Bridging Gaps in Long COVID Therapy: A Mini Review.

Protracted return to sport (RTS) following COVID-19 is common due to long-term cardiopulmonary symptoms and persistent fatigue. In athletes, low exercise tolerance may result in emotional distress. The aim of this study is to assess the symptom severity, the management thereof and the impact on quality of life (QOL) as endurance athletes return to their preillness level of sports participation. A cross-sectional survey-based mixed methods study of long-distance athletes was performed. Quantitative data included sport and disease characteristics, fatigue score and management of persistent symptoms. A total of 295 survey responses were included. The mean age was 45.1 (10.2) years and 54.7% were male. Barriers to exercise included tachycardia (72%), fatigue (72%), dyspnoea (58%) and inability to exercise at high intensities (75%). High physical and mental fatigue scores were found, the former significantly predicting return to sport. Qualitative data were collected through open-ended questions exploring challenges faced when returning to sport post-COVID-19 convalescence and the impact on their QOL. Biopsychosocial well-being constituted three themes: Physical, Psychological and Social. Categories with high code frequencies included persistent cardiopulmonary symptoms, physical fatigue, emotional distress and social disengagement. Mixing the methods revealed that the athletes' QOL deteriorated due to protracted RTS after COVID-19. A multidisciplinary approach to management may be required by endurance athletes.

Penile induration disease, commonly known as Peyronie's disease (PD), is a connective tissue disorder that affects the penis, leading to the development of fibrous plaques, penile curvature, and erectile dysfunction. PD is a common male reproductive system disease with a complex etiology involving multiple genes, signaling pathways, and different phenotypes. The etiology and pathogenesis of PD remain poorly understood, hindering the development of effective treatment strategies. By understanding the underlying mechanisms of PD, we can pave the way for targeted therapies and improved patient outcomes. We reviewed the epidemiology and pathophysiology of PD. We performed database searches on Google Scholar, PubMed, Medline, and Web of Science from inception to September 2023. The literature reviewed included priapism guidelines, review articles, current trial studies, and various literature related to PD. This article provides a comprehensive overview of the current research progress on the disease, focusing on its genetic factors, signaling pathways, cellular mechanisms, phenotypic manifestations, and therapeutic targets. It can help identify individuals at higher risk, aid in early detection and intervention, and provide insights into fibrosis and tissue remodeling. It can also reveal potential therapeutic targets, guide accurate diagnoses and treatment strategies, and address the impact of the disease on patients' quality of life. By integrating insights from genomics, molecular pathways, clinical phenotypes, and therapeutic potentials, our research aims to achieve a deeper and more comprehensive understanding of PD, propelling the field toward innovative strategies that enhance the lives of those affected by PD. The complex manifestations and pathogenesis of PD necessitate the use of multiple treatment methods for personalized care.

Hernia is a physiological condition that significantly impacts patients’ quality of life. Surgical treatment for hernias often involves the use of specialized meshes to support the abdominal wall. While this method is highly effective, it frequently leads to complications such as pain, infections, inflammation, adhesions, and even the need for revision surgeries. According to the Food and Drug Administration (FDA), hernia recurrence rates can reach up to 11%, surgical site infections occur in up to 21% of cases, and chronic pain incidence ranges from 0.3% to 68%. These statistics highlight the urgent need to improve mesh technologies to minimize such complications. The design and material composition of meshes are critical in reducing postoperative complications. Moreover, integrating drug-eluting properties into the meshes could address issues like infections and inflammation by enabling localized delivery of antibiotics and anti-inflammatory agents. Mesh design is equally important, with innovative structures like auxetic designs offering enhanced mechanical properties, flexibility, and tissue integration. These advanced designs can distribute stress more evenly, reduce fatigue, and improve performance in areas subjected to high pressures, such as during intense coughing, sneezing, or heavy lifting. Technological advancements, such as 3D printing, enable the precise fabrication of meshes with tailored designs and properties, providing new opportunities for innovation. By addressing these challenges, the development of next-generation mesh implants has the potential to reduce complications, improve patient outcomes, and significantly enhance quality of life for individuals undergoing hernia repair.

