Special Issue "COVID-19 after One Year of Clinical Experience: Unexpected Clinical Presentations or Complications and Post-COVID-19 Clinical Features"

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Coronaviruses (CoV) and COVID-19 Pandemic".

Deadline for manuscript submissions: 30 April 2022.

Special Issue Editors

Dr. Pierpaolo Di Micco
E-Mail Website
Guest Editor
Dr. Anna Annunziata
E-Mail Website
Guest Editor
UOC Fisiopatologia e Riabilitazione Respiratoria Monaldi Hospital, UOC UTSIR COVID, Cotugno Hospital, 80131 Naples, Italy
Interests: pneumology; intensive care; rare disease; non invasive mechanical ventilation; invasive mechanical ventilation; weaning from tracheostomy; neuromuscular disorders

Special Issue Information

Dear Colleagues,

Nearly one year ago, the SARS-CoV-2 outbreak began, and our work has changed since. Scientific literature contributed to the knowledge of this virus and its related infectious diseases, with the number of submissions and articles around the world increasing exponentially as a result.

Each colleague contributed by sharing their working experience, and COVID-19 has thus been associated to a number of relevant clinical abnormalities per se and\or during treatment.

Immunopathological complication and thrombotic complications have been identified since the first reports from China, but the description of other complications such as liver and cardiac damages have also been associated to COVID-19.

On the other hand, since COVID-19 is a newly identified disease, little is known about post-COVID-19 clinical features that are an emerging cause of chronic disability for several patients. 

Indeed, in recent months, evidence has emerged that in patients with microbiological healing from COVID-19, many residual symptoms persist. The persistence of respiratory, cardiovascular or metabolic disorders, due to persistent chronic inflammation, sequelae of organ damage, and complications from the prolonged hospitalization and social isolation results in post acute COVID-19 syndrome. Follow up is needed after COVID-19, with appropriate management of clinical sequelae.

Thus, the aim of this thematic series is to report unusual clinical presentations or complications of COVID-19 and post-COVID-19 clinical features. Scientific contributions may be submitted as original articles, reviews, or brief clinical series.

We look forward to reading about your clinical experience in the daily clinical management of COVID-19 from diagnostics to therapeutic aspects.

Dr. Pierpaolo Di Micco
Dr. Anna Annunziata
Guest Editors

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Keywords

  • COVID-19
  • SARS
  • immunopathological disease
  • venous thromboembolism
  • post-COVID-19

Published Papers (8 papers)

