in vitro with OKT3 and K562 cells, and evaluated for functional markers by flow cytometry. Ex vivo analysis identified 16.21% of total γδ T cells as Vδ1⁻Vδ2⁻. SD patients presented a lower frequency of TRAIL⁺ and of IL-17-producing Vδ2 cells, as well as lower value of fluorescence intensity values for TNF-α in Vδ2 cells, than MWO₂ patients (p < 0.05). In addition, paired analyses showed a lower frequency of IL-17-producing than CD161⁺ Vδ2 cells in SD patients (p < 0.05). These observations suggest a more restricted response potential of the Vδ2 subset in severe disease, show the impact of general immune dysregulation on these cells, or even suggest some role for IL-17-producing Vδ2 cells in preventing critical symptoms. Full article

Background: Long COVID in children is increasingly recognized, yet its clinical predictors and objective biological correlates remain insufficiently characterized. Objectives: The objective was to compare clinical, demographic, and laboratory characteristics between children with and without long COVID and to identify associated variables. Methods: We conducted a retrospective observational case–control study at the “Dr. Victor Gomoiu” Children’s Clinical Hospital, including pediatric patients with confirmed SARS-CoV-2 infection. Cases were defined as children with symptoms persisting ≥12 weeks after acute infection, while controls had no persistent symptoms at ≥12 weeks. Results: Eighty-nine children with long COVID and 88 matched controls were included. Children with long COVID were significantly older (1.79 ± 0.90 vs. 1.14 ± 0.80 years, p < 0.001) and more frequently from urban areas (86.5% vs. 69.3%, p = 0.0099). Lymphocyte, monocyte, and basophil counts were significantly lower in the Long COVID group, while D-dimer, ferritin, serum iron, urea, and creatinine levels were significantly higher. A multivariate predictive model demonstrated excellent discrimination (AUC = 0.94), with optimal sensitivity (84.3%) and specificity (89.8%) at a probability threshold of 0.48. Conclusions: Long COVID in children was associated with identifiable clinicobiological features. An exploratory composite model showed good discrimination but requires external validation. Full article

During the pre-Omicron phases of the COVID-19 pandemic, patients with hematological neoplasms were characterized by very high morbidity and mortality rates. Remdesivir, a viral RNA-polymerase inhibitor, interferes with key SARS-CoV-2 enzymes, preventing the virus from multiplying. The use of convalescent plasma (CP) in treating patients with COVID-19 has been shown to be beneficial in patients with an impaired humoral response to infection, including most of those on active treatment for hematologic malignancies. This retrospective, non-interventional study was performed using the Croatian Cooperative Group for Hematological Diseases database of patients with hematological malignancies infected with SARS-CoV-2. Patients treated with remdesivir and/or CP were matched to those untreated according to age, disease type, and antineoplastic therapy. We identified 119 patients treated with remdesivir and/or CP fulfilling entry criteria and matched 116 according to our established criteria to one of the 374 untreated patients. Treatment significantly reduced COVID-19 mortality. The beneficial effect of antiviral therapy was limited to those who started antiviral treatment within 7 days of the onset of symptoms. Due to the exclusive enrolment of hematological patients with COVID-19, our study provides unique insights into the benefits of early application of both antiviral and CP therapy. It emphasizes the need for early administration before the infection has transformed into the hyperinflammatory phase. Full article

Background: Cognitive difficulties are common after SARS-CoV-2 infection, yet their neurobiological underpinnings remain uncertain. Cognitive symptoms in post-COVID-19 condition (PCC) are often characterised by attentional and executive dysfunction, although the relationship between subjective symptoms and objective neurobiological changes remains uncertain. Methods: Adults previously hospitalised with COVID-19 who reported persistent cognitive symptoms underwent neuropsychological testing and 3 T MRI. The protocol included high-resolution volumetric imaging, diffusion-based tractography, and magnetic resonance spectroscopy (MRS) of frontal white matter. Data were compared with age- and sex-matched controls from a pre-COVID-19 cohort and against pooled normative MRS datasets. Analyses adjusted for intracranial volume, sex, and time since infection, with false-discovery-rate correction. This study was exploratory and hypothesis-generating in design. Results: Thirty participants were recruited; twenty-nine completed MRI acquisition. Participants (mean age 58 years; 62% female; approximately two years post-infection) demonstrated selective impairments in attention, working memory, and verbal fluency. No widespread volumetric or white-matter differences were identified, although reduced posterior hypothalamic volume and altered occipito-parietal connectivity were observed. MRS demonstrated reduced N-acetylaspartate and elevated choline, myo-inositol, and glutamate-glutamine ratios relative to normative reference ranges. No significant associations were observed between imaging measures and cognitive or symptoms outcomes after correction. Conclusions: PCC is characterised by circumscribed cognitive changes and subtle neural differences, but these objective changes do not closely align with subjective symptom severity. This mismatch shares phenotypic features with functional cognitive disorder and suggests that post-COVID-19 “brain fog” is not driven by structural or neurochemical changes alone. Instead, it potentially reflects a combination of mild neurobiological effects and functional cognitive processes. Together, these findings highlight the importance of considering both brain-based and functional contributors to persistent cognitive complaints after SARS-CoV-2 infection. Full article

