![]() In general, patients admitted to our hospital were either elderly or at a high risk of severe respiratory failure however, patients who required tracheal intubation were transferred to other hospitals that provided intensive care for COVID-19 respiratory failure. All patients were diagnosed with COVID-19 by positive nasopharyngeal swab polymerase chain reaction (PCR). This hospital is a tertiary medical center in Osaka Prefecture offering treatment for COVID-19. Higashiosaka City Medical Center is the central public hospital of Higashi-Osaka City, a city in the Kinki region of Japan, with a total population of approximately 500,000. Participants and surveys of residual symptoms Here, we focused on serum ferritin, a common clinical marker of inflammation, and investigated the association between ferritin levels and Brain Fog after COVID-19. In this context, we hypothesized that the overactivation of monocytes in COVID-19 causes Brain Fog. Recently, it was reported that the overactivation of brain monocytes leads to neuroinflammation in patients with COVID-19 14, 15. This difference between common respiratory viral infections and COVID-19 shows that neuroinflammation leading to Brain Fog may be related to the specific pathogenesis of COVID-19. Compared to the prevalence of Brain Fog which we empirically know after ordinary upper respiratory viral infections, the prevalence of 17.8% 2 months after COVID-19 infection is quite high 13. A previous report indicated that Brain Fog was reported in 81% of patients who self-presented to a Neuro-COVID clinic, and some of them showed abnormalities detected on brain MRI 11.īrain Fog is thought to be caused by neuroinflammation 12. ![]() Many people suffer from Brain Fog after COVID-19, which reduces the patient's quality of life and intellectual work. Brain Fog has received increased attention after the COVID-19 epidemic. Brain Fog is not specific to long COVID, and the term Brain Fog was reported before the coronavirus disease 2019 (COVID-19) epidemic and is a general term for being dazed or foggy. It is defined as an altered state of consciousness in which a person is less wakeful, aware, alert, and focused than usual 9, 10. One of the most common and serious symptoms of Long COVID is Brain Fog. Long COVID is a significant public health issue because it can severely impact work and quality of life, even after a mild COVID infection 6, 7, 8. The definition of Long COVID varies the Centers for Disease Control and Prevention (CDC) explains that symptoms begin 4 weeks after infection 4, and the World Health Organization (WHO) states that symptoms begin 12 weeks after infection and last for at least 2 months 5. ![]() Post-coronavirus disease (COVID) syndrome (also termed Long COVID) includes respiratory symptoms such as dyspnea, cough, and phlegm, and symptoms related to neuropsychiatric symptoms such as olfactory and taste disorders, fatigue, cognitive impairment, concentration or memory issues and delirium 3. Although vaccines reduce the mortality rate 1, more than 80% of patients reportedly suffer some residual symptoms even several months after onset 2. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is endemic. This study provides a novel insight into the pathogenic mechanism of Brain Fog after COVID-19. High ferritin levels in patients with Brain Fog may reflect the contribution of chronic inflammation in the development of Brain Fog. We found a positive correlation between serum ferritin levels during hospitalization and Brain Fog after COVID-19. We conducted phase analysis and evaluated the interaction of each phase with ferritin levels and Brain Fog. In addition, we excluded confounders as far as possible using propensity score analyses and found that ferritin was independently associated with Brain Fog in most of the models. We focused on serum ferritin levels in this study and collected information on the onset of Brain Fog through questionnaires and found that high ferritin levels during hospitalization were associated with the occurrence of Brain Fog. However, neither the pathogenesis nor the treatment of this condition remains unknown. Brain Fog, one of the symptoms of Long COVID, is a major public health issue because it can impair patients’ quality of life even after recovery from the disease. Most patients suffer residual symptoms, the so-called “Long COVID,” which includes respiratory and neuropsychiatric symptoms. The coronavirus disease 2019 (COVID-19) remains an epidemic worldwide.
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