@article {pmid41771995,
year = {2026},
author = {Liu, F and Xia, Y and Lee, AC and Chen, Y and Chen, Z and He, Y and Chan, CH and Cai, J and Yuen, TT and Ye, ZW and Zhang, J and Qian, Z and Yuen, KY and Chan, JF and Chu, H},
title = {Prolonged dysregulation and pathological changes in the upper respiratory tract of SARS-CoV-2 infected hamsters.},
journal = {Npj viruses},
volume = {4},
number = {1},
pages = {},
pmid = {41771995},
issn = {2948-1767},
support = {17118621, 17119122//General Research Fund/ ; C7103-22G//Collaborative Research Fund/ ; T11-709/21-N//Theme-Based Research Scheme/ ; HKU RFS2425-7S06//Research Fellow Scheme/ ; COVID1903010-14, 23220522, CID-HKU1-5//the Health and Medical Research Fund/ ; projects 2021YFC0866100 and 2023YFC3041600//National Key Research and Development Program of China/ ; 2023A1515012325, 2023A1515011891, 2024A1515010848, 2023A1515011910//General Programme, Guangdong Provincial National Science Foundation, China/ ; },
abstract = {Respiratory long COVID symptoms, including dyspnea and breathing pattern disorders, are frequently reported in convalescent COVID-19 patients. Yet the mechanisms driving these persistent respiratory manifestations remain poorly elucidated. In this study, we characterized persistent upper respiratory tract pathology in SARS-CoV-2-infected hamsters. Strikingly, we observed persistent expression of SARS-CoV-2 nucleocapsid (N) protein and subgenomic RNA (sgRNA) gene, which resulted in sustained tissue pathologies, dysregulation of pro-inflammatory markers, pro-apoptotic genes, as well as the altered expression of viral entry receptors, in the nasal turbinate of infected hamsters up to 120 days post-infection. These findings indicate that residual viral components may contribute to dysregulation of tissue repair and remodeling, chronic tissue pathology, and potentially enhanced susceptibility to secondary respiratory infections upon SARS-CoV-2 infection even upon recovery of acute infection. Collectively, our study provides insights into potential drivers of post-acute COVID-19 sequelae in the upper respiratory tract.},
}

@article {pmid41771135,
year = {2026},
author = {Lim, SY and Lee, J and Chang, E and Kwon, JS and Jang, CY and Seo, Y and Park, JJ and Na, SH and Park, H and Jang, HM and Yun, SC and Kim, SH},
title = {Neither Metformin nor Ursodeoxycholic Acid Effectively Treats Postacute Sequelae of COVID-19 : A Randomized Clinical Trial.},
journal = {Annals of internal medicine},
volume = {},
number = {},
pages = {},
doi = {10.7326/ANNALS-25-04883},
pmid = {41771135},
issn = {1539-3704},
abstract = {BACKGROUND: There is no proven treatment to alleviate symptoms of postacute sequelae of SARS-CoV-2 infection (PASC), despite its substantial public health burden.

OBJECTIVE: To evaluate the efficacy of metformin and ursodeoxycholic acid (UDCA) in improving PASC symptoms in adults.

DESIGN: Double-blind, placebo-controlled, randomized clinical trial. (Clinical Research Information Service: KCT0009342).

SETTING: Two tertiary hospitals in South Korea, July 2024 to April 2025.

PARTICIPANTS: Of 666 adults screened, 396 with a PASC index score of 12 or greater were randomly assigned.

INTERVENTION: Oral metformin (uptitrated to 1500 mg/d), UDCA (900 mg once daily), or double placebo for 14 days (1:1:1).

MEASUREMENTS: Proportion of participants achieving PASC recovery (index score <12) at 8 weeks.

RESULTS: Among 396 randomized participants (median age, 36 years [IQR, 28 to 49 years]; 72% women), 132 received metformin, 132 received UDCA, and 132 received placebo. The mean interval from SARS-CoV-2 infection was 9.8 months (SD, 7.5). The mean baseline PASC score was 19.3 (SD, 5.7). Recovery occurred in 63.6% (84 of 132) with metformin, 68.2% (90 of 132) with UDCA, and 68.2% (90 of 132) with placebo. Mean changes in PASC scores from baseline to week 8 were -10.05 (95% CI, -11.35 to -8.76) with metformin and -10.62 (CI, -11.79 to -9.45) with UDCA, compared with -10.43 (CI, -11.69 to -9.18) with placebo.

LIMITATION: Findings may not be generalizable to patients with more severe or persistent long COVID.

CONCLUSION: A 2-week course of metformin or UDCA did not significantly improve recovery from PASC.

PRIMARY FUNDING SOURCE: National Institute of Infectious Diseases, National Institute of Health, South Korea.},
}

@article {pmid41770566,
year = {2026},
author = {Shah, RM and Shah, KM and Chen, J and Sawano, M and Bhattacharjee, B and Krumholz, HM},
title = {Long COVID and Recovery Among US Adults.},
journal = {JAMA network open},
volume = {9},
number = {3},
pages = {e260374},
doi = {10.1001/jamanetworkopen.2026.0374},
pmid = {41770566},
issn = {2574-3805},
}

@article {pmid41768981,
year = {2026},
author = {Lim, L and Hosseinkhah, N and Van Buskirk, M and Oei, K and Berk, A and Pushparaj, A and Liburd, J and Abbaspour, Z and Rubine, J and Jackson, D and Zomorrodi, R},
title = {Photobiomodulation for cognitive dysfunction (Brain Fog) in post-COVID-19 condition: a randomized double-blind sham-controlled pilot trial.},
journal = {EClinicalMedicine},
volume = {92},
number = {},
pages = {103730},
pmid = {41768981},
issn = {2589-5370},
abstract = {BACKGROUND: Post-COVID-19 condition (PCC) affects millions globally, with cognitive dysfunction ("brain fog") impairing daily functioning in up to 88% of patients. No effective treatments exist for PCC-related cognitive impairment. Photobiomodulation (PBM), a non-invasive therapy delivering near-infrared light, enhances mitochondrial function and reduces neuroinflammation, showing promise in neurological disorders. This study aimed to evaluate the efficacy and safety of home-based intranasal and transcranial PBM (itPBM) for PCC cognitive dysfunction.

METHODS: This randomized, double-blind, sham-controlled pilot trial in the USA (ClinicalTrials.govNCT05857124) enrolled 43 adults (18-65 years) with PCC cognitive symptoms ≥12 weeks post-infection. Participants were randomized 1:1, stratified by age (<45 vs ≥ 45 years), using computer-generated assignment to 8 weeks of daily 20-min itPBM, 6 days per week, with the Vielight Neuro RX Gamma device or sham, targeting the brain's default mode network, followed by 4 weeks of observation. Participants, investigators, and assessors were masked to group assignment. The primary outcome was mean change in Creyos cognitive battery composite score at Day 56. Secondary outcomes included fatigue, quality of life, and safety. Analyses used mixed-model repeated measures in the per-protocol population.

FINDINGS: The trial was completed, with 43 participants randomized (23 active, 20 sham) and 41 analyzed (21 active, 20 sham). They were recruited between July 5, 2023, and September 1, 2024. Active itPBM improved composite cognitive scores more than sham (mean difference 0.043, 95% CI -0.007 to 0.092, p = 0.088), with significant gains in participants <45 years (prespecified but exploratory, p = 0.028). Attention tasks improved consistently (p < 0.050 at multiple timepoints). Secondary outcomes mobility favored sham (p = 0.007), and fatigue also favored sham. No serious adverse events occurred; compliance was high (median 55 days, interquartile range 2 days).

INTERPRETATION: Home-based itPBM is safe and feasible, showing potential cognitive benefits for PCC brain fog, particularly in younger adults. Larger trials are needed to confirm efficacy and optimize parameters.

FUNDING: Vielight Inc.},
}

@article {pmid41768410,
year = {2026},
author = {Hung, TS},
title = {Rehabilitation strategies for long COVID: integrating human factors engineering.},
journal = {Frontiers in rehabilitation sciences},
volume = {7},
number = {},
pages = {1708460},
pmid = {41768410},
issn = {2673-6861},
abstract = {Long COVID presents unique challenges that extend beyond conventional biomedical rehabilitation, necessitating strategies that are adaptive, multidisciplinary, and patient-centered. This mini-review synthesizes current evidence on physical, cognitive, and occupational rehabilitation, and introduces human factors engineering as a framework to optimize the design, delivery, and usability of interventions. Emerging approaches such as telerehabilitation, cognitive ergonomics, and structured return-to-work programs illustrate the value of integrating clinical rehabilitation with user-centered design. Yet critical gaps remain, including the limited number of randomized controlled trials, the heterogeneity of outcome measures, and the lack of systematic integration between rehabilitation and human factors research. Addressing these challenges will be essential to develop effective, scalable, and sustainable interventions. By aligning rehabilitation protocols with the principles of human factors engineering, future practice can better enhance efficacy, promote sustained patient engagement, and ultimately improve the quality of life for individuals living with long COVID.},
}

@article {pmid41767632,
year = {2026},
author = {Ziauddeen, N and Pantelic, M and O'Hara, ME and Hastie, C and Alwan, NA},
title = {Symptom Patterns, Recovery, and Impact of Long COVID: Findings From a Longitudinal Survey.},
journal = {Open forum infectious diseases},
volume = {13},
number = {2},
pages = {ofag040},
pmid = {41767632},
issn = {2328-8957},
abstract = {BACKGROUND: Long COVID is a predominantly multisystem, often disabling, condition that develops following SARS-CoV-2 infection. We aimed to characterize the pattern, triggers, and impact of Long COVID symptoms.

