A scoping review of regulatory T cell dynamics in convalescent COVID-19 patients – indications for their potential involvement in the development of Long COVID?

Background Recovery from coronavirus disease 2019 (COVID-19) can be impaired by the persistence of symptoms or new-onset health complications, commonly referred to as Long COVID. In a subset of patients, Long COVID is associated with immune system perturbations of unknown etiology, which could be related to compromised immunoregulatory mechanisms. Objective The objective of this scoping review was to summarize the existing literature regarding the frequency and functionality of Tregs in convalescent COVID-19 patients and to explore indications for their potential involvement in the development of Long COVID Design A systematic search of studies investigating Tregs during COVID-19 convalescence was conducted on MEDLINE ( via Pubmed) and Web of Science. Results The literature search yielded 17 relevant studies, of which three included a distinct cohort of patients with Long COVID. The reviewed studies suggest that the Treg population of COVID-19 patients can reconstitute quantitatively and functionally during recovery. However, the comparison between recovered and seronegative controls revealed that an infection-induced dysregulation of the Treg compartment can be sustained for at least several months. The small number of studies investigating Tregs in Long COVID allowed no firm conclusions to be drawn about their involvement in the syndrome’s etiology. Yet, even almost one year post-infection Long COVID patients exhibit significantly altered proportions of Tregs within the CD4+ T cell population. Conclusions Persistent alterations in cell frequency in Long COVID patients indicate that Treg dysregulation might be linked to immune system-associated sequelae. Future studies should aim to address the association of Treg adaptations with different symptom clusters and blood parameters beyond the sole quantification of cell frequencies while adhering to consensualized phenotyping strategies

A scoping review of regulatory T cell dynamics in convalescent COVID-19 patients – indications for their potential involvement in the development of Long COVID?

BackgroundRecovery from coronavirus disease 2019 (COVID-19) can be impaired by the persistence of symptoms or new-onset health complications, commonly referred to as Long COVID. In a subset of patients, Long COVID is associated with immune system perturbations of unknown etiology, which could be related to compromised immunoregulatory mechanisms.ObjectiveThe objective of this scoping review was to summarize the existing literature regarding the frequency and functionality of Tregs in convalescent COVID-19 patients and to explore indications for their potential involvement in the development of Long COVIDDesignA systematic search of studies investigating Tregs during COVID-19 convalescence was conducted on MEDLINE (via Pubmed) and Web of Science.ResultsThe literature search yielded 17 relevant studies, of which three included a distinct cohort of patients with Long COVID. The reviewed studies suggest that the Treg population of COVID-19 patients can reconstitute quantitatively and functionally during recovery. However, the comparison between recovered and seronegative controls revealed that an infection-induced dysregulation of the Treg compartment can be sustained for at least several months. The small number of studies investigating Tregs in Long COVID allowed no firm conclusions to be drawn about their involvement in the syndrome’s etiology. Yet, even almost one year post-infection Long COVID patients exhibit significantly altered proportions of Tregs within the CD4+ T cell population.ConclusionsPersistent alterations in cell frequency in Long COVID patients indicate that Treg dysregulation might be linked to immune system-associated sequelae. Future studies should aim to address the association of Treg adaptations with different symptom clusters and blood parameters beyond the sole quantification of cell frequencies while adhering to consensualized phenotyping strategies

Update eines systematischen Review mit Meta-Analyse von randomisierten kontrollierten Studien