This chapter investigates the impact of the quality of life (QoL) construct on mental health policy and resource allocation, with a focus on the care and treatment of people with a diagnosis of schizophrenia or other functional psychoses. We review the many approaches that have been taken towards QoL and the impact of schizophrenia on the individual, family and society. The role of QoL in public policy in general and in particular the salience of specific measures of health-related quality of life (HRQoL) is discussed. A brief analysis of recent mental health policy documents from seven Anglophone documents is presented – from which it is concluded that QoL is losing out to the rhetoric of ‘recovery’. We end with a discussion of the real-world drivers for resource allocation and the often tenuous link between policy and practice.

Breast cancer survivors who suffer from persistent, debilitating fatigue years after their diagnosis have something in common: their immune systems don't shut down following treatment, according to researchers at UCLA's Jonsson Cancer Center.This constant immune system activation, which researchers discovered by measuring specific proteins in blood samples from survivors, may be causing the fatigue, UCLA researchers theorize. Their discovery may lead to behavioral interventions such as tai chi and yoga that will help alleviate persistent fatigue, which affects about a third of breast cancer survivors for years after they complete treatment.The study is the first to look at the cellular basis for immune activation in fatigued breast cancer survivors, said Dr. Michael Irwin, a researcher at UCLA's Jonsson Cancer Center and the study's lead author. The research appears in the May 1, 2006 issue of Clinical Cancer Research, a peer-reviewed journal of the American Association of Cancer Research."Without knowing why this fatigue happens at the cellular level, we can't develop efficient therapies to treat it," said Irwin, who also serves as director of the Cousins Center for Psychoneuroimmunology at the Semel Institute for Neuroscience and Human Behavior at UCLA."Breast cancer survivors can be severely disabled by fatigue and that can dramatically impact their quality of life. That's the tragedy of our treatments for cancer," Irwin said. "We have focused on treating the disease, but we should also focus on the patient's well being later. Right now, we have no treatment for cancer-related fatigue and we need something that will allow patients to return to their prior level of functioning."Dr. Patricia Ganz, a nationally renowned expert who has studied quality of life in breast cancer survivors for two decades, agrees that fatigue is a serious problem for survivors, a fact that their primary care physicians don't always understand."When breast cancer survivors talk to their physicians about being tired and how it affects their lives, they're often told that they survived cancer, so they should be grateful to be alive," said Ganz, one of the co-authors of the study. "But their fatigue is a very real problem that needs to taken seriously and addressed."A small study at UCLA had previously demonstrated abnormalities in immune activation in breast cancer survivors. If researchers could determine the biological factors underlying this activation, and therefore fatigue, they could uncover a biomarker for the condition that could help them predict which patients would suffer from fatigue and which would not, Irwin said.Irwin and his colleagues took blood samples from breast cancer survivors one to five years out from diagnosis and placed them into two groups, those who suffered from persistent fatigue and those who did not. The researchers measured the levels of a pro-inflammatory cytokine protein in their blood - levels that indicated the immune system was turned on. Irwin said the pro-inflammatory protein levels were significantly different between the two groups. Those with persistent fatigue had 30 percent more of the proteins circulating in their blood. Additionally, their immune cells produced more cytokines in laboratory analyses than the cells from survivors without fatigue, and those cytokines were more efficient at producing the pro-inflammatory proteins driving the immune response."This study proved that there is an aberrant immune response in breast cancer survivors with persistent fatigue," Irwin said. "With this information, we may now be able to identify those patients at greatest risk for persistent fatigue and implement interventions early on that will lessen the severity and duration of the fatigue."The immune systems of women undergoing treatment for breast cancer are activated at high levels to help them fight disease and help the body recover from the side effects of chemotherapy and radiation. Some data suggest that survivors who develop fatigue might have immune system changes before the cancer and the treatments may be exacerbating that. Further studies are needed to understand how this immune activation occurs and what clinical factors predispose to it, Irwin said"We know from studies that animals with immune activation and cytokines circulating in their blood don't move around a lot, they don't eat, they don't engage in sexual activity," Irwin said. "From our study, we believe that the severity of fatigue in breast cancer survivors is not related to the type of treatment they received or its duration, but rather that the fatigue is driven by constant immune activation. Their immune systems simply don't shut down after treatment."Irwin and his team studied 32 breast cancer survivors with persistent fatigue and compared their blood samples to 18 survivors who did not suffer from fatigue. The pro-inflammatory proteins in the blood of fatigued cancer survivors could be used as a biomarker to classify those women who may suffer from fatigue after treatment. In those who appear to be predisposed to fatigue - the women whose immune systems have not shut off as they should - it may be possible in the future to provide interventions can right away that might eliminate or, at the least, alleviate the severity and duration of the fatigue.While there are drugs such as statins that can be used to dampen immune response, future studies by Irwin and his team will focus on behavioral interventions such as tai chi and yoga. Exercise and meditation, Irwin said, have been shown to decrease levels of pro-inflammatory cytokine expression in the blood."If we can identify survivors at greatest risk of persistent fatigue, we can implement interventions early on to help them," Irwin said. "That would be good news for the increasing numbers of women who are surviving breast cancer every year."The number of breast cancer survivors is steadily increasing due to advances in screening and treatment strategies. More patients are being diagnosed with early stage breast cancer and are surviving longer. In fact, breast cancer survivors are the largest group of patients to overcome any type of cancer in the United States. It is estimated that there are more than 2 million breast cancer survivors in the U.S. today.UCLA's Jonsson Comprehensive Cancer Center comprises more than 240 researchers and clinicians engaged in research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating the results into leading-edge clinical studies. In July 2005, the Jonsson Cancer Center was named the best cancer center in the western United States by U.S. News & World Report, a ranking it has held for six consecutive years.For more information, contact: Kim Irwin; Tel.: 310.206.2805; Email: kirwin@mednet.ucla.edu