METHODS: Data from a 1-year follow-up of an online survey originally conducted in November 2020 were used. Surveys were coproduced with people living with Long COVID. Participants were adults with Long COVID following confirmed or probable SARS-CoV-2 infection who were not hospitalized in the first 2 weeks of illness. The baseline survey recruited from social media and online support groups using convenience nonprobability sampling.

RESULTS: Of the 2210 first survey participants invited, 1153 (52%) responded to the follow-up survey. The mean age was 47.7 years (standard deviation 10.6) with 84% females, 83% UK-based, 78% university-qualified, and 90% reporting good to excellent health before SARS-CoV-2 infection. Median duration of illness was 19.8 months (interquartile range, 19.3-20.1) at follow-up. Only 5% of participants reported full recovery, and 45% reported a constant pattern of illness (as opposed to fluctuating or relapsing) compared to 17% at baseline. An equal proportion reported being unable to work at baseline (20.4%) and follow-up (20.6%). However, a higher proportion reported being made redundant or taking early retirement at follow-up (8.9%) than at baseline (2.2%).

CONCLUSIONS: This study highlights the prolonged nature of Long COVID as well as the impact on work. This has the potential to widen health inequalities and increase hardship in individuals whose life circumstances and job types may not allow them to make necessary adaptations.},
}

@article {pmid41766190,
year = {2026},
author = {Smyth, N and Ahmad, A and Begum, S and Chaudhry, A and Clark, S and Wright, A and Gimblett, K and Ridge, D and Chew-Graham, CA and Gopal, D and Alwan, NA and Kingstone, T},
title = {Co-Creating Publicly Available Resources to Increase Awareness of and Support for Long Covid Among Ethnic Minority Communities.},
journal = {Health expectations : an international journal of public participation in health care and health policy},
volume = {29},
number = {2},
pages = {e70596},
doi = {10.1111/hex.70596},
pmid = {41766190},
issn = {1369-7625},
support = {NIHR203106//National Institute for Health Research/ ; },
abstract = {INTRODUCTION: Stigma and discrimination make healthcare challenging for people living with Long Covid, especially those from ethnic minority groups. Since their experiences are under-researched and may differ from other groups, it is crucial that healthcare guidance is informed by the lived experiences of diverse groups.

METHODS: Findings from underpinning research (hearing from the unheard: Impact of Long Covid in Black and minority ethnic groups in the UK: HI-COVE - 31 interviews with ethnic minority individuals living with Long Covid) informed the development of two resources aimed at raising awareness of the challenges faced by ethnic minority groups and offer ways to best support these groups. People living with Long Covid (N = 4) provided feedback on the two resources. Feedback was guided by a topic guide. Minimal changes were made following feedback.

RESULTS: Resource 1: Four participants who took part in the underpinning research, worked with an Artist (AW) to curate artwork. The artwork created was a video called 'Still Looking for Answers' https://www.youtube.com/watch?v=GDt-Ro1Cql8&t=1s. It comprises anonymised patient narratives and imagery (performed by actors) and a soundscape to convey ethnic minority lived experiences of Long Covid. Resource 2: an online learning tool called 'Health and Social Care PROfessional-Long Covid': H-Pro-LC tool: https://clineduniverse.org/hicove/story_html5.html shares challenges people from ethnic minority groups face when accessing healthcare for Long Covid. The resource includes guidance on supporting people, particularly people from ethnic minority backgrounds, presenting to primary care with (probable) symptoms of Long Covid.

CONCLUSIONS: These publicly available resources aim to raise awareness of Long Covid: they encourage viewers to emotionally connect with experiences of Long Covid as well as offer ways to support people living with the condition, particularly among people from ethnic minority groups.

The underpinning research of these resources were extensively informed by both patient (N = 7) and expert advisory groups (N = 6). Co-creation approaches (through workshops, meetings and written feedback) from people living with Long Covid, carers, stakeholders and members of the public informed the design, development, innovation and impact of resources developed. People with lived experience of Long Covid provided feedback on the resources developed in this study.},
}

@article {pmid41766005,
year = {2026},
author = {Zawadzki, J and Kania, J and Murkos, M and Zgoła, D and Noga, A and Nowak, P and Kulińska, W and Pawlik, P and Kudliński, B},
title = {Four year mortality and quality of life after ICU treatment for COVID 19 related acute respiratory distress syndrome.},
journal = {Scientific reports},
volume = {},
number = {},
pages = {},
doi = {10.1038/s41598-026-42341-1},
pmid = {41766005},
issn = {2045-2322},
abstract = {Severe COVID-19 leading to ARDS and ICU admission is associated with high early mortality, yet data on long-term outcomes and societal burden remain limited, particularly in Central and Eastern Europe. To describe 4-year mortality, patient-reported functional status and health-related quality of life (HRQoL) among ICU-treated COVID-19 ARDS patients, and to explore early factors associated with short- and long-term mortality as well as long-term recovery. Single-center retrospective-prospective cohort study with structured 4-year telephone follow-up. 283 adults treated in the Temporary ICU Hospital in Zielona Góra, Poland (December 2020-July 2021). Follow-up interviews were completed in 81 of 157 confirmed 4-year survivors. Associations with 30-day mortality and late mortality (among 30-day survivors) were explored using multivariable logistic regression. Survivors completed a structured interview assessing HRQoL (EQ-5D-5 L/EQ-VAS), dyspnoea severity assessed with the mMRC scale, functional status assessed with PCFS, fatigue, brief cognitive screening items, return to work, rehabilitation use, and financial burden. A cumulative post-ICU impairment score (0-6 domains) was constructed. Cost estimates were exploratory and based on public ICU reimbursement rates and patient-reported rehabilitation burden. Thirty-day mortality was 29.0%, and cumulative 4-year mortality was 45%. In adjusted analyses, older age and higher white blood cell count at ICU admission were associated with mortality endpoints (model discrimination up to AUC 0.86, depending on endpoint). Among 4-year survivors, 27.5% reported clinically relevant fatigue, 46.8% insomnia, and a substantial proportion reported persistent limitations across functional and EQ-5D domains. Rehabilitation was reported by 39% and was associated with lower QALY, likely reflecting greater baseline impairment. Median 4-year QALY was 3.7, varying significantly by fatigue, dyspnoea, return-to-work status, and subjective cognitive complaints. Among ICU-treated COVID-19 ARDS patients, long-term mortality remained high and many survivors reported persistent multidomain impairment years after discharge. These findings support structured post-ICU follow-up pathways and targeted rehabilitation and occupational support for long-COVID survivors.},
}

@article {pmid41764705,
year = {2026},
author = {Kirwin, E and Adibnia, E and Wiggins, M and Sander, B and Xie, F and Ohinmaa, A and Johnson, JA and Norris, C and Rafferty, E and MacDonald, SE and Round, J and , },
title = {The impact of testing positive versus negative for COVID-19 on health-related quality of life: cross-sectional evidence from the Alberta post-COVID-19 follow-up survey.},
journal = {Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation},
volume = {35},
number = {4},
pages = {},
pmid = {41764705},
issn = {1573-2649},
support = {FRN#173622//Canadian Immunization Research Network/ ; FRN#173622//Canadian Immunization Research Network/ ; },
}

@article {pmid41761660,
year = {2026},
author = {Geng, S and Li, L},
title = {Immune exhaustion, the culprit for long COVID and chronic complications.},
journal = {Journal of leukocyte biology},
volume = {},
number = {},
pages = {},
doi = {10.1093/jleuko/qiag029},
pmid = {41761660},
issn = {1938-3673},
}

@article {pmid41758880,
year = {2026},
author = {Meyer, F and Traidl, S and Ameri, M and Dreher, A and Abu-Rashed-Kufs, N and Vontobel, J and Möhrenschlager, M and Duchna, HW and Sandberg, F and Brüggen, MC},
title = {Distinguishing post-COVID from long-COVID in adults: Development and validation of a biomarker signature using targeted proteomics and machine learning in a cross-sectional observational study.},
journal = {PloS one},
volume = {21},
number = {2},
pages = {e0338451},
pmid = {41758880},
issn = {1932-6203},
abstract = {BACKGROUND: COVID-19 can have diverse clinical manifestations, ranging from asymptomatic infection to critical illness with multiorgan involvement. While many patients recover fully, others develop long-COVID, a heterogeneous condition marked by persistent symptoms beyond the acute phase. The immunological pathomechanisms between long-COVID and other post-acute recovery states remain unclear.

OBJECTIVE: To characterize and compare clinical, pulmonary, and proteomic profiles of patients with long-COVID (LC) and those recovering from severe COVID-19 without long-COVID (post-severe-COVID, PC), and to evaluate the predictive potential of machine learning-based biomarker analysis.

METHODS: In this monocentric, prospective observational study with a cross-sectional design, patients undergoing rehabilitation were included at admission. Clinical data, detailed symptom profiles, and lung function testing, including diffusing capacity of the lungs, were collected. Serum proteomics covering immune response and inflammation panels was performed, and a Random Forest classifier was applied to identify biomarkers differentiating LC and PC.

