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Post covid syndrome
- 3. Since December 2019, coronavirus disease 2019 (COVID‑19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection, has rapidly swept the world. As of February 9, 2021, there were more than 107 million confirmed cases and nearly 2.3 million deaths worldwide.
- 5. • When the COVID-19 pandemic began, initial descriptions of the symptomology focused on the clinical presentations of patients in the acute, inpatient setting. • More recently, data have emerged that some patients continue to experience symptoms related to COVID-19 after the acute phase of infection. • There is currently no clearly delineated consensus definition for the condition: terminology has included “long COVID,” “post- COVID syndrome” and “post-acute COVID-19 syndrome.”
- 15. Liang X, et al, CNS Neurosci Ther. 2020 Aug;26(8):876-8 Post traumatic stress disorder
- 16. - It appears that SARS-CoV-2 can likely do long-term damage in different parts of the body through:- 1. Direct effects of viral infection and tissue damage 2. Collateral damage from excessive inflammation 3. Post-viral autoimmunity 4. The consequences of thrombotic complications
- 17. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 15 (2021) 145e146 Diagnosis
- 21. - Effects on lung fucntion - Post covid lung fibrosis - Thromboembolism Post covid effects on lungs:
- 22. Torres-Castro R, et al. Pulmonol. 2020. https://doi.org/10.1016/j.pulmoe.2020.10.013
- 25. Risk factors: 1. Advanced age 2. Increased disease severity 3. Comorbidities such as hypertension, diabetes, and coronary artery disease 4. Lab findings: lymphopenia, leukocytosis, and elevated LDH 5. Prolonged ICU stay / mechanical ventilation. risk of ventilator- induced lung injury (VILI). 6. Smoking 7. Alcohol Abuse: WHO and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have issued communications warning people to avoid excessive drinking
- 26. Two iatrogenic factors potentially contributing to the fibrosis encountered in survivors of severe COVID‑19 pneumonia are: 1- Oxygen toxicity 2- Ventilator‑induced lung injury (VILI)
- 27. In the current SARS‑CoV‑2 pandemic, the molecular basis of progression to pulmonary fibrosis and PC‑ILD is still unclear but is believed to be multifactorial PATHOGENIC MECHANISMS
- 29. A 58-year-old male patient was diagnosed with COVID-19 on 27 January 2020. He received lung transplantation on 29 February 2020, 7 days after the veno-venous (VV) ECMO establishment. The patient recovered quickly having no sign of viral infection relapse. Explanted lung showed Extensive fibrosis, inflammatory cells infiltration and haemorrhage in the lungs Chen X et all, Eur J Clin Invest. 2021;51:e13443
- 30. Huang W, et al. Journal of Infection (2020), Reference: YJINF 4859 a) A 33-year-old male with critical pneumonia who undergone both ARDS and mechanical ventilation, discharged at March 5, 2020 with subtle linear opacities on follow-up CT. b) A 69-year-old male with critical pneumonia, undergone both ARDS and mechanical ventilation and discharged at March 1, 2020 with fibrotic pulmonary remodeling on follow-up CT
- 32. - Currently, no fully proven options are available for the treatment of post inflammatory COVID 19 pulmonary fibrosis. - Though risk-benefit ratio should be assessed prior to use, prolonged low dose corticosteroid may prevent remodeling of lung in survivors. - Various treatment strategies are under evaluation. Gentile F, et al. Eur J Prev Cardiol. 2020;27(13):1442-6. Treatment
- 37. Our findings suggest that some patients with severe COVID-19 develop fibrotic lung disease for which lung transplantation is their only option for survival. Bharat et al., Sci. Transl. Med. 12, eabe4282 (2020)
- 41. Klok FA et al; Thromb Res, 2020 Jul;191:145-7
- 43. - For nonhospitalized patients with COVID-19, anticoagulants and antiplatelet therapy should not be initiated for the prevention of venous thromboembolism (VTE) or arterial thrombosis unless the patient has other indications for the therapy. Non-Hospitalized Patients
- 44. - Hospitalized adults with COVID-19 should receive prophylactic dose anticoagulation. Anticoagulant or antiplatelet therapy should not be used to prevent arterial thrombosis outside of the usual standard of care for patients without COVID-19. Hospitalized Patients - Hospitalized patients with COVID-19 should not routinely be discharged from the hospital while on VTE prophylaxis.
- 52. Extended VTE prophylaxis after hospital discharge can be considered in patients who are at low risk for bleeding and high risk for VTE. Modified IMPROVE VTE risk score ≥ 4 or Modified IMPROVE VTE risk score ≥ 2 and D-dimer level > 2 times the upper limit of normal Plus IMPROVE BLEED risk score < 7
- 57. Remember: 1. Post covid syndrome can occur in patient without symptoms during acute stage. 2. Fatigue is the most common symptoms. 3. PTSD is common especially after ICU admission. 4. Regular follow up is mandatory for patient liable to post covid lung fibrosis. 5. Consider extended VTE prophylaxis after hospital discharge, in patients who are at low risk for bleeding and high risk for VTE.
- 58. Thank you