Introduction: In 2012 a systematic review and meta-analysis of seven randomized controlled trails was published evaluating the efficacy of emergency department initiated tobacco control (ETC). They showed only a short-term effect. Therefore the objective is to provide an update of the systematic review and meta-analysis determining the efficacy of ED-initiated tobacco control. Methods: A literature search in 7 electronic databases was conducted after registration of the study protocol with the Prospero database in May 2015. Inclusion criteria were randomized controlled trials with ED patients of any age who were current smokers and who were offered a tobacco control intervention. A minimum requirement was the availability of an abstract in English or Spanish language. The publication date had to be after October 4th, 2010, the end date of the previous review. The outcome parameter was point prevalence of the self-reported 7-days tobacco use abstinence at 1 to 12 months follow up. The proportion of tobacco abstinence was calculated for each study for each of the different follow-up times and pooled across studies using Mantel-Haenszel relative risks. To calculate the combined effect of ETC across all follow-up times generalized linear mixed effects models were used. In addition, sensitivity analyses were conducted. Results: The literature search retrieved 3723 studies. After screening for inclusion criteria four new trails, 3 full texts and one abstract, with 1392 participants were included. Overall eleven studies were used for the update of the meta-analysis. At 1 month follow up the point prevalence tobacco abstinence of ETC was RR = 1.49 (95% confidence interval (CI): 1.08, 2.05), p = 0,014, 3 studies. After 3 months follow up it resulted in RR=1.38 (95%-CI: 1.12, 1.71), p =0,003, 9 studies; after 6 months in RR=1.09 (95%-CI: 0.84, 1.41), p = 0,536, 5 studies and after one year in RR=1.26 (95%-CI: 1.00, 1.59), p = 0,050, 3 studies. The combined long-term effect of ETC over all follow up times showed RR = 1.40 (95%-CI: 1.06, 1.86), p = 0.023. Pooling the eight studies evaluating motivational interviewing on site versus booster phone call resulted in RR = 1.39 (95%-CI 1.00, 1.92), p= 0.048. Conclusions: This review and meta-analysis strengthens the evidence for the beneficial impact of smoking cessation in the emergency department setting. Especially approaches including booster sessions after the initial contact in the emergency department seem to be an effective intervention. It could be an important strategy to motivate also hard-to-reach smokers to tobacco cessation.Einleitung: Im Jahr 2012 wurde ein systematisches Review mit Meta-Analyse von sieben randomisierten kontrollierten Studien veröffentlicht, die die Effektivität einer qualifizierter Raucherberatung in Rettungsstellen (qRbR) untersuchte. Die Meta-Analyse konnte keinen Langzeiteffekt einer qRbR nachweisen. Das Ziel der jetzigen Studie war es daher, ein Update des systematischen Reviews mit Meta-Analyse durchzuführen. Methode: Das Studienprotokoll wurde im Mai 2015 im internationalen Register für systematische Reviews (PROSPERO) registriert. Die Literaturrecherche erfolgte in sieben elektronischen Datenbanken. Eingeschlossen wurden randomisierte kontrollierte Studien mit Rettungsstellenpatienten, die eine qRbR erhielten. Zusätzlich musste mindestens ein deutscher, englischer oder spanischer Abstract vorhanden sein und das Publikationsdatum nach dem vierten Oktober 2010 liegen, dem Enddatum des vorherigen Reviews. Primäre Zielgröße war die 7 -Tage-Punkt-Prävalenz-Tabakabstinenz nach einem, drei, sechs und 12 Monaten Follow-up. Das relative Risiko (RR) für eine Tabakabstinenz nach einer qRbR (d.h. der Benefit einer qRbR) wurde für jede Studie und jeden Follow-up- Zeitpunkt einzeln, sowie gepoolt für jeden Follow-up-Zeitpunkt mittels Mantel- Haenszel-Relativen Risiken (MH-RRs) berechnet. Mittels linearer gemischter Modelle wurde zusätzlich der Langzeiteffekt der qRbR über alle Studien und alle Follow-up-Zeitpunkte hinweg kalkuliert. Abschließend wurden einzelne Sensitivitätsanalysen durchgeführt. Ergebnisse: Die Literatursuche erbrachte zunächst 3723 Treffer, von denen, nach Prüfung der Ein- und Ausschlusskriterien, vier Studien mit insgesamt 1392 Teilnehmern in das Update eingeschlossen wurden. Eine Studie war lediglich als Abstract verfügbar. Somit lagen elf randomisierte kontrollierte Studien für die Meta-Analyse vor. Einen Monat nach einer qRbR ergab sich ein gepoolter Benefit von RR = 1.49 (95% Konfidenzintervall (KI): 1.08, 2.05), p = 0,014, 3 Studien. Nach 3 Monaten betrug das RR=1.38 (95%-KI: 1.12, 1.71), p =0,003, 9 Studien; nach 6 Monaten: RR=1.09 (95%-KI: 0.84, 1.41), p = 0,54, 5 Studien und ein Jahr nach einer qRbR betrug das RR=1.26 (95%-KI: 1.00, 1.59), p = 0,050, 3 Studien. Der kombinierte Langzeiteffekt über alle Follow-up-Zeitpunkte hinweg zeigte einen relativen Benefit von RR = 1.40 (95%-KI: 1.06, 1.86), p = 0.023. Eine Subgruppenanalyse von acht Studien, mit motivierenden Telefonanrufen nach der Rettungsstellenbehandlung, erbrachte einen gepoolten Benefit von RR = 1.39 (95%-CI 1.00, 1.92), p= 0.048. Zusammenfassung: Qualifizierte Raucherberatungen in der Rettungsstelle sind effektiv, um eine wiederholte Tabakabstinenz über sieben Tage für einen Zeitraum von bis zu 12 Monaten herbeizuführen. Da in Rettungsstellen Patienten einfach zu erreichen sind und viele der dort Vorstelligen rauchen, könnten solche Programme eine wichtige Strategie sein, um gerade diese Patienten zum Tabakverzicht zu motivieren. Eine besondere Bedeutung haben dabei qRbRs, bei denen zusätzlich motivierende Telefonanrufe nach der Rettungsstellenbehandlung stattfinden