Development of National Research and Clinical Agendas for Patient-Reported Outcomes in IR: Proceedings from a Multidisciplinary Consensus Panel

Performing fourth-level liver surgery is an exceptionally demanding procedure, fraught with significant risks and technical complexities. Patients undergoing such operations face elevated surgical hazards, substantial physical trauma, prolonged recovery periods, and a multitude of factors that can profoundly impact their postoperative quality of life (QoL). Despite these challenges, there remains a notable gap in the literature regarding the long-term QoL outcomes for these individuals. This study seeks to evaluate the QoL of patients who have undergone fourth-level liver surgery and to identify key factors influencing their recovery. The findings aim to offer clinical insights that can enhance postoperative care and improve patient outcomes. Employing a prospective longitudinal cohort design, this study enrolled patients who received fourth-level liver surgery at a major tertiary hospital in Chengdu, affiliated with a university. QoL assessments were conducted using the EQ-5D-5L scale at three intervals post-discharge: one week, one month, and three months. This study enrolled 125 participants and tracked their health-related QoL using the EQ-5D-5L Utility Index (UI) (health utility values). Initially, 1 week post-discharge, most patients’ UI scores fell within the range of − 0.2 to 0.6. These values improved significantly over time, rising to 0.7–1.0 after 1 month and stabilizing between 0.8 and 1.0 by the 3 month mark. On average, patients reported experiencing pain for 4.18 days (± 9.72) following discharge. Statistical analyses—both univariate and multivariate—were performed to identify factors influencing QoL at different recovery stages. The findings revealed that admission method was a key determinant of QoL during the 1–3 month period post-discharge. Marital status emerged as a significant factor in the first week, while post-discharge pain levels primarily impacted QoL at the 1 month mark. After fourth-level liver surgery, the vast majority of patients regain their mobility, the ability to care for themselves, and their typical daily activities by 3 months post-discharge. Patients who are admitted to the emergency department tend to experience a lower QoL from 1 to 3 months following their discharge, compared to those who are admitted to the regular department. The persistent pain is a major culprit in diminishing a patient’s overall well-being. Consequently, prompt pain management and rehabilitation workouts are essential for expediting recovery and enhancing the patient’s QoL.