RESULTS: LC (n = 24) patients were younger (52 years vs. 58 years in PC), predominantly female (66.7% vs. 30.0% in PC), and reported fatigue, neurocognitive symptoms, and exercise intolerance, whereas PC (n = 40) patients showed greater pulmonary impairment, as shown by reduced diffusing capacity (46% vs. 72.5% in LC p<0.001). Proteomic profiling revealed distinct immune and inflammatory signatures between groups. Applying a random forest classification algorithm, we were able to distinguish between the LC and the PC group with a high degree of accuracy of around 89%, using LAMP3 (Lysosome-associated membrane glycoprotein 3), CKAP4 (cytoskeleton associated protein 4) and KRT19 (Keratin 19).

CONCLUSIONS: This study introduces a novel characterization of patients recovering from severe COVID-19 without long-COVID, enabling clearer differentiation between persistent and recovering trajectories. Combining clinical data, pulmonary function, and proteomic machine learning analysis provides insight into post-acute COVID-19 biology and identifies candidate biomarkers for improved diagnosis.},
}

@article {pmid41757223,
year = {2026},
author = {Agyemang, C and Norredam, M},
title = {Beyond broad categories: understanding ethnic differences in long COVID.},
journal = {The Lancet regional health. Europe},
volume = {63},
number = {},
pages = {101622},
pmid = {41757223},
issn = {2666-7762},
}

@article {pmid41756785,
year = {2026},
author = {Fanelli, M and Petrone, V and Chirico, R and Coppola, L and Sorace, C and Cipriani, C and Longo, G and Girasole, M and Collacchi, F and Radu, CM and Miele, MT and Lucas, A and Teti, E and Malagnino, V and Iannetta, M and Malergue, F and Bernardini, S and Balestrieri, E and Sarmati, L and Grelli, S and Minutolo, A and Matteucci, C},
title = {CD169[+] and HLA-DR[+] extracellular vesicles are highly represented in human plasma and dynamically expressed in SARS-CoV-2 infection and long COVID-associated sequelae.},
journal = {Frontiers in cellular and infection microbiology},
volume = {16},
number = {},
pages = {1686186},
pmid = {41756785},
issn = {2235-2988},
abstract = {INTRODUCTION: Elevated inflammation and immune dysregulation are the main consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The dysregulated inflammatory state persists after coronavirus disease 2019 (COVID-19), establishing the post-acute sequelae of SARS-CoV-2 infection in individuals with long COVID (LC). The role of CD169[+] monocytes in the early diagnosis of SARS-CoV-2 infection and their association with severe outcomes were demonstrated in COVID-19 patients (COV). We aimed to delineate specific myeloid activation that characterizes the acute and post-acute phases of SARS-CoV-2 infection, evaluating the correlation between cellular and extracellular vesicles (EVs).

METHODS: Blood samples from COV, LC, and healthy donors (HD) were collected at Tor Vergata University Hospital in Rome. Plasmatic EVs were isolated by differential centrifugation and evaluated by flow cytometry and atomic force microscopy (AFM). Leukocyte subpopulations and different sizes of circulating EVs (100-200, 240-500, >500 nm) were characterized for HLA-DR and CD169 expression in COV, LC, and HD through flow cytometry. Serum inflammatory markers were assessed by the ELLA immunoassay system. The analyzed markers were associated with clinical and biochemical parameters in COV and LC.

RESULTS: The analysis of HLA-DR[+], CD169[+], and HLA-DR[+]CD169[+] leukocytes confirmed our previous results in which the activated monocytes CD169[+]HLA-DR[+] were found significantly high in COV, persisting in LC, and correlated differently with coagulation markers and inflammatory cytokines. Similar to cellular levels, the percentage and number of HLA-DR[+]CD169[+] EVs were significantly elevated in COV and persisted in LC compared to HD. Different HLA-DR and CD169 expressions were found according to EV size in COV, LC, and HD, and correlations with biochemical parameters and circulating inflammatory markers were found. A positive correlation of HLA-DR and CD169 expression among monocytes and circulating EVs was found, supporting a possible connection between the two compartments and circulating inflammatory mediators. Moreover, the characterization by flow cytometry of EV cell derivation and cytokine cargo revealed EVs as sensitive indicators of both acute and persistent immune perturbations, bridging viral antigen persistence with inflammatory signaling in long COVID.

CONCLUSION: Myeloid activation markers and inflammatory cytokines are dynamically expressed between blood cells and circulating extracellular vesicles, underlining multilevel cell-to-cell communications, opening new possibilities to monitor COVID-19 and long COVID-associated sequelae.},
}

@article {pmid41756626,
year = {2026},
author = {Pleguezuelos, E and Del Carmen, A and Sánchez-Nuño, S and Serra-Payá, N and Moreno, E and Molina-Raya, L and Jerez-Molina, C and Girabent Farrés, M and Castizo-Olier, J and Biurrun-Garrido, A and Viñals, X and Serra-Prat, M and Garnacho-Castaño, MV},
title = {Extracellular-to-total body water ratio is associated with comorbidity and cardiorespiratory fitness in older adults with post-COVID-19 syndrome.},
journal = {Frontiers in nutrition},
volume = {13},
number = {},
pages = {1715783},
pmid = {41756626},
issn = {2296-861X},
abstract = {BACKGROUND: Post-coronavirus disease 2019 (post-COVID-19) syndrome is associated with persistent impairments in physical fitness and altered body composition, particularly in older adults. The extracellular-to-total body water (ECW/TBW) ratio has been linked to poor outcomes in clinical populations. However, its association with cardiorespiratory fitness (CRF) and muscular fitness (MF) in older adults with post-COVID-19 syndrome remains unclear. This study aimed to examine the associations between ECW/TBW ratio, CRF, MF, and other variables in this population.

METHODS: A cross-sectional study was conducted in 71 older adults with post-COVID-19 syndrome. Hydration status and body composition were assessed using bioelectrical impedance analysis (BIA). CRF was evaluated by cardiopulmonary exercise testing (CPET; peak oxygen uptake, VO2peak), and MF was assessed using isokinetic and functional performance tests. Associations between ECW/TBW ratio, fitness outcomes, and other variables were analyzed through multi-variate linear regression models adjusted for age and sex. Results: Higher ECW/TBW ratio was significantly associated with lower VO2peak (β = -0.010, p = 0.048) and greater comorbidity burden (β = 0.003, p = 0.002). No significant associations were observed between ECW/TBW ratio and MF variables (p > 0.05).

CONCLUSIONS: The ECW/TBW ratio is independently associated with comorbidity burden and CRF, but not with MF, in older adults with post-COVID-19 syndrome. The Charlson Comorbidity Index emerged as the strongest determinant of ECW/TBW ratio. These findings highlight the potential relevance of integrating hydration monitoring and CRF assessment into rehabilitation strategies, and support further investigation of their role in the clinical management of older adults with post-COVID-19 syndrome.},
}

@article {pmid41754590,
year = {2026},
author = {De Stefanis, S and Colavita, F and Maggi, F and Antonioli, M},
title = {SARS-CoV-2 Persistence and the Gut Microbiota: New Insights into Long COVID Pathogenesis.},
journal = {Viruses},
volume = {18},
number = {2},
pages = {},
doi = {10.3390/v18020247},
pmid = {41754590},
issn = {1999-4915},
support = {Ricerca Corrente Linea 1 - Progetto 1 to IRCCS INMI L. Spallanzani//Ministero della Salute/ ; Ricerca di Ateneo 2024- Dipartimento di Biologia (AutoCuRC)//University of Rome Tor Vergata/ ; },
abstract = {In December 2019, the world experienced the emergence of a new virus, SARS-CoV-2, which caused the 2020 pandemic. SARS-CoV-2 causes COVID-19, primarily affecting the respiratory system, as well as the gastrointestinal tract. Remarkably, one in eight COVID-19 patients develops Long COVID, which is linked to SARS-CoV-2 persistence in the gastrointestinal tract, resulting in chronic inflammation and microbiota dysregulation. Given that gut microbiota dysbiosis plays a pivotal role in antiviral defense and gastrointestinal conditions, here we examine emerging evidence on how persistent SARS-CoV-2 infection may contribute to the aetiology of enteric disorders. In particular, we emphasise the intricate connection between chronic inflammation caused by persistent SARS-CoV-2 infection (e.g., irritable bowel syndrome and inflammatory bowel disease) and the possible development of diseases such as Crohn's disease and ulcerative colitis.},
}

@article {pmid41754542,
year = {2026},
author = {Puigdellívol-Sánchez, A and Arévalo-Genicio, A and García-Arqué, MC and Gragea-Nocete, M and Lozano-Paz, C and Moro-Casasola, V and Pérez-Díaz, C and Valls-Foix, R and Roca-Puig, R and Llistosella, M},
title = {Long COVID and Reduced Thrombosis in Antihistamine-Treated Patients: An Observational Study in the Metropolitan Area of Barcelona.},
journal = {Viruses},
volume = {18},
number = {2},
pages = {},
doi = {10.3390/v18020197},
pmid = {41754542},
issn = {1999-4915},
support = {grant number PT-082023-EP subproject COVID-P.//GENERALITAT DE CATALUNYA/ ; },
abstract = {BACKGROUND: Early evidence from a nursing home in Yepes (Toledo, Spain) indicated that antihistamines combined with azithromycin prevented deaths and hospitalizations during the first COVID-19 wave. Subsequent data from the Consorci Sanitari de Terrassa (CST) showed that patients chronically taking antihistamines had significantly reduced hospital admissions and mortality. However, a concerning rise in long COVID incidence (2-5%) after the third infection and a doubling of thrombosis rates in patients over 60 were observed.

OBJECTIVE: This study aimed to determine whether chronic antihistamine prescription is associated with a reduction in long COVID syndrome and thrombotic events.