The impact of Post-COVID-Syndrome on functioning – results from a community survey in patients after mild and moderate SARS-CoV-2-infections in Germany

Background!#!In COVID-19 survivors a relatively high number of long-term symptoms have been observed. Besides impact on quality of life, these symptoms (now called Post-COVID-Syndrome) may have an impact on functioning and may also hinder to participation in social life in affected people. However, little is known about developing such syndrome a for patients with mild and moderate COVID-19 who did not need hospitalization or intensive care.!##!Methods!#!A cross-sectional study in 1027 patients with mild or moderate COVID-19 was performed in two communities in Bavaria, Germany. The Rehabilitation-Needs-Survey (RehabNeS) including the Short Form 36 Health Survey (SF-36) on health-related quality of life, was used. Descriptive statistics were calculated.!##!Results!#!In all, 97.5% of patients reported one symptom in the infection stage, such as fatigue, respiratory problems, limitations of the senses of taste and smell, fear and anxiety and other symptoms. In this time period, 84.1% of the participants experienced activity limitations and participation restrictions such as carrying out daily routines, handling stress, getting household tasks done, caring for/supporting others, and relaxing and leisure concerns. In all, 61.9% of participants reported persisting symptoms more than 3 months after infection. These were fatigue, sleep disturbances, respiratory problems, pain, fear and anxiety, and restrictions in movement; 49% of the participants reported activity limitations and participation restrictions. Predominately, these were handling stress, carrying out daily routines, looking after one's health, relaxing and leisure activities and doing house work. The impacts on quality of life and vocational performance were rather low.!##!Conclusion!#!The results show that long-term symptoms after mild and moderate COVID-19 are common and lead to limitations of activities and participation. However, it seems that in most cases they are not severe and do not lead to frequent or serious issues with quality of life or work ability

Definitions and symptoms of the post-COVID syndrome: an updated systematic umbrella review

Post-COVID syndrome (PCS) describes a persistent complex of symptoms following a COVID-19 episode, lasting at least 4 to 12 weeks, depending on the specific criteria used for its definition. It is often associated with moderate to severe impairments of daily life and represents a major burden for many people worldwide. However, especially during the first two years of the COVID-19 pandemic, therapeutic and diagnostic uncertainties were prominent due to non-specific definitions that overlooked functional deficits and lacked objective assessment. The present work comprehensively examines the status of PCS definitions as depicted in recent reviews and meta-analyses, alongside exploring associated symptoms and functional impairments. We searched the database Pubmed for reviews and meta-analysis evaluating PCS in the period between May 31, 2022, to December 31, 2023. Out of 95 studies, 33 were selected for inclusion in our analyses. Furthermore, we extended upon prior research by systematically recording the symptoms linked with PCS as identified in the studies. We found that fatigue, neurological complaints, and exercise intolerance were the most frequently reported symptoms. In conclusion, over the past eighteen months, there has been a notable increase in quantity and quality of research studies on PCS However, there still remains a clear need for improvement, particularly with regard to the definition of the symptoms necessary for diagnosing this syndrome. Enhancing this aspect will render future research more comparable and precise, thereby advancing and understanding PCS

Which factors have an association to the Quality of Life (QoL) of people with acquired Spinal Cord Injury (SCI)? A cross-sectional explorative observational study

Study design!#!Cross-sectional explorative observational study.!##!Objectives!#!To identify factors which have an association to the self-perceived Quality of Life (QoL) for persons with acquired spinal cord injury (SCI).!##!Setting!#!Eight specialized SCI-centers in Germany. The GerSCI survey is the German part of the International Spinal Cord Injury Survey (InSCI).!##!Methods!#!Self-disclosure questionnaire, created from the InSCI group, translated and adapted for Germany. The questionnaire collects a very broad range of data and, and due to its design as a self-report, is particularly suitable for the analysis on QoL. Because of the content, which is binding for all participating states, it allows a direct comparability of the results. Included in Germany were 1479 persons with acquired SCI aged 18 years and older.!##!Results!#!Various factors were identified with high associations to QoL, including changeable and unchangeable ones, such as those of particular importance: pain, sleep problems, sexual dysfunction, age, and time since onset of SCI. Some results confirmed reports of previous studies, others were surprising.!##!Conclusion!#!this study provides an important basis for the planned analysis of the InSCI participating countries in the 6 WHO regions. Germany was able to contribute the largest study population. The concrete study design of InSCI allows us to directly compare data and helps us to improve ourselves within the framework of a 'learning health system'. Medical measures can be orientated towards the found results, in order to ensure the best possible care and support by the therapeutic team, individually adapted to the person, place of residence and impairment