Multisystem Involvement in Post-acute Sequelae of COVID-19 (PASC)


Posted: 2021-12-25 20:00:00
Objective: To describe cerebrovascular, neuropathic and autonomic features of post-acute sequelae of COVID-19 (PASC). Methods: This retrospective study evaluated consecutive patients with chronic fatigue, brain fog and orthostatic intolerance consistent with PASC. Controls included postural tachycardia syndrome patients (POTS) and healthy participants. Analyzed data included surveys and autonomic (Valsalva maneuver, deep breathing, sudomotor and tilt tests), cerebrovascular (cerebral blood flow velocity (CBFv) monitoring in middle cerebral artery), respiratory (capnography monitoring) and neuropathic (skin biopsies for assessment of small fiber neuropathy) testing and inflammatory/autoimmune markers. Results: Nine PASC patients were evaluated 0.7±0.3 years after a mild COVID-19 infection, treated as home observations. Autonomic, pain, brain fog, fatigue and dyspnea surveys were abnormal in PASC and POTS (n=10), compared to controls (n=15). Tilt table test reproduced the majority of PASC symptoms. Orthostatic CBFv declined in PASC (-20.0±13.4%) and POTS (-20.3±15.1%), compared to controls (-3.0±7.5%,p=0.001) and was independent of end-tidal carbon dioxide in PASC, but caused by hyperventilation in POTS. Reduced orthostatic CBFv in PASC included both subjects without (n=6) and with (n=3) orthostatic tachycardia. Dysautonomia was frequent (100% in both PASC and POTS) but was milder in PASC (p=0.013). PASC and POTS cohorts diverged in frequency of small fiber neuropathy (89% vs. 60%) but not in inflammatory markers (67% vs. 70%). Supine and orthostatic hypocapnia was observed in PASC. Interpretation: PASC following mild COVID-19 infection is associated with multisystem involvement including: 1) cerebrovascular dysregulation with persistent cerebral arteriolar vasoconstriction; 2) small fiber neuropathy and related dysautonomia; 3) respiratory dysregulation; 4) chronic inflammation. This article is protected by copyright. All rights reserved. Keywords: Brigham protocol; Long COVID; PASC; POTS; Post COVID Syndrome; Post-acute Sequelae of COVID-19; Postural tachycardia syndrome; dysautonomia; small fiber neuropathy.

参考サイト PubMed: covid-19


4月 07, 2021 bioassociates2


コロナウイルスは、いばらの冠に似た密集した表面受容体を備えた構造をしている。 これらのスパイク状タンパク質は健康な細胞をしっかり掴み、ウイルスRNAの侵入を引き起こす。 ウイルスの形状と感染戦略は一般的に理解されているが、その物理的完全性についてはほとんど知られていない。MITの機械工学科の研究者による新研究は、コロナウイルスが医用画像診断で使用される周波数内で超音波振動に対して脆弱である可能性があることを示唆している。…

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