METHODS: We analyzed anonymized data from the CST population (n = 192,651 as of March 2025). Variables included age, gender, chronic antihistamine use, number of chronic treatments (nT), COVID-19 vaccination status, SARS-CoV-2 infection history, long COVID (LC) incidence, and aggregated thrombotic events. Odds ratios (OR) were calculated using chi-square tests.

RESULTS: The prevalence of LC increased progressively with successive infections in the non-antihistamine group. No significant differences were found with the antihistamine group, which presented no LC cases among the 52 patients with three documented infections. Thrombotic events were significantly less frequent in antihistamine users with at least one chronic prescription (p < 0.0001).

CONCLUSIONS: Results suggest a protective effect of antihistamines against thrombotic events. While confirmation via multicenter, randomized trials is needed, a pragmatic approach using antihistamines could be considered for symptomatic patients in the early stage of infection.},
}

@article {pmid41754151,
year = {2026},
author = {Caliman-Sturdza, OA and Gheorghita, RE and Soldanescu, I and Dimian, M and Mangul, S},
title = {Vitamin D in Infectious Diseases: A Narrative Review Focusing on COVID-19, Long COVID, and Influenza.},
journal = {Nutrients},
volume = {18},
number = {4},
pages = {},
doi = {10.3390/nu18040634},
pmid = {41754151},
issn = {2072-6643},
abstract = {Vitamin D is a secosteroid hormone traditionally recognized for its role in bone and mineral metabolism, but it is increasingly understood to also function as an important immunomodulator influencing susceptibility to and outcomes of infectious diseases. This narrative review summarizes current evidence on the immunological, clinical, and preventive effects of vitamin D in the context of novel coronavirus disease (COVID-19), post-acute sequelae of SARS-CoV-2 infection (long COVID), and influenza. Mechanistically, vitamin D enhances innate immune defenses through the induction of antimicrobial peptides, including cathelicidin and defensins, and modulates adaptive immunity by suppressing maladaptive Th1/Th17 responses while promoting regulatory T-cell activity. Observational studies have frequently associated vitamin D deficiency with more severe COVID-19 outcomes; however, these associations may be influenced by confounding factors and reverse causality. Some meta-analyses suggest that vitamin D supplementation reduced rates of intensive care unit admission and ventilatory support, particularly among older adults and individuals with low baseline serum 25-hydroxyvitamin D concentrations. Emerging evidence also indicates that inadequate vitamin D status may be associated with an increased risk and symptom burden of long COVID, although causality has not been established. In the case of influenza, a limited number of randomized controlled trials (RCTs) and meta-analyses report a modest but statistically significant reduction in infection risk, especially with daily or weekly vitamin D supplementation in populations with low baseline vitamin D levels. Clinical guidelines consistently recommend maintaining adequate vitamin D status for general health but do not endorse high-dose vitamin D as a treatment for COVID-19 due to inconsistent trial findings. Overall, vitamin D should not be considered a standalone therapeutic agent; rather, maintaining sufficient vitamin D levels represents a low-risk, potentially beneficial strategy to support immune resilience against respiratory viral infections.},
}

@article {pmid41753154,
year = {2026},
author = {Munguía, L and Silva, S and Villarreal, F and Nájera, N and Ceballos, G},
title = {Effects of Cacao Flavonoids in Long COVID-19 Patients with Chronic Fatigue: FLALOC, a Placebo-Controlled Randomized Clinical Trial.},
journal = {Journal of clinical medicine},
volume = {15},
number = {4},
pages = {},
doi = {10.3390/jcm15041468},
pmid = {41753154},
issn = {2077-0383},
support = {SIP20240889 and SIP 20240919//Instituto Politécnico Nacional/ ; },
abstract = {Background: In the context of long COVID, persistent fatigue is among the most prevalent symptoms that can develop after SARS-CoV-2 infection. Mitochondrial myopathy and endothelial dysfunction, which are triggers of inflammation, have emerged as prominent causes of long COVID-induced fatigue. Interestingly, the intake of flavanols, particularly (-)-epicatechin (EC), has been associated with the positive modulation of endothelial and mitochondrial structure and function. Methods: In this work, we conducted a randomized, double-blind, placebo-controlled clinical trial to determine whether an EC-enriched supplement (ECES) improves plasma markers of inflammation, endothelial structure, and fatigue-related endpoints in patients with long COVID-19. Results: The study included 46 subjects (mean age 52 years) who were instructed to consume two capsules/day for 90 days of either ECES (n = 23) or placebo (n = 23). Endpoints assessed included mean changes in plasma inflammatory markers (IL-1β, IL-6, and TNF-α) and endothelial dysfunction markers (syndecan-1), handgrip strength, fatigue scale, and quality of life (QoL). The results showed significant improvements in the ECES group for inflammatory markers, syndecan-1, and fatigue compared with the placebo group. Conclusions: The results yield intriguing positive findings for EC and open a new avenue for treating long COVID.},
}

@article {pmid41752954,
year = {2026},
author = {Morales-Vazquez, HN and Cardona-Müller, D and Grover-Paez, F and Ramos-Becerra, CG and Cardona-Muñoz, EG and Ramos-Zavala, MG and Carmona-Huerta, J and Hernandez-Del-Rio, JE and Miranda-Aquino, T and Gonzalez-Padilla, C and Lopez-Gradilla, CJ},
title = {Arrhythmias as Part of Long COVID Syndrome in Hospitalized Patients That Survived a Severe COVID-19 Infection and the Potential Protective Role of Metformin in These Patients.},
journal = {Life (Basel, Switzerland)},
volume = {16},
number = {2},
pages = {},
doi = {10.3390/life16020319},
pmid = {41752954},
issn = {2075-1729},
abstract = {BACKGROUND: Cardiac arrhythmias are a frequent complication of acute SARS-CoV-2 infection. However, their long-term prevalence and clinical determinants among patients with post-COVID-19 syndrome, especially those previously hospitalized, remain poorly defined.

OBJECTIVES: To assess the prevalence and types of arrhythmias in long COVID patients following hospitalization and to identify associated clinical risk factors.

METHODS: In this cross-sectional study, 53 patients previously hospitalized with confirmed COVID-19 were evaluated ≥3 months post-infection. All participants underwent a standardized clinical assessment, 12-lead electrocardiography, and 24 h Holter monitoring. Logistic and Cox regression analyses were performed to identify predictors of arrhythmia.

RESULTS: Arrhythmias were identified in 41.5% (n = 22) of patients. Atrial fibrillation (32%) was the most frequent arrhythmia, followed by sinus bradycardia (27%) and sinus tachycardia (18%). Age (OR 1.06, 95% CI 1.01-1.10, p = 0.01) and length of hospital stay (OR 1.1, 95% CI 1.01-1.2, p = 0.04) were independently associated with arrhythmia. Biguanide (metformin) therapy was inversely associated with the occurrence of arrhythmia (Exp(B) = 0.017, p = 0.008). Dyspnea (82.4%) and palpitations (41.5%) were the most commonly reported symptoms.

CONCLUSIONS: Arrhythmias are common in patients with long COVID following severe disease. Advanced age and prolonged hospitalization are significant risk factors, while biguanide use may offer a protective effect. These findings underscore the need for targeted cardiac surveillance in this population.},
}

@article {pmid41751924,
year = {2026},
author = {Camici, M and Franco, M and Talamanca, L and Paulicelli, J and Scarnecchia, L and Petino, M and Mazzotta, V and Mastrorosa, I and Cimini, E and Tartaglia, E and Notari, S and Zuppi, P and Baldelli, R and Bocci, MG and Maggi, F and Girardi, E and Antinori, A},
title = {Prevalence of Circulating Autoantibodies Against G-Protein-Coupled Receptors as Potential Biomarkers for Long COVID: Preliminary Investigations.},
journal = {International journal of molecular sciences},
volume = {27},
number = {4},
pages = {},
doi = {10.3390/ijms27041787},
pmid = {41751924},
issn = {1422-0067},
abstract = {This prospective, single-center, case-control study investigated circulating autoantibodies (AAbs) targeting G protein-coupled receptors (GPCRs) in Long COVID (LC) patients to identify potential diagnostic biomarkers and therapeutic targets. Fifteen participants were enrolled at the LC clinic in Rome: eleven with severe LC-defined as >4 persistent symptoms (fatigue, cognitive impairment, poor exercise tolerance, dyspnea, arthralgia, or dysautonomic manifestations) >3 months post-infection-and four asymptomatic post-COVID (APC) individuals. Fatigue was assessed using the Fatigue Assessment Scale (FAS ≥ 22; severe ≥ 35). Auto-Abs against AT1R, endothelin receptor A, adrenergic (α1, α2, β1, β2), and muscarinic (M1-M5) receptors were quantified, along with blood cortisol and ACTH levels. SARS-CoV-2-specific T-cell responses to Spike and Nucleocapsid proteins were evaluated by ELISpot assay. In our small cohort, LC patients were younger, had fewer comorbidities (p = 0.03), fewer vaccine doses (p = 0.03), and higher FAS scores (33 vs. 12; p = 0.001). Mean GPCR AAbs levels were higher in LC than in APC (8.88 vs. 5.45 Units/mL; p = 0.17), indicating a coherent autoimmune signature in LC that correlates with symptom development. Morning cortisol was lower in LC (12.7 vs. 17 mg/dL; p = 0.01), and T-cell responses tended to be weaker. These findings suggest GPCR AAbs may serve as biomarkers and therapeutic targets for a subset of patients, guiding diagnosis and treatments with IV immunoglobulin or immunoadsorption.},
}