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Research

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Article
Clinical Study on the Efficacy and Safety of Arginine Administered Orally in Association with Other Active Ingredients for the Prevention and Treatment of Sarcopenia in Patients with COVID-19-Related Pneumonia, Hospitalized in a Sub-Intensive Care Unit
Healthcare 2022, 10(1), 162; https://doi.org/10.3390/healthcare10010162 - 14 Jan 2022
Viewed by 304
Abstract
In order to evaluate the efficacy of oral supplementation with 3 g of arginine per day associated with creatine, L-carnitine, aspartic acid, magnesium, selenium and vitamins C and E (Argivit© Aesculapius Farmaceutici) in the prevention and treatment of sarcopenia in patients with COVID-19-related [...] Read more.
In order to evaluate the efficacy of oral supplementation with 3 g of arginine per day associated with creatine, L-carnitine, aspartic acid, magnesium, selenium and vitamins C and E (Argivit© Aesculapius Farmaceutici) in the prevention and treatment of sarcopenia in patients with COVID-19-related pneumonia, we conducted a parallel randomized study comparing it with standard therapy alone. Forty patients on standard therapy plus supplementation were compared with a control group of 40 patients, all hospitalized at the sub-intensive care unit of the Del Mare Hospital in Naples, with a clinical diagnosis of SARS-CoV-2 infection and COVID-19 pneumonia. Muscle strength was assessed with the handgrip test and muscle ultrasound. Arginine-supplemented patients had an average grip strength of 23.5 at the end of hospitalization compared with 22.5 in the untreated group with less reduction, showing statistical significance (p < 0.001). In the same way, the thickness of the vastus lateralis quadriceps femoris muscle measured at the end of hospitalization showed less reduction on ultrasound, with a higher average value in the group receiving treatment than in the group of patients without supplementation (p < 0.001). Upon discharge there was a 58.40% reduction in ventilation days in patients with arginine supplementation compared with the control group. Full article
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Article
Association of Mortality-Related Risk Factors in Patients with COVID-19: A Retrospective Cohort Study
Healthcare 2021, 9(11), 1468; https://doi.org/10.3390/healthcare9111468 - 29 Oct 2021
Cited by 1 | Viewed by 509
Abstract
COVID-19 is a rapidly disseminating infectious disease conferred by the World Health Organization (WHO) as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics data have been identified for patients with COVID-19, but mortality-related risk factors and a comprehensive clinical course [...] Read more.
COVID-19 is a rapidly disseminating infectious disease conferred by the World Health Organization (WHO) as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics data have been identified for patients with COVID-19, but mortality-related risk factors and a comprehensive clinical course of disease in a developing country have not been specifically defined. This retrospective, single-center cohort study involved all successive inpatients having a positive COVID-19 polymerase chain reaction (PCR), with deceased or discharged clinical outcomes from 1 January to 10 May 2021. Data were extracted from electronic medical records on demographic, clinical, radiological, and laboratory findings as well as complications faced and treatment provided during follow-up, involving serial samples for viral RNA identification, and compared between the dead and survivors. To investigate the risk factors associated with in-hospital mortality, we employed the multivariate logistic regression model. In this study, 2048 patients were involved, 1458 of whom were discharged, and 590 died in hospital. More than half of patients were identified as male with old age being the potential risk factor of mortality. Exactly 94.8% of all patients presented with fever at the time of admission. Several comorbidities were present in the study population, with the most frequent comorbidity being cardiovascular diseases (1177 of 2048) and hypertension (975 of 2048) followed by cerebrovascular disease and diabetes mellitus. Mortality rates for infected patients were observed as higher in severe patients (46.3%) compared with non-severe cases (26.1%) during a follow-up. Multivariate regression analysis showed a significant association of in-hospital mortality of patients with older age, presence of hypertension and cardiovascular diseases as underlying comorbidities, increased level of cardiac troponin I and d-dimer concentration on admission, as well as septicemia and ARDS as a complication during illness. To minimize the risk of death in COVID19 patients, as well as the risk of severe complications, urgent public health measures should be properly planned and implemented on those vulnerable populations. To detect early manifestations of clinical problems, thorough and regular follow-up is warranted. Full article
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Article
Remdesivir in Severe COVID-19 and Non-Invasive Ventilation: A Real-Life Experience
Healthcare 2021, 9(9), 1108; https://doi.org/10.3390/healthcare9091108 - 27 Aug 2021
Cited by 2 | Viewed by 591
Abstract
Background: Antiviral treatment is a hot topic regarding therapy for COVID-19. Several antiviral drugs have been tested in the months since the pandemic began. Yet only Remdesivir obtained approval after first trials. The best time to administer Remdesivir is still a matter for [...] Read more.
