Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls

Background The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01–1.03), male (1.54, 1.16–2.04), neither obese nor severely obese (1.82, 1.06–3.13 and 4.19, 2.14–8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09–2.22) or cardiovascular disease (1.33, 1.00–1.79), and shorter hospital admission (1.01 per day, 1.00–1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

Background No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. Findings 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7–9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46–0·99]), obesity (0·50 [0·34–0·74]) and invasive mechanical ventilation (0·42 [0·23–0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74–1·00]), at 5 months (0·74 [0·64–0·88]) to 1 year (0·75 [0·62–0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. Interpretation The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. Funding UK Research and Innovation and National Institute for Health Research

Variability of Sporadic-e (es) layer at two equatorial stations: Fortaleza (3os, 38ow) and Ilorin (8.5on, 4.5oe)

The day time variability of sporadic-E (Es) layer at Fortaleza (3oS, 38oW) and Ilorin (8.5oN, 4.5oE) during the solstice and equinox periods have been investigated using hourly daily Digisonde ionograms. The result show that during the equinox period, the critical frequency (foEs) of the Es-layer at Fortaleza dropped to minimum values before rising to its first peack values by 0900 hrs LT and 1000 hrs LT in March and September respectively. On the other hand, a continuous rise in the value of foEs from sunrise till the first peack values of 6.0MHz by 0800 hrs LT and 5.5MHz by 0700 hrs LT was observed during the June and December solstices respectively. At Ilorin, the foEs reached its first peack values of 5.5MHz by 1200 hrs LT and 6.0MHz by 1000 hrs LT during the March and September equinoxes respectively. A double peack of about 5.4MHz by 0800 hrs LT and 6.5MHz by 1300 hrs LT was observed during the June Solstice as compared to the single peack of about 7.00MHz during the December solstice. The height (hmEs) of Es was lower at Fortaleza than at Ilorin for all the seasons (with a difference of between 2 and 4 km, depending on the month). For all the seasons and months investigated, the E-layer was never observed earlier than 0900 hrs LT at Fortaleza. At Ilorin, the E-layer was formed right from sun rise with frequencies lower than at Fortaleza. These results comfirm the latitudinal variation of the sporadic-E layer at the equatorial region. It also showed that the E-layer is formed earlier in Ilorin than at Fortaleza with a time lag of about 3 hours. Keywords: Sporadic-E (Es) layer, Critical frequency (foEs), virtual height (hmE), Equinox, Solstic

Incidence of Impacted Mandibular Canine and Associated Pathologies in an Orthodontic Patient Population in Lagos, Nigeria

Background: Mandibular canine impaction is less frequent in our environment with various factors implicated in the aetiology and with several associated pathologies. the advent of the technique of panoramic radiography has helped with the diagnosis of this condition.Objective: The aim of the study was to investigate the incidence of impacted mandibular canines and the classification of associated pathology.Methods: A retrospective cohort study of 1250 panoramic radiographs taken of patients who presented to the Orthodontic Unit of Lagos University Teaching Hospital, Lagos, Nigeria between January, 2001 and September, 2008. The clinical data and panoramic radiographs were reviewed and observations on the status of missing permanent mandibular canine, symptoms as well as treatment methods employed were made.Results: The incidence of mandibular canine impaction was found to be 1.36 % in the studied demand population. A total of 17 patients (10 females and 7 males) had impacted mandibular canines. In this study 5 (27.8%) impacted canines were extracted, seven canines (38.9%) were attached to bonded brackets after surgical exposure and traction was applied while six (33.3%) impacted mandibular canines were left in place for periodic observation.Conclusion: The incidence of impacted mandibular canines was found to be high in the subpopulation studied. However, this may not be unrelated with the fact that this is a demand population.Keywords: impacted canine, mandibular canine impaction, incidence

Endourology in a Nigerian Tertiary Hospital – current level of practice and challenges

Background: Endourology is rapidly advancing in developed countries. However, the level of practice in public tertiary hospitals in developing countries is abysmally low. Objective: To review the current practice of endourology in a Nigerian public tertiary hospital and discuss the challenges faced during the study period. Setting: This review was done at the urology unit of the Obafemi Awolowo University Teaching Hospitals Complex [OAUTHC], Ile-Ife, Nigeria.Materials and Methods: A retrospective review of medical notes of all patients who have had diagnostic and therapeutic endourological procedure in our practice between June 2002 and May 2004 was carried out Results: Forty nine medical notes were available for review. A total of 51 procedures were carried out, representing twenty percent of the total urological procedures done by the unit during the study period. The commonest indication for an endourological procedure was bladder outlet obstruction. The commonest procedure performed was urethrocystoscopy. There was one complication and one failed procedure. Conclusion: Although endourological applications have many advantages over open urological procedures, endourological practice is low due to lack of equipment personnel and funding. Advances in endourological practice are desired and this will require improvement in infrastructure, training of personnel and a whole reorientation in our choices of the care we give our patients. Keywords: endourology, scope, challenges Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 268-27