@article {pmid41751338,
year = {2026},
author = {Notarte, KI and Catahay, JA and Velasco, JV and Ver, AT and Lee, J and Rizk, JG and Lippi, G and Fernández-de-Las-Peñas, C},
title = {Complement System Dysregulation in the Immunopathogenesis of Long COVID: Systematic Evidence Synthesis.},
journal = {Biomedicines},
volume = {14},
number = {2},
pages = {},
doi = {10.3390/biomedicines14020439},
pmid = {41751338},
issn = {2227-9059},
abstract = {Background/Objective: Long COVID is an important cause of disability following SARS-CoV-2 infection; yet, its underlying mechanisms are not completely understood. One proposed mechanism is the long-lasting dysregulation of the immune complement system. This systematic review is the first to summarize the current evidence and evaluate the potential role of long-lasting complement activation in people with long COVID. Methods: A systematic electronic search on PubMed, MEDLINE, CINAHL, and Embase was conducted up to 15 October 2025, to identify studies investigating complement activation in people with the post-COVID-19 condition. The Newcastle-Ottawa Scale was used to evaluate the risk of bias and methodological quality. Results: Among the 247 studies initially identified, eleven met the inclusion criteria, comprising 1435 individuals (age: 48.5 years, 70% females) with long COVID and 1124 controls (age: 43.6 years, 60% females). All studies were of a high quality, with scores ranging from 7 to 8 stars (mean: 7.6 ± 0.5). The activation of the classical complement pathway was investigated in nine studies, whereas the lectin, alternative, and terminal complement pathways were each assessed in three studies. Multiple studies investigated several complement pathways. The results were heterogeneous since several markers of complement activation spanning the classical (C2, C4a, C4b, and C1s-C1INH), alternative (Ba, iC3b, and Factor D), and terminal (C5bC6, C5a, C9, and TCC) pathways were elevated, whereas other markers were not significantly different (C3, C4, and C4d) between patients with/without long COVID. In addition, markers spanning the lectin complement pathway (MBL, and MASP1-C1INH) were not significantly different between individuals with and without long COVID. Conclusions: The current evidence suggests potential long-lasting complement system dysregulation in individuals with long COVID, although the clinical significance remains controversial, due to heterogenous findings. Specific post-COVID symptom clusters, such as fatigue, dyspnea, or brain fog, have been linked to a distinct pattern of complement dysregulation. Substantial methodological heterogeneity, including differences in follow-up periods, complement markers, assessment methods, and control groups, along with the small number of available studies, underscores the need for further research to clarify the mechanisms linking complement dysregulation to long COVID.},
}

@article {pmid41751249,
year = {2026},
author = {Daodu, LP and Raste, Y and Allgrove, JE and Arrigoni, FIF and Kayyali, R},
title = {Association Between COVID-19 Vaccination and Long COVID Symptoms in Hospitalised Survivors: Distinguishing Prevention from Reverse Causality.},
journal = {Biomedicines},
volume = {14},
number = {2},
pages = {},
doi = {10.3390/biomedicines14020350},
pmid = {41751249},
issn = {2227-9059},
support = {KU-RCP10656/"Long COVID -Croydon//Croydon Health Services NHS Trust/ ; },
abstract = {Background: While COVID-19 vaccination significantly reduces acute disease severity, its impact on the incidence of long COVID remains debated, with some observational studies paradoxically suggesting higher symptom rates among vaccinated individuals. This study aimed to resolve this controversy by distinguishing between the protective effects of prior immunity and the confounding influence of reverse causality. Methods: We conducted a retrospective cohort study of 627 adults hospitalised for COVID-19 in London. Participants were stratified into two analytical cohorts based on vaccination timing: a "prevention cohort" (vaccinated ≥14 days pre-infection) and a "post-acute cohort" (vaccinated post-infection). Multivariable Bayesian logistic regression was employed to estimate Adjusted Odds Ratios (aOR) for long COVID, controlling for age, gender, BMI, comorbidities, and acute length of hospital stay (LoS). Results: In the prevention cohort, prior vaccination demonstrated a non-significant protective trend against long COVID (aOR 0.81; 95% CI 0.45-1.42; p = 0.45), with no significant difference observed between homologous and heterologous regimens. The post-acute cohort exhibited a strong, significant positive association (aOR 3.41; 95% CI 2.23-5.52; p < 0.001), indicating substantial indication bias, with symptomatic individuals more likely to seek vaccination. The strongest independent predictors of long COVID were comorbidities (aOR 2.78) and prolonged acute hospitalisation (≥4 days; aOR 1.82). Conclusions: Vaccination administered prior to infection demonstrates a protective trend against long COVID, whereas the strong association observed with post-infection vaccination reflects indication bias, with symptomatic survivors being more likely to seek immunisation. Clinical strategies to mitigate post-acute sequelae should prioritise reducing acute disease severity and managing comorbidities, which were identified as the dominant independent predictors of risk in hospitalised patients.},
}

@article {pmid41750353,
year = {2026},
author = {Makki, R and Kassem-Moussa, S and Al Nemer, F and El Majzoub, R and Fayyad-Kazan, H and Rachidi, W and Badran, B and Fayyad-Kazan, M},
title = {MicroRNAs in Long COVID: Key Regulators, Biomarkers, and Therapeutic Targets of Post-SARS-CoV-2 Sequelae.},
journal = {Biomolecules},
volume = {16},
number = {2},
pages = {},
doi = {10.3390/biom16020283},
pmid = {41750353},
issn = {2218-273X},
abstract = {COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), is clinically defined by persistent symptoms that endure beyond acute infection and affect multiple organ systems, including the immune, cardiopulmonary, neurological, and metabolic axes. The underlying mechanisms remain poorly resolved, limiting the development of targeted diagnostics and therapeutics. MicroRNAs (miRNAs), as key post-transcriptional regulators of gene expression, control inflammatory networks, antiviral responses, mitochondrial bioenergetics, and fibrotic pathways, all of which are implicated in long COVID pathogenesis. Recent studies show durable changes in circulating miRNA signatures months after recovery from the acute phase, suggesting a role in maintaining chronic immune activation and metabolic dysfunction. Importantly, circulating miRNAs are stable, quantifiable in biofluids, and reflect systems-level dysregulation, positioning them as promising biomarker candidates for patient stratification, symptom clustering, and disease monitoring. Moreover, miRNA-directed interventions, such as mimics and antagomiRs, represent an emerging precision-medicine strategy to correct sustained molecular disturbances. This review summarizes current evidence linking miRNAs to long COVID, highlights their biomarker potential, and discusses therapeutic avenues that may help advance mechanism-based interventions for this globally emerging chronic condition.},
}

@article {pmid41750136,
year = {2026},
author = {Qazi, S and Shields, C and Cabrera, K and Nguyen, J and Donthineni, PR and Barthelemy, N and Gunawardene, A and Sepulveda-Beltran, P and Tamariz, L and Galor, A},
title = {Ocular Symptoms as a Marker of Dysautonomia in Long-COVID Patients: A Cross-Sectional Analysis.},
journal = {Brain sciences},
volume = {16},
number = {2},
pages = {},
doi = {10.3390/brainsci16020135},
pmid = {41750136},
issn = {2076-3425},
support = {UM SIP 2018-2R//University of Miami Interdisciplinary Team Science Award/ ; },
abstract = {Background/Objectives: Post-coronavirus syndrome (long-COVID) refers to a multi-systemic range of symptoms that follows acute SARS-CoV-3 infection. Long-COVID has been linked with autonomic neuropathy as well as dry-eye disease (DED), an umbrella term that includes a variety of ocular symptoms and signs. Despite these associations, little is known about the co-occurrence of DED and dysautonomia symptoms in individuals with long-COVID. This study aims to examine relationships between dysautonomia and ocular symptoms in a long-COVID patient population. Methods: Cross-sectional study of 162 veterans with long-COVID. The Composite Autonomic Symptom Score-31 (COMPASS-31) assessed dysautonomia symptoms, and the NASA lean test and heart-rate variability metrics captured dysautonomia signs. Dry-eye disease (DED) symptoms were measured with the 5-Item Dry-Eye Questionnaire (DEQ5) and the Ocular Surface Disease Index (OSDI), while ocular pain intensity and neuropathic pain descriptors were evaluated using a Numerical Rating Scale (NRS) and select questions from the Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-Eye), respectively. Results: Most participants (78%) reported DED symptoms (DEQ5 ≥ 6). Nearly all COMPASS-31 domains were associated with DED symptoms, with the strongest correlation observed between the OSDI and pupillomotor scores (r = 0.67, p < 0.001). Among the autonomic signs, the strongest associations were observed between the change in systolic and diastolic blood pressure from baseline to 8 min and ocular pain triggered by temperature (r = -0.44 and r = -0.48, respectively, p < 0.01 for both). On linear regression analyses, pupillomotor and secretomotor symptoms remained positively associated with DED symptoms, while autonomic signs were most closely related to ocular pain metrics, with fluctuating blood pressure changes during orthostasis relating to neuropathic symptoms. Conclusions: DED symptoms, including ocular pain intensity, relate to autonomic symptoms in a long-COVID cohort. While associations with autonomic signs were less consistent, these data suggest that subtle autonomic variability relates to ocular pain in the long-COVID setting.},
}