Background: Antiviral treatment is a hot topic regarding therapy for COVID-19. Several antiviral drugs have been tested in the months since the pandemic began. Yet only Remdesivir obtained approval after first trials. The best time to administer Remdesivir is still a matter for discussion and this could also depend upon the severity of lung damage and the staging of the infection. Methods: We performed a real-life study of patients hospitalized forCOVID-19 and receiving non-invasive ventilation (NIV). In this single-center study, a 5 day course of Remdesivir was administered as compassionate use. Further therapeutic supports included antibiotics, low molecular weight heparin and steroids. Data collection included clinical signs and symptoms, gas exchange, laboratory markers of inflammation, and radiological findings. Major outcomes were de-escalation of oxygen-support requirements, clinical improvement defined by weaning from ventilation to oxygen therapy or discharge, and mortality. Adverse drug reactions were also recorded. All data were collected during hospitalization and during a 20-day follow up after treatment. Results: 51 patients were enrolled. A global clinical improvement was recorded in 22 patients (43%) at 12 days, and 36 (71%) at 20 days; in particular, at 12 days, 27 patients (53%) also had a de-escalation of oxygen-support class from a therapeutic point of view. Remdesivir use was associated with a lower hazard ratio for clinical improvement in the elderly (older than 70 years) and in subjects with more extensive lung involvement (total severity score at HRCT of more than 14). The 20-day mortality was 13%. Conclusions: Results demonstrated that Remdesivir is associated with an improvement in clinical, laboratory and radiological parameters in patients with severe COVID-19 and showed an overall mortality of 13%. We conclude that, in this cohort, Remdesivir was a beneficial add-on therapy for severe COVID-19, especially in adults with moderate lung involvement at HRCT. Full article
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Article
Cutaneous Manifestations in SARS-CoV-2 Infection—A Series of Cases from the Largest Infectious Diseases Hospital in Western Romania
Healthcare 2021, 9(7), 800; https://doi.org/10.3390/healthcare9070800 - 25 Jun 2021
Cited by 2 | Viewed by 582
Abstract
(1) Background: SARS-CoV-2 infection, which appeared as an isolated epidemic outbreak in December 2019, proved to be so contagious that, within 3 months, the WHO declared COVID-19 a pandemic. For one year (pre-vaccination period), the virus acted unhindered and was highly contagious, with [...] Read more.
(1) Background: SARS-CoV-2 infection, which appeared as an isolated epidemic outbreak in December 2019, proved to be so contagious that, within 3 months, the WHO declared COVID-19 a pandemic. For one year (pre-vaccination period), the virus acted unhindered and was highly contagious, with a predominantly respiratory-oriented aggression. Although this lung damage, responsible for the more than 3,090,025 deaths, has provided sufficient data to facilitate the understanding of pathogenic mechanisms, other observation data, which meet the quality of emerging clinical aspects, such as rashes, remain without well-defined etiopathogenic support or a well-contoured clinical framework. (2) Methods and Results: We followed the occurrence of cutaneous manifestations in patients hospitalized during the second and third outbreak of SARS-CoV-2 in the main clinics of infectious diseases of our county, Timis, and recorded laboratory investigations and clinical evolution for five suggestive cases. (3) Conclusions: The presented cases, added to many other present and future clinical observations, will allow for better knowledge and understanding of SARS-CoV-2 infection, a requirement that has become a global priority for the entire medical and scientific community. Full article
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Article
Diabetes Mellitus—A Risk Factor for Unfavourable Outcome in COVID-19 Patients—The Experience of an Infectious Diseases Regional Hospital
Healthcare 2021, 9(7), 788; https://doi.org/10.3390/healthcare9070788 - 23 Jun 2021
Cited by 1 | Viewed by 635
Abstract
Early research into the implications concerning the evolution of the infection caused by the new coronavirus in people with glucose metabolism dysfunction, in this case diabetics, shows that severe forms of the disease predominate in this risk category. Moreover, it seems that even [...] Read more.
Early research into the implications concerning the evolution of the infection caused by the new coronavirus in people with glucose metabolism dysfunction, in this case diabetics, shows that severe forms of the disease predominate in this risk category. Moreover, it seems that even in patients with normal glycaemic status, COVID-19 may predispose to the development of hyperglycaemia which modulates immune mechanisms and inflammatory responses, with direct effects on morbidity and mortality. Thus, taking into account these scientific data, as well as the increased frequency of diabetes in the general population, we aimed to assess the risk of an unfavourable outcome of diabetic patients, which is in a strong connection with the presence and severity of pulmonary disease such as interstitial pneumonia/bronchopneumonia, as well as the effectiveness of Tocilizumab administration. The results of our study indicate a three-fold higher risk of death in patients with diabetes and COVID-19 (RR = 3.03; IC95%: 2.37–3.86; p = 0.001),compared to nondiabetic patients, and the risk of developing severe forms of acute respiratory failure was 1.5 times higher in the first studied category. In conclusion, we can say that the diabetic diagnosed with SARS-CoV-2 infection is more predisposed to immunological and organic dysfunctions that may ultimately result in death, and treatment with monoclonal anti-IL-6 antibodies was more effective in diabetic patients than non-diabetics (p < 0.05). The effectiveness of Tocilizumab was significant in both studied groups, but diabetic patients responded better to this therapy compared to non-diabetes-mellitus (DM) ones (76.7% vs. 35% p = 0.001). Full article