On both sides of the ocean.

Background: Hospitalization during the COVID-19 pandemic has been linked with increased psychological distress, cognitive impairment, and reduced quality of life (QoL). Posttraumatic stress symptoms (PTSS) and rumination may significantly influence QoL outcomes, yet the mechanisms underlying these effects remain poorly understood. Based on the Cognitive Aging Model, this study examines the mediating effects of cognitive and emotional functioning, loneliness, and posttraumatic growth (PTG) on the connection between PTSS/rumination and QoL among patients hospitalized with COVID-19, including the moderator effect of sex, time since discharge, and admission to the intensive care unit (ICU). Methods: A cohort of 258 patients previously hospitalized with COVID-19 as the primary or secondary diagnosis was assessed 6 to 24 months post-discharge. Participants completed validated self-report and neuropsychological assessments of PTSS, rumination, cognitive function, psychological morbidity (depression and anxiety), loneliness, PTG, and QoL. Path analysis and multigroup analysis were employed to assess mediating and moderating effects. Results: PTSS and rumination were associated with reduced physical and mental QoL, primarily via increased psychological morbidity, impaired cognitive functioning, loneliness, and reduced PTG. Rumination showed strong direct and indirect effects on multiple mediators. Only sex and time since discharge significantly moderated pathways, with women showing a strong association between rumination and cognitive impairment/loneliness, while the association between loneliness and mental QoL was significant only in men and in recently discharged patients. Conclusions: PTSS and rumination contribute negatively to QoL in post-discharged patients with COVID-19 through emotional, cognitive, and social pathways, influenced by sex and duration since discharge. The findings underscore the significance of comprehensive long-term care methods focused on cognitive rehabilitation, psychosocial sT, and social reintegration for COVID-19 survivors.

Epilepsy is a neurological disease characterized by seizures, which affects up to 65 million people worldwide (1). About two-thirds of patients with epilepsy are able to achieve seizure control with current antiseizure medication (ASM) (2), whereas one-third of epilepsy patients are difficult to treat, i.e., patients with drug-resistant epilepsy (DRE). In addition, ASM can induce (serious) adverse events and a significant reduction of the quality of life (QoL), leading to ASM retention rates around 50% (3). DRE can induce neurobiochemical alterations and emotional and physical dysfunctions. The multifaceted status of DRE patients underscores the emphasis on non-pharmacological options, and therapies that target multiple mechanisms are likely to be more effective to treat DRE (4), thereby acting as a “magic shotgun” rather than a “magic bullet.” If epilepsy surgery is not an option in a patient with DRE, vagus nerve stimulation (VNS) (5) or dietary treatments, such as the ketogenic diet (KD), are valuable alternative options (5–7). Initial studies with dietary treatments report on the classical KD, consisting of 80% fat and 20% protein plus carbohydrate (4:1 KD) or 75% fat and 25% protein plus carbohydrate (3:1 KD) (8). A KD using medium-chain triglycerides (MCTs) leads to more ketones/kcal of energy and a more efficient absorption (9). Therefore, the MCT diet is less restrictive since it consists of a lower amount of fat and a higher intake of protein and carbohydrate (10). The modified Atkins diet (MAD) (11) and the low-glycemic index treatment (LGIT) (12) are other dietary therapies mimicking the seizure reduction result of the KD, but they are less restrictive. Clinical studies show that both modalities (VNS and KD) lead to a seizure frequency reduction (SFR) by at least 50% in half of the DRE patients. A recent study proposed a treatment algorithm for pediatric DRE, including non-pharmacological treatment options such as VNS and the KD (13). Interestingly, the KD therapy has some advantages in comparison to VNS: the SFR is slightly higher for patients on the KD (14); the KD is non-invasive, and there are few to no neurotoxic effects when compared to multiple ASM (6). Nevertheless, there are barriers and disadvantages in putting the KD into practice, such as palatability issues, compliance issues, side effects (usually mild), variable response rates, and restrictions to the daily life of the patient (15). Overall, a multidisciplinary team (pediatric neurologist, dietician/nutritionist, and a primary care-giver) is indispensable when dietary treatments are initiated and also during maintenance (16). Currently, we are unable to pinpoint the mechanism(s) of action of the KD, and it is possible that dietary therapies will be classified as “magic shotguns” (17–20). Therefore, our aim was to elaborate on the newest pathways involved, such as the gut microbiome and serine synthesis.