@article {pmid41749635,
year = {2026},
author = {Esposito, SMR and Maglietta, G and Campana, BR and Fainardi, V and Poeta, M and Zampogna, S and Colomba, C and Suppiej, A and Cardinale, F and Bosis, S and Castagnola, E and Midulla, F and Giaquinto, C and Giordano, P and Biasucci, G and Nunziata, F and Grandinetti, R and Condemi, A and Raiola, G and Guarino, A and Diodati, F and Caminiti, C and , },
title = {Phenotyping Pediatric Long COVID: Symptom Clusters from a Longitudinal Multicenter Italian Cohort.},
journal = {Children (Basel, Switzerland)},
volume = {13},
number = {2},
pages = {},
doi = {10.3390/children13020279},
pmid = {41749635},
issn = {2227-9067},
abstract = {Background: The aim of this study was to identify patient clusters based on acute symptom profiles and individual characteristics most likely to develop pediatric post-acute sequelae of SARS-CoV-2 infection (PASC), as well as clusters among patients with PASC based on post-acute sequelae and associated characteristics. Methods: This multicenter cohort study in 12 Italian pediatric units enrolled patients aged 0-17 years within three months of a laboratory-confirmed SARS-CoV-2 infection. Participants who completed at least two surveys developed by the ISARIC over one year were analyzed. PASC was defined per WHO criteria. Multiple Correspondence Analysis and Hierarchical Clustering were performed. Results: Of 1137 children enrolled, 850 (76%) completed at least two surveys. The most prevalent age group was older children (6-11 years) (46%); adolescents (12-17) and young children (0-5) were numerically similar. Males were more represented (51.9%), except for the adolescent group (45.1%). PASC occurred in 32.8% of participants, with the distribution of sequelae types varying by age. Clustering in COVID-19 cases identified three clusters: young children mainly presented with respiratory symptoms and with a higher risk of hospitalization, while older children were spared in both acute and post-acute phases. Adolescents, particularly females, reported more pronounced acute symptoms and developed PASC more frequently. Clustering analysis of cases with PASC identified three clusters, confirming these age-related patterns. Young children still exhibited respiratory sequelae, and older children confirmed good recovery with minimal complications, while adolescents, especially females, remained the most affected subgroup, reporting persistent neuropsychological sequelae such as fatigue and insomnia. Conclusions: Findings support age-tailored follow-up, emphasizing respiratory monitoring for young children and targeted neuropsychological care for adolescents, particularly girls.},
}

@article {pmid41749262,
year = {2026},
author = {Odeh, A and Formanek, VL and Smith, C and Jha, N and Tajino, J and Lewis, JH and Gastineau, L and Patel, S and Zhao, S and Wei, L and Moberly, AC and Merfeld, DM and Simons, CT and Kobel, MJ and Zhao, K},
title = {Objective assessment of long-term impact of COVID-19 on multiple sensory functions.},
journal = {BMC medicine},
volume = {},
number = {},
pages = {},
doi = {10.1186/s12916-026-04726-x},
pmid = {41749262},
issn = {1741-7015},
support = {R01 DC020737/DC/NIDCD NIH HHS/United States ; },
abstract = {BACKGROUND: This ongoing study investigates the impact of post-acute sequelae of SARS-CoV-2 infection (PASC) on broad sensory functions.

METHODS: Sixty subjects aged 27-78 years were recruited who had contracted COVID-19 between 1/17/2020 and 12/21/2023 and had persistent symptoms (4.3-52.9, median = 27.48 months). Quantitative sensory assessments included (1) smell: 9-Item NIH toolbox odor identification, detection threshold to phenyl-ethyl alcohol, and retronasal candy test; (2) taste: modified NIH toolbox; (3) chemesthesis: nasal menthol lateralization thresholds and oral capsaicin identification; (4) hearing: pure-tone audiometry, otoacoustic emissions, words-in-noise recognition, and Dichotic Digits Test; (5) vestibular/balance: video head impulse testing, Subjective Visual Vertical, vestibular perceptual thresholds, and modified Romberg balance test; and (6) cognitive assessment: The Self-Administered Gero-Cognitive Exam, Digit Symbol Substitution Test, and Trail-Making Test.

RESULTS: Overall, subjects self-reported high and overlapping dysfunctions: 67.3% smell, 63.6% taste, 56.5% balance and dizziness, 31.8% auditory, and 51.3% brain fog or cognitive dysfunctions, with varying discrepancy to the measured and confirmed deficits (smell 65.5%, taste 16%, vestibular 31.6%, hearing 53.4%, and cognition 19.1%). Significant associations were found between confirmed vestibular and auditory impairments (p = 0.04), and cognitive impairments with central components of vestibular (p = 0.03) and auditory (p = 0.01) impairments, but not with their peripheral components. Similarly, strong associations were found between identification components of smell and taste tests (p = 0.003), which may involve more central processing, but not with threshold tests (a more peripheral process). Hospitalization significantly associated with smell (p = 0.05), cognitive (p = 0.009), vestibular (p = 0. 001), and peripheral auditory (p = 0.01) dysfunctions. Age significantly associated with auditory (p = 0.02), vestibular (p = 0.01) and central olfactory (p = 0.03) dysfunctions.

CONCLUSIONS: COVID-19 impacts sensory systems broadly and differently, both peripherally and centrally, driven in part by aging, initial disease severity, and underlying post-COVID cognitive dysfunctions. Subjective symptoms may not always be corroborated by measured deficits.},
}

@article {pmid41747471,
year = {2026},
author = {Szwarcwald, CL and de Almeida, WDS and de Souza Junior, PRB and de Castilho, EA and Damacena, GN and Gomes, CS and Malta, DC},
title = {Impact of the COVID-19 pandemic on the health situation of the Brazilian population.},
journal = {The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases},
volume = {30},
number = {2},
pages = {105790},
doi = {10.1016/j.bjid.2026.105790},
pmid = {41747471},
issn = {1678-4391},
abstract = {INTRODUCTION: The analysis of COVID-19 mortality revealed that the Brazilian population was critically impacted by the pandemic. However, many knowledge gaps remain regarding COVID-19 morbidity in the country. This article aims to analyze the consequences of the coronavirus disease on health situation of the Brazilian population.

METHODS: This was a cross-sectional epidemiological online survey using an electronic questionnaire between July and December 2023. The sampling method used was the virtual Respondent Driven Sampling (RDS). Changes in socioeconomic conditions were assessed in the post-pandemic period. Anti-COVID-19 vaccination coverage, prevalence of SARS-CoV-2 infection were estimated, as well as of sequelae lasting three months or more (Long COVID) among confirmed cases. Associations of Long COVID with self-reported heath status, sleep disorders, and depressive symptoms were analyzed.

RESULTS: The sample included 3805 individuals 18-years or older. Regarding vaccination, 61.5 % (95 % CI: 58.0 %-65.0 %) stated they had received 3‒4 doses. In the post-pandemic period, 41.6 % faced financial difficulties. Prevalence of confirmed SARS-CoV-2 infection was 40.2 %, 6.4 % of respondents reported having had COVID-19, although not confirmed by test, and 15.3 % did not know if they had been infected with the coronavirus. Among those infected, 32.0 % (95 % CI: 28.8 %-35.3 %) reported Long COVID, 21.4 % reported a COVID-19-related illness, and 5.2 % needed and obtained hospitalization. Long COVID was associated with worsening self-rated health, sleep disorders, feelings of depression and 27.7 % were unable to perform their usual activities for one month or more.

CONCLUSION: The results of this study showed that Brazil was severely affected by the COVID-19 pandemic, both in terms of mortality and morbidity. The availability of timely post-pandemic data, as presented in this study, may be highly relevant to inform public policies aimed at promoting healthy behaviors, controlling NCDs, improving mental health care, and supporting specialized care for Long COVID within the public health system.},
}

@article {pmid41745098,
year = {2026},
author = {Zoccali, F and Fratini, C and Pennacchia, F and Cascone, F and de Vincentiis, M and Petrella, C and Barbato, C and Minni, A},
title = {Hyperbaric Oxygen Therapy on Long COVID Symptoms: A Breath of Fresh Air.},
journal = {Diseases (Basel, Switzerland)},
volume = {14},
number = {2},
pages = {},
doi = {10.3390/diseases14020060},
pmid = {41745098},
issn = {2079-9721},
abstract = {Long COVID is defined as "the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanations", as reported by the World Health Organization. A growing number of people are dealing with a variety of lingering symptoms even after recovering from an acute infection. These can include fatigue, muscle pain, shortness of breath, headaches, cognitive issues, neurodegenerative symptoms, anxiety, depression, and a feeling of hopelessness, and therapeutic options for long COVID are investigated. The potential of hyperbaric oxygen therapy (HBOT) to improve chronic fatigue, cognitive impairments, and neurological disorders has been established; therefore, the use of HBOT to treat long COVID has also been studied. The aim of this literature search is to analyze the state of the art of a potential role of HBOT to improve chronic fatigue, cognitive impairments and neurological disorders. A literature analysis was performed, focusing on the clinical efficacy of HBOT for treating long COVID symptoms. The results from January 2021 to October 2025, using a standard registry database, showed 21 studies, including one case report, ten randomized controlled trial, eight systematic reviews and three studies regarding the molecular mechanism and markers changing after HBOT. They suggested that HBOT can improve quality of life, fatigue, cognition, neuropsychiatric symptoms and cardiopulmonary functions. HBOT is a safe treatment and has shown some benefits for long COVID symptoms. To precisely define indications, protocols, and post-treatment evaluations, we need to conduct more in-depth, large-scale studies.},
}