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Article
The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax
Healthcare 2021, 9(6), 620; https://doi.org/10.3390/healthcare9060620 - 22 May 2021
Cited by 2 | Viewed by 820
Abstract
Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pneumomediastinum and [...] Read more.
Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pneumomediastinum and pneumothorax in SARS-CoV2-Acute Respiratory Distress Syndrome (ARDS), what symptoms may predict a severe and potentially fatal complication and what therapeutical approach may provide a better outcome. Methods: In this single center cohort study, we recorded data from 45 critically ill COVID-19 patients who developed one or more complicating events among pneumomediastinum, subcutaneous emphysema and pneumothorax. All patients showed ARDS and underwent non-invasive ventilation (NIV) at baseline. Patients with mild to moderate ARDS and pneumomediastinum/pneumothorax (n = 25) received High Flow Nasal Cannula (HFNC), while patients with severe ARDS and pneumomediastinum/pneumothorax underwent HFNC (n = 10) or invasive mechanical ventilation (IMV) (n = 10). Results: Pneumomediastinum/pneumothorax developed in 10.5% of subjects affected by SARS-coV2-ARDS. Dyspnea affected 40% and cough affected 37% of subjects. High resolution computed tomography of the chest showed bilateral diffuse ground glass opacities (GGO) in 100% of subjects. Traction bronchiolectasis, reticulation, crazy paving and distortion were observed in 64%. Furthermore, 36% showed subcutaneous emphysema. Non-severe ARDS cases received HFNC, and 76% patients recovered from pneumomediastinum/pneumothorax over a median follow up of 5 days. Among severe ARDS cases the recovery rate of pneumomediastinum/pneumothorax was 70% with the HFNC approach, and 10% with IMV. Conclusion: HFNC is a safe and effective ventilatory approach for critical COVID-19 and has a positive role in associated complications such as pneumomediastinum and pneumothorax. Full article
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Case Report
An Elderly COVID-19 Patient with Community-Acquired Legionella and Mycoplasma Coinfections: A Rare Case Report
Healthcare 2021, 9(11), 1598; https://doi.org/10.3390/healthcare9111598 - 21 Nov 2021
Viewed by 384
Abstract
The combination of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection and other respiratory pathogens is a real challenge for health care systems in terms of diagnosis, treatment, and management. Most of the reported bacterial coinfections among SARS-CoV-2 patients are hospital-acquired infections that [...] Read more.
The combination of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection and other respiratory pathogens is a real challenge for health care systems in terms of diagnosis, treatment, and management. Most of the reported bacterial coinfections among SARS-CoV-2 patients are hospital-acquired infections that occurred after several days of hospitalization. Little is known about the incidence of community-acquired atypical bacterial coinfections with SARS-CoV-2. In this work, we report on a rare case of an elderly SARS-CoV-2 patient with underdiagnosed bacterial coinfections who received care in the medical ward for 23 days then was discharged home. Retrospective serological investigation revealed positivity for Legionella pneumophila and Mycoplasma pneumoniae, indicating double community-acquired atypical bacterial coinfections that were in agreement with clinical manifestations that patients showed at his admission to the hospital. Screening for possible community-acquired respiratory co-pathogens among elderly SARS-CoV-2 patients is critical for effective treatment and management. Full article
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Case Report
Facial Diplegia—Complication or Manifestation of SARS-CoV-2 Infection? A Case Report and Systemic Literature Review
Healthcare 2021, 9(11), 1492; https://doi.org/10.3390/healthcare9111492 - 02 Nov 2021
Viewed by 470
Abstract
Since the outbreak of the new coronavirus, healthcare systems around the world have witnessed not only COVID-19 symptoms but also long-term complications of the aforementioned, including neurological problems. We report a clinical case of an adult patient with bilateral facial nerve palsy and [...] Read more.
Since the outbreak of the new coronavirus, healthcare systems around the world have witnessed not only COVID-19 symptoms but also long-term complications of the aforementioned, including neurological problems. We report a clinical case of an adult patient with bilateral facial nerve palsy and progressive ascending paresis of the limbs after contracting the novel coronavirus (COVID-19). Additionally, the systematic review aimed to identify and summarize specific clinical features, outcomes and complications of the studies focusing on bilateral facial diplegia as a sequela of COVID-19 infection. The total number of analyzed patients was 15. Only one patient was diagnosed with isolated bilateral palsy; the rest had Guillain-Barré Syndrome (GBS). With one exception, all the presented cases had favorable outcomes, with facial palsy recovery from slight to almost complete. In patients with a confirmed COVID-19 diagnosis, bilateral facial palsy may be an isolated symptom as well as a variant of GBS. Symptoms of cranial nerve damage during a COVID-19 infection may explain the appearance of facial nerve damage. In order to clarify the spectrum of neurological manifestations and a causal relation between SARS-CoV-2, COVID-19 vaccination and neurological symptoms, direct attention towards the study of this virus is crucial. It seems reasonable to recognize human coronavirus as another potential GBS trigger. Full article
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