Background and Objectives: Macroeconomic instability, particularly income loss, inflation and unemployment, is increasingly recognized as a psychosocial stressor that may influence both symptom burden and healthcare-seeking behavior. This single-center study investigated the association of income, inflation and unemployment with private-sector hospital visits for primary headache disorders and assessed whether economic stressors were associated with different patterns across demographic groups. Materials and Methods: We conducted a single-center, retrospective, ecological quarterly time-series analysis of hospital visits for primary headache disorders between 2016 and 2024 in a private tertiary care hospital in Turkey. After exclusions, 18,522 eligible hospital-visit records were included and categorized by sex and age (<18, 18–64, and ≥65 years). National data on real gross domestic product (GDP), consumer price index (CPI), unemployment and a COVID-19 period indicator were used. Counts were modeled with log-linked Poisson or negative binomial generalized linear models selected through overdispersion diagnostics, with seasonal controls and HAC-robust inference. Results: In most groups, higher GDP was associated with more primary headache visits, whereas higher inflation was consistently associated with fewer visits. The association with unemployment was heterogeneous: visits decreased significantly among the working-age population but increased among older adults. Contemporaneous models outperformed one-quarter lagged alternatives, suggesting that private-sector healthcare seeking may change within the same quarter as macroeconomic shocks. Conclusions: In this private hospital setting, macroeconomic deterioration was associated with reduced primary headache visits, particularly among working-age patients. These findings suggest that financial constraints may suppress private-sector healthcare utilization despite possible increases in stress-related symptoms, and that private hospital data may underestimate headache-related healthcare need during economic crises. Full article

Background/Objectives: Long COVID is characterized by persistent symptoms following SARS-CoV-2 infection and places a considerable burden on patients and healthcare systems due to its complex, multisystemic nature. In Austria, little is known about how affected individuals navigate existing healthcare structures and where obstacles occur. This study aimed to explore healthcare pathways, perceived barriers, and needs among people living with long COVID in Lower Austria. Methods: An exploratory qualitative study was conducted using semi-structured interviews with eleven adults residing in Lower Austria who reported symptoms persisting for at least four months after COVID-19 infection and still present at interview. Participants were recruited from a rehabilitation center, a neurology department, and an online patient group. Interviews were audio-recorded, transcribed verbatim, pseudonymized, and analyzed by the first author using inductive qualitative content analysis following Mayring, supported by MAXQDA 2024 software. Results: On average, each participant consulted five medical points of care and seven healthcare professionals. Approximately half utilized Austria’s private healthcare sector in addition to the public one. Key barriers included fragmented care coordination, long waiting times, lack of specialist availability, financial burden, and insufficient recognition of symptoms by healthcare providers. Rehabilitation services were widely perceived as beneficial. Conclusions: Care experiences of the interviewed individuals with long COVID in Austria frequently deviate from national guideline recommendations. Although findings cannot be generalized beyond this exploratory sample, they suggest that enhancing general practitioner (GP) training, reinforcing care coordination, and broadening access to specialized interdisciplinary centers may improve equity and quality of long COVID care. Full article

Background/Objectives: Long COVID-19 (LC-19), also known as Post-Acute COVID-19 Syndrome (PACS), is a chronic condition some people experience after an initial SARS-CoV-2 infection. The etiology of this complex, multifactorial disease remains largely unknown, although various theories have been propounded. This study aims to profile and compare the metabolic activity of cells of normal and LC-19 patients. Methods: A cohort of 20 individuals, 10 with LC-19 and 10 without LC-19, was selected based on their post-COVID-19 symptomatology. Saliva was tested for opportunistic viruses like Epstein–Barr virus (EBV) and Human Herpesvirus 6 (HHV-6). Lymphoblastoid cell lines derived from blood were analyzed using the Biolog Phenotype Mammalian Microarrays (PM-M1, PM-M6, and PM-M7) to assess metabolic activity across a wide array of growth substrates and effector molecules. Results: Unique metabolic profiles emerged across the controls and LC-19 groups. The SARS-CoV-2 infection causes an over two-fold enhanced utilization of glycolytic and anaerobic substrates and a reduced response to growth factors and effectors. The increased energy source utilization assessed in PM-M1 is unsustainable, and the LC-19 groups demonstrate this with a clear correlation with the number of LC-19 symptoms, demonstrating a trend consistent with metabolic reprogramming. The infection also results in a reduced response to growth factors and effectors, assessed in PM-M6 and PM-M7, with the level of reduction commensurate with the symptom burden. Conclusions: The data from the patient groups were analyzed and compared to construct a metabolic profile unique to individuals who developed LC-19, which could, in the future, be used for diagnosis and to identify targets for therapeutic intervention. Our study identified an LC-19-specific metabolic profile indicative of adaptive responses to stress, cellular dysfunction, and prolonged inflammation, leading to the reprogramming of bioenergetic pathways. Full article