@article {pmid41742356,
year = {2026},
author = {Ogbu-Nwobodo, L and Hwong, AR and Murphy, K and Goldman, ML and Dilley, JW},
title = {Long COVID in Populations With Serious Mental Illness: Clinical and Policy Implications.},
journal = {Psychiatric services (Washington, D.C.)},
volume = {},
number = {},
pages = {appips20240457},
doi = {10.1176/appi.ps.20240457},
pmid = {41742356},
issn = {1557-9700},
abstract = {As the world recovers from the height of the COVID-19 pandemic with ongoing plans for a strengthened behavioral health infrastructure-from crisis services to long-term care-one of the health conditions that has emerged is long COVID. This multisystem condition is characterized by persistent symptoms that develop after the acute phase of COVID-19 infection. Although the full clinical and scientific understanding of long COVID's neuropsychiatric impact is still evolving, a sizable cohort of patients has emerged with various long-term and often confusing symptoms, which can include cognitive impairment, mood dysregulation (e.g., anxiety or depression), sleep disturbances, posttraumatic symptoms, and chronic fatigue. Recognizing long COVID's debilitating impact on quality of life and wide-ranging societal consequences, the authors sought to summarize current knowledge about long COVID among individuals with a preexisting serious mental illness and to propose care and treatment recommendations for clinicians and public policy makers.},
}

@article {pmid41741603,
year = {2026},
author = {Santos-de-Araújo, AD and de Oliveira Garcia, BR and Bassi-Dibai, D and Júnior, NFS and Ricci, PA and Camargo, PF and Marmorato, KTM and Phillips, SA and Arena, R and Borghi-Silva, A},
title = {A single bout of submaximal aerobic functional capacity test acutely promotes endothelial function in long COVID patients.},
journal = {Scientific reports},
volume = {},
number = {},
pages = {},
doi = {10.1038/s41598-026-41182-2},
pmid = {41741603},
issn = {2045-2322},
support = {24/22713-3//Fundação de Amparo à Pesquisa do Estado de São Paulo/ ; },
}

@article {pmid41740316,
year = {2026},
author = {Spedding, M and Aerts, J and Alexander, S and Bellozzi Woestelandt, AG and Chiricozzi, E and Henriques, A and Lledo, PM and Loeffler, JP and Perera, R and Platt, FM and Pradat, PF and Rene, F and Schapira, A and St Clair, L and Talbot, K and Taquet, M and Toborek, M and Turner, B and Zandi, M and Gressens, P},
title = {Links between COVID-19, long COVID, and neurodegeneration: The role of glycosphingolipids.},
journal = {Pharmacological reviews},
volume = {78},
number = {2},
pages = {100113},
doi = {10.1016/j.pharmr.2026.100113},
pmid = {41740316},
issn = {1521-0081},
abstract = {Glycosphingolipids (GSLs) play major roles in viral infections by mediating viral entry and egress from cells in lipid rafts; however, GSLs are also important in neurodegenerative diseases. The role of GSLs in acute COVID-19 infection is critical but remains less-studied in the sequelae of long COVID (post-COVID condition); because the same enzymes that regulate GSL metabolism are critical for viral entry and exit, neuromuscular junctions, neurological function, and cellular metabolism, it is important to determine whether long COVID may increase the risk of subsequent neurodegeneration. SARS-CoV-2 infection alters lipid metabolism and oxygen use and can bind to and modify the expression of neurotrophic GSLs such as GM1 ganglioside. GM1 (N-acetylneuraminic acid) is human-specific and probably evolved as a result of a pandemic 3-2.5 million years ago that drove its selection. GM1 functions as a coreceptor with angiotensin-converting enzyme 2 for SARS-CoV-2 while also being a neurotrophin. Viral multiplication takes place in the endoplasmic reticulum/Golgi apparatus, where GSLs are synthesized. This review defines the complex interaction between viruses, GSLs, and neurodegeneration, which provides new perspectives on the interlinked metabolic changes. A European working group has been set up to assess the risks of neurodegeneration with long COVID, based on potential GSL-mediated mechanisms. SIGNIFICANCE STATEMENT: The SARS-CoV-2 pandemic has resulted in a large number of subjects living with long-term consequences (long COVID). Glycosphingolipids and gangliosides are involved in both viral infections and neurodegeneration; hence, it is important to evaluate whether long COVID may increase the risk of neurodegeneration via this route. This study is the result of a European consortium formed to evaluate this possibility.},
}

@article {pmid41737593,
year = {2026},
author = {Thangaleela, S and Wang, CK},
title = {Impact of nutrition on long COVID.},
journal = {Sports medicine and health science},
volume = {8},
number = {2},
pages = {128-144},
pmid = {41737593},
issn = {2666-3376},
abstract = {Long COVID is characterized by a group of persistent symptoms following the acute SARS-COV2 infection, which presented a multifaceted challenge to the healthcare systems all over the globe. The long COVID symptoms span various organ systems including the respiratory, cardiovascular, gastrointestinal, and neurological manifestations. Mitochondrial dysfunction and immune dysregulation play crucial roles in the long COVID pathophysiology. Recently nutritional intervention gained much attention in managing post-viral syndromes. Effective interventions like supplementation of omega-3 fatty acid, macro and micro nutrients, and vitamins help to reduce systemic inflammation and counteract muscle wasting. Other approaches like nutritional recovery, dietetic interventions, continuous nutritional care post-hospital discharge, nutritional rehabilitation programs, whole-diet approaches like Mediterranean diet, plant-based diet, and caloric optimization, improve overall functional recovery. Physical activity and exercise regimes have been shown to improve fatigue, dyspnea, and cognitive function. Tailored exercise regimes may promote safe rehabilitation. Certain ineffective interventions, such as non-personalized approaches, high dose of antioxidants, use of herbal products that are not clinically validated need to be addressed. Dietary interventions such as personalized nutritional counseling have been demonstrated to improve physical performance in long COVID patients. Further research is needed to refine protocols and identify optimal combinations of dietary and movement-based therapies to support the recovery of long-COVID patients. This narrative review focuses on the ongoing researches that reveals the intricate relationship between nutrition and long COVID recovery and also establishes effective protocols for nutritional care.},
}

@article {pmid41737426,
year = {2026},
author = {Dalfardi, B and Abtahi, H and Edalatifard, M and Mozaffari, S and Rahimi, B and Roostaei, G and Khoshnam Rad, N},
title = {The Impact of COVID-19 on Obstructive Pulmonary Diseases: A Narrative Review of Long-Term Consequences and Vaccination Strategies.},
journal = {Health science reports},
volume = {9},
number = {2},
pages = {e71882},
pmid = {41737426},
issn = {2398-8835},
abstract = {BACKGROUND AND AIMS: The COVID-19 pandemic has posed significant challenges for individuals with obstructive pulmonary diseases (OPDs), such as asthma and chronic obstructive pulmonary disease (COPD). Emerging evidence highlights the complex interplay between SARS-CoV-2 infection and OPDs, including increased risks of severe disease, long-term sequelae, and potential new-onset respiratory conditions. This narrative review synthesizes current knowledge on the pathophysiological mechanisms, clinical outcomes, and management strategies for COVID-19 in OPD patients, with a focus on long-term consequences and vaccination efficacy.

METHODS: A comprehensive literature search was conducted using PubMed, Embase, and Scopus (January 2020-June 2025). Inclusion criteria encompassed original studies, reviews, and meta-analyses examining COVID-19's impact on asthma or COPD, while non-English publications, animal studies, and case reports were excluded. Data were extracted and thematically synthesized to address acute outcomes, long COVID, vaccination, and therapeutic considerations.

RESULTS: Risk and Severity: COPD patients faced higher risks of severe COVID-19 (hospitalization, ICU admission, and mortality), while asthma phenotypes influenced outcomes (eosinophilic asthma conferred milder disease).Long COVID: Persistent respiratory symptoms (dyspnea and cough), fatigue, and cognitive dysfunction were prevalent in OPD patients, with new-onset asthma reported post-infection.Vaccination: mRNA vaccines significantly reduced severe outcomes in OPDs, though biologic therapies in asthma may attenuate immune responses.Treatment: Antivirals (e.g., nirmatrelvir-ritonavir) and corticosteroids were effective, but drug interactions (e.g., CYP3A4 inhibitors) required careful management.

CONCLUSION: COVID-19 exacerbates OPD-related morbidity, underscoring the need for tailored prevention (vaccination and early diagnosis) and multidisciplinary management. Future research should prioritize phenotype-specific therapeutic strategies and long-term surveillance to mitigate post-COVID sequelae in this vulnerable population.},
}

@article {pmid41736939,
year = {2026},
author = {Sharp, M and Jones, C and Marshall, ZA and Birkett, S and Cable, NT and Harwood, AE},
title = {Understanding the factors influencing participant engagement and adherence in exercise referral in the City of Manchester.},
journal = {BMJ open sport & exercise medicine},
volume = {12},
number = {1},
pages = {e003157},
pmid = {41736939},
issn = {2055-7647},
abstract = {OBJECTIVES: To identify demographic, clinical, socioeconomic and referral-pathway determinants of engagement, early dropout and non-participation in a large metropolitan exercise referral scheme (ERS), and to assess whether machine learning (ML) methods provide additional explanatory value beyond conventional regression.

METHODS: This retrospective cohort study analysed data from 11 909 adults (≥18 years) referred for ERS in Manchester, UK, between 27 January 2022 and 28 February 2025. Outcomes were programme adherence (completion of ≥12 exercise sessions), early dropout and non-participation. Multinomial logistic regression was used to examine predictors of outcomes. ML methods, including Random Forest models and k-means clustering, were applied to assess predictive performance, rank feature importance and identify participant subgroups.