Heart failure is a major health problem, often accompanied by limited physical activity and severe effects in various areas of patient quality of life. Self-care, as well as compliance with medication, can further contribute to clinical stability and improved patient outcomes. The purpose of this chapter is to assess the effect of self-care and compliance with medication, on the quality of life of patients with heart failure. The research sample consisted of 67 patients diagnosed with heart failure who visited the cardiology outpatient clinic of a general hospital in the capital of Greece. The assessment of self-care behavior was performed by the scale EHFScBS and SCHFI v.6, the Morsiky Green Levine Adherence Scale (MAQ) was used for the evaluation of adherence to medical treatment, while for the evaluation of the quality of life the questionnaire MLWHFQ was used. The multifactorial linear regression analysis showed that age, compliance with medication and scoring in the dimension "Self-care confidence" relates independently to the overall quality-of-life scale rating. In particular, participants over 80 had a significantly higher score, that is, worse quality of life, compared to those under the age of 70 (p<0.001), while participants with low compliance with treatment had a significantly worse quality of life compared to participants with high compliance (p<0.001). It has been noticed that the better self-care they had and the higher compliance with their medication, their quality of life was better. Self-care behavior and adherence to medical treatment of patients with heart failure are related to their quality of life. Age, educational level, and "Self-care confidence" are factors that influence self-care behavior, compliance with medication, and quality of life. In-depth patient information on the need for adherence to therapeutic guidelines may help to reduce pharmaceutical costs and maximize the therapeutic effect. For this reason, health professionals treating these patients should take into account all the factors that negatively affect their quality of life and treat them with the appropriate interventions.

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide and significantly impact patients' quality of life (QoL) and mental health. A healthy lifestyle has been recognized as an essential factor in reducing the burden of CVD and improving patient outcomes. This study aimed to investigate the relationship between the Healthy Lifestyle Index and QoL and depression among patients with CVD. This descriptive-analytical cross-sectional study was conducted in 2024 among 182 patients with confirmed CVD who were referred to Imam Khomeini Hospital in Tehran. Data were collected using three validated instruments: a demographic questionnaire, the Short Form-12 Health Survey (SF-12) to assess QoL, and the Patient Health Questionnaire-9 (PHQ-9) to measure depression. The Healthy Lifestyle Index included physical activity, dietary habits, smoking, alcohol use, and social interaction. Generalized linear models were used to examine the associations between lifestyle components and outcomes (QoL and depression), adjusting for key confounders. All statistical analyses were performed using SPSS software version 22. The findings showed that the mean SF-12 QoL score among participants was 84.29 (SD = 7.53), and the mean age was 59.54 years (SD = 11.73). Physically active patients had significantly higher QoL scores (mean = 88.3) compared to inactive individuals (mean = 82.1) (P < 0.001). Greater social interaction was also associated with better QoL (mean = 87.9 vs. 80.4, P < 0.001). In contrast, alcohol consumption was associated with lower QoL (mean = 79.2 vs. 85.1, P = 0.04). Smoking status, BMI, and healthy eating score were not significantly related to QoL. Moreover, participants with higher Healthy Lifestyle Index scores had lower depression scores (mean PHQ-9 = 5.2 vs. 8.7, P < 0.01). The results highlight the importance of promoting physical activity, reducing alcohol consumption, and encouraging social engagement as key components of healthy lifestyle interventions for patients with CVD. These strategies may effectively improve QoL and reduce depressive symptoms, underscoring the need for holistic and behaviorally focused approaches in the routine care of cardiovascular patients.