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID-19 syndrome (LC) show substantial clinical overlap, but direct comparative microbiome studies remain limited. Methods: In this cross-sectional study, we compared the fecal gut microbiome of patients with ME/CFS, LC, and healthy controls (HC) within a unified analytical framework using 16S rRNA profiling, differential abundance testing, and multivariate modeling. We also examined associations between microbiome variation and questionnaire-derived symptom-domain scores. Results: Alpha-diversity did not differ significantly among groups, whereas beta-diversity analyses showed small but significant disease-associated community differences with broad overlap between cohorts. Differential abundance analysis identified stronger signals in disease-versus-control contrasts than in the direct ME/CFS vs. LC contrast. Both ME/CFS and LC shared enrichment of Sutterella and depletion of Terrisporobacter and Lachnospiraceae relative to HC. Predicted functional profiling showed shared disease-versus-control changes in pathways related to anaerobic acetate/H₂ carbon flow, inositol/polyol degradation, phosphonate/C1-related metabolism, and lysine-derived fermentation. Regression analyses showed the strongest microbiome associations with fatigue-related and physiosomatic domains, while affective, cognitive, and gastrointestinal outcomes showed weaker signals. Conclusions: Overall, these findings support the presence of overlapping but non-identical gut microbiome alterations in ME/CFS and LC. The results provide a basis for future longitudinal and multi-omics studies aimed at clarifying the stability, functional relevance, and clinical utility of these microbial patterns. Full article

Objectives: This study aimed to estimate the prevalence of Post-COVID-19 Syndrome among older adults in Indonesia, using time-based definitions of symptoms persisting beyond >4 weeks, >8 weeks, and >12 weeks. Methods: A retrospective cohort study was conducted among 329 older patients (≥60 years) hospitalized with COVID-19 in two tertiary hospitals in Jakarta from January to December 2021. Data on risk factors and persistent symptoms were collected from medical records and interviews. Results: The prevalence of Post-COVID-19 Syndrome was 31% (>4 weeks), 18.24% (>8 weeks), and 10.64% (>12 weeks). Significant predictors included frailty (OR 2.814), immobility during hospitalization (OR up to 4.767), higher number of initial symptoms (OR 2.043), constipation, instability, and sensory impairment during follow-up. Conclusions: Frailty, symptom burden, and geriatric syndromes, particularly immobility are strongly associated with Post-COVID-19 Syndrome in older adults. Clinical Implications: Early identification of frailty, geriatric syndromes (especially immobility), and high initial symptom burden is essential for risk stratification, targeted monitoring, and implementation of preventive and rehabilitative interventions to reduce long-term post-COVID-19 complications in older populations. Full article

COVID-19 has had profound global impacts, and Long COVID may continue to affect quality of life and well-being in some individuals. Young adults may be particularly vulnerable to these impacts due to ongoing physiological, behavioral, and psychological development. This study aimed to examine the associations between Long COVID, mental health-related outcomes, and quality of life among university students. A total of 365 Thai undergraduate students participated in this cross-sectional study screening for Long COVID. Long COVID symptoms, mental health, sleep quality, and quality of life were assessed using validated Thai versions of the Long COVID Screening Questionnaire, DASS-21, PSQI, and EQ-5D-5L. Regression and group comparison analyses were conducted between participants with Long COVID and those without Long COVID. Fatigue and cough were the most reported symptoms, while sleep disturbances were also prevalent. Long COVID was associated with significantly lower quality of life scores (p = 0.035). However, no significant differences were observed in DASS-21 or PSQI scores between groups. Vaccination doses and prior COVID-19 infections differed significantly between groups (p < 0.001 and p = 0.017). These findings highlight the multisystem impacts of Long COVID and emphasize the importance of identification and supportive interventions to enhance student health and well-being. Full article

Background: Globally, around 400 million people are estimated to be affected by long COVID, yet treatment options remain scarce. A systematic review published in 2025 indicated that non-invasive brain stimulation may help reduce some long COVID symptoms. If repetitive transcranial magnetic stimulation (rTMS) has therapeutic potential for these patients, then a clear synthesis of the evidence is necessary to determine efficacy and potential for implementation. Methodology: This systematic review and narrative synthesis was conducted in accordance with PRISMA guidelines. The search, completed on the 4th of December 2025, covered four databases and grey literature. Studies were included if they examined long COVID and rTMS. Findings: A meta-analysis was not possible due to insufficient reported data across studies. Instead, a structured narrative synthesis was conducted on four included studies. The structured narrative synthesis of four studies indicates that rTMS is feasible and is associated with reported improvements in fatigue, mood, and cognitive symptoms in individuals with long COVID. However, all included evidence is based on uncontrolled case series and retrospective analyses, meaning no causal conclusions can be drawn and findings should be interpreted as exploratory. Conclusions: Taken together, the evidence remains preliminary and highlights the need for well-designed randomised controlled trials to assess efficacy. Full article