The main objectives of this symposium were to review the importance of topical therapies in the treatment of psoriasis and the unmet clinical and patient quality of life (QoL) needs that still exist, to discuss the innovation seen with reformulations of existing active pharmaceutical ingredients (API), and to align changes in future dermatology practice with these topical treatment innovations. Mr Fernández introduced the topic of ‘looking to the future’, with a wide-ranging, big-picture view of the changing face of medical practice and the increasing role of technology, including specific examples of how these trends will affect dermatology practice. Prof Surber built on the theme of innovation to discuss how novel products and approaches can be pursued in dermatology, particularly in the area of topical psoriasis treatments. Prof Surber’s presentation and the subsequent talk by Dr Bewley described how innovations can translate into improved patient outcomes in key areas, including psoriasis control, itching, sleep, and overall health-related QoL. Prof Bonnekoh tied the various threads of the symposium together by showing how the new technological and pharmacological options could help clinicians evolve their overall approach to long-term topical management of psoriasis, moving from a more reactive mindset to safe and effective proactive control. Finally, the audience was given the opportunity to ask questions in a brief panel discussion.

The Venezuelan migratory flow is considered as the largest exodus in Latin America's recent history. More than 640,000 Venezuelans have entered Brazilian territory in recent years. Examine whether sociodemographic, community support, and perceived prejudice variables are associated with the physical and psychological dimensions of Quality of Life (QoL) among first-generation Venezuelan migrants in Southern Brazil. The sample was composed of 195 participants who fulfilled 4 pen-and-paper instruments about: sociodemographic characteristics, QoL, community support, and perceived prejudice. Linear regression models were used to investigate the variables associated with physical and psychological QoL. Prejudice was negatively associated with physical (β = -.279, p < .001) and psychological QoL (β = -.351, p < .001), whereas community support was positively associated (β = -.159, p = .026) to physical QoL. Both models were significant and explained 16.5% (physical) and 17.9% (psychological) of the variance. Post hoc analysis pointed out that the effect of community support on psychological QoL was mediated by perceived prejudice. The results point out the relevance of developing public policies to raise awareness of the host community regarding international migration. This approach may tackle negative perceptions toward migrants, while reducing discriminatory practices.

BackgroundDespite growing interest in cutaneous adverse events (CAEs) and their management in patients with cancer, they are often underreported and there are no extensive data on their impact on quality of life (QoL). Healthcare professionals should consider this issue in order to minimize its negative impact on QoL and improve patient outcomes. This study evaluates the impact of CAEs on QoL in outpatients receiving anticancer drugs and aims to determine the differences in QoL between conventional chemotherapy versus targeted therapies.MethodsA total of 114 cancer patients with CAEs were included in this observational, cross-sectional study. Patient-reported outcomes instruments (Functional Assessment of Cancer Therapy – General, Dermatology Life Quality Index, and Skindex-16) were used.ResultsMean scores in QoL indices were 65.3±13.4, 8.4±5, and 30.8±16.9 in Functional Assessment of Cancer Therapy – General, Dermatology Life Quality Index, and Skindex-16, respectively. The CAEs that had the greatest impact on dermatologic-related QoL were hand–foot skin reaction, rash, palmo-plantar erythrodysesthesia, and papulopustular eruption. No significant differences in QoL indices according to the type of treatment (conventional chemotherapy versus targeted therapy) were observed.ConclusionsCAEs, and particularly hand–foot toxicities, rashes, and papulopustular eruptions, can have an impact on QoL in outpatients receiving anticancer drugs as evaluated with three different patient-reported outcomes instruments. No differences in QoL related to CAEs were observed between conventional chemotherapy and targeted therapy.