RESULTS: Of 11 909 referrals, 34.6% completed the programme, 34.2% declined to participate and 8.0% left early. Younger age, higher neighbourhood deprivation and psychosocial referral reasons (eg, loneliness, long covid) were associated with lower completion. Participants referred through outreach/social prescribing pathways were substantially more likely to remain in an 'intends to participate' state rather than complete, compared with those referred through clinical pathways. Random Forest models demonstrated good predictive accuracy, with early engagement indicators and deprivation emerging as the strongest predictors. Clustering identified a high-risk subgroup characterised by younger age, higher deprivation and low early attendance.

CONCLUSIONS: Engagement and adherence in ERS were strongly shaped by early engagement, deprivation, age and referral pathways. ML methods identified high-risk subgroups and reinforced the importance of early attendance. Targeted early support and ML-informed risk indicators may improve retention, particularly among younger and more deprived participants.},
}

@article {pmid41736814,
year = {2026},
author = {Isangwe, S and Talbot, D and Coutu, MF and Canitrot, E and Décary, S and Falcone, EL and Ouakki, M and Latouche, P and Piché, A and Simard, M and Balem, M and De Serres, G and Carazo, S},
title = {Functional impact of long COVID among healthcare workers with comorbidities in Quebec, Canada: a cross-sectional study.},
journal = {BMJ public health},
volume = {4},
number = {1},
pages = {e004108},
pmid = {41736814},
issn = {2753-4294},
abstract = {INTRODUCTION: Long COVID is a frequent post-infectious chronic condition that impacts quality of life and work performance. Whether individuals with comorbidities experience a greater functional impact of long COVID is unknown. We evaluated the functional impact of long COVID among healthcare workers (HCWs) with chronic cardiovascular diseases, chronic respiratory diseases, obesity or a history of depression, and compared it with that of HCWs without comorbidities.

METHODS: We conducted a cross-sectional study in Quebec, Canada. We compared self-reported long COVID cases to COVID-19-infected controls without long COVID on work ability, work functioning, health-related absenteeism, dyspnoea-associated impairment and psychological distress among HCWs (a) with at least one of the four comorbidities, (b) with each of the four comorbidities and (c) without comorbidities. We used inverse probability of exposure and robust Poisson regressions to estimate adjusted prevalence differences (aPD) and prevalence ratios. Comorbidity data were obtained from the Quebec integrated chronic disease surveillance system.

RESULTS: A total of 3754 and 8439 HCWs with and without comorbidities, respectively, were included. Among HCWs with at least one of the four comorbidities, long COVID was associated with higher prevalence of low work ability (aPD=15%, 95% CI: 12% to 18%), low work functioning (aPD=27%, 95% CI: 22% to 31%), health-related long-term absenteeism (aPD=8%, 95% CI: 5% to 11%), dyspnoea-associated impairment (aPD=23%, 95% CI: 19% to 26%) and psychological distress (aPD=24%, 95% CI: 20% to 28%). aPDs were greater among HCWs with comorbidities than among those without for low work ability (p=0.013 for interaction), for low work functioning (p=0.034) and for dyspnoea-associated impairment (p<0.001).

CONCLUSION: Long COVID is associated with significant functional impairment among HCWs with pre-existing chronic conditions. HCWs with at least one of the four comorbidities experience lower work ability, lower work functioning and more dyspnoea-associated impairment compared with those without comorbidities.},
}

@article {pmid41736389,
year = {2026},
author = {Rayner, C and Smith, N and Milne, R and Mir, G and de Kock, J and Bakerly, ND and , },
title = {'What Do People With Long Covid Want From Healthcare Services?' A Qualitative Exploration From Lived Experience.},
journal = {Health expectations : an international journal of public participation in health care and health policy},
volume = {29},
number = {2},
pages = {e70607},
pmid = {41736389},
issn = {1369-7625},
support = {//National Institute for Health and Care Research/ ; },
mesh = {Humans ; Qualitative Research ; *COVID-19/therapy/psychology ; Female ; United Kingdom ; *Health Services Accessibility ; Male ; Middle Aged ; Adult ; Interviews as Topic ; Aged ; SARS-CoV-2 ; Chronic Disease ; Delivery of Health Care ; },
abstract = {BACKGROUND: Long COVID (LC) is a chronic, multisystem condition affecting millions globally, with significant personal, social and economic consequences. Despite increasing recognition of its impact, healthcare services for LC remain inconsistent with patients frequently encountering fragmented services, scepticism and delays leading to patient-voiced frustration. Therefore, understanding patient priorities is crucial for optimising service provision.

OBJECTIVES: To explore what individuals with LC want from healthcare services-drawing on their lived experience and collaborative insights with clinicians and researchers, to inform principles for improving care delivery, barriers to access, expectations for service improvement, and the role of multidisciplinary care in managing LC.

METHODS: A qualitative study using thematic analysis was conducted, incorporating multiple data sources, including semi-structured interviews, workshops, and a patient-led audit. Key themes were identified, focusing on healthcare access, clinical assessments, treatment options, and service organisation.

STUDY PARTICIPANTS: Twenty-seven LC sufferers from the LOCOMOTION Patient Advisory Group (PAG) and Patient Advisory Network (PAN), along with clinicians and researchers involved in LC service provision across the United Kingdom, participated in the study.

RESULTS: Three major themes emerged: (1) Who the services are for: Equity of access for all those with LC. Barriers such as stigma, inequitable access and lack of clinician awareness need to be addressed. (2) What services should do: Consistent and standardised assessments and diagnostic clarity-particularly for modifiable conditions like autonomic dysfunction-and an emphasis on the need for early medical intervention, not just rehabilitation. (3) How services should operate: Care should be coordinated, proactive and adaptable to evolving evidence. Patients should not be discharged without ongoing review. Multidisciplinary collaboration should be patient-centred and informed by up-to-date research.

CONCLUSIONS: LC services should be designed to provide equitable, standardised and evidence-based care. Early intervention, appropriate medical testing and sustained follow-up are critical to improving patient outcomes. Patients emphasised the importance of being heard and the value of receiving timely care that reflects the latest scientific understanding and recognises their condition as real, treatable and deserving of ongoing clinical attention. Incorporating these insights into healthcare design may improve outcomes, service efficiency and trust between patients and providers.

Patients led all phases of this study, including design, analysis and writing, through active co-production with the LOCOMOTION research team. The paper was born out of discussions within the LOCOMOTION study's Patient Advisory Group (PAG). It was taken forward by C.R., N.S. and R.M., all members of the PAG, working closely with N.B., H.d.K. and G.M.},
}

Humans
Qualitative Research
*COVID-19/therapy/psychology
Female
United Kingdom
*Health Services Accessibility
Male
Middle Aged
Adult
Interviews as Topic
Aged
SARS-CoV-2
Chronic Disease
Delivery of Health Care

@article {pmid41735088,
year = {2026},
author = {Yu, T and Wang, L},
title = {Commentary on 'Prevalence and trajectories of post-COVID-19 neuromuscular conditions: A systematic-review and meta-analysis'.},
journal = {Journal of the neurological sciences},
volume = {},
number = {},
pages = {125799},
doi = {10.1016/j.jns.2026.125799},
pmid = {41735088},
issn = {1878-5883},
}

@article {pmid41734323,
year = {2026},
author = {Löwy, I},
title = {[Long Covid: a long story].},
journal = {Medecine sciences : M/S},
volume = {42},
number = {2},
pages = {187-193},
doi = {10.1051/medsci/2026017},
pmid = {41734323},
issn = {1958-5381},
mesh = {Humans ; *COVID-19/psychology/complications/epidemiology ; SARS-CoV-2 ; Post-Acute COVID-19 Syndrome ; *Psychophysiologic Disorders/psychology/diagnosis/etiology ; Chronic Disease ; },
abstract = {Patients with long Covid experience multiple, often very debilitating symptoms, yet their test results frequently appear normal. In the absence of objective indicators of a recognized disease, some professionals may conclude that the patient is suffering from a psychosomatic disorder. These patients face an epistemic injustice, that is, a failure to recognize their suffering as real. This injustice is rooted in a longstanding history of medically invisible disorders, which are diagnosed mainly on the basis of the patient's own narrative. The difficulties experienced by patients with long Covid cannot be dissociated from this history.},
}

Humans
*COVID-19/psychology/complications/epidemiology
SARS-CoV-2
Post-Acute COVID-19 Syndrome
*Psychophysiologic Disorders/psychology/diagnosis/etiology
Chronic Disease

@article {pmid41734322,
year = {2026},
author = {Gougeon, ML and Salmon, D},
title = {[Long COVID].},
journal = {Medecine sciences : M/S},
volume = {42},
number = {2},
pages = {185-186},
doi = {10.1051/medsci/2026016},
pmid = {41734322},
issn = {1958-5381},
}

@article {pmid41734308,
year = {2026},
author = {Rosenthal, E and Lert, F and Yazdanpanah, Y},
title = {[Long Covid: how to prevent, treat and advance research?].},
journal = {Medecine sciences : M/S},
volume = {42},
number = {2},
pages = {117-119},
doi = {10.1051/medsci/2026022},
pmid = {41734308},
issn = {1958-5381},
}

@article {pmid41732704,
year = {2026},
author = {Chen, Z and Li, B and Chen, Y and Liu, J and Luo, F and Ogunyemi, KO and Ge, Y and Ke, Y and Yang, Y and Chen, X and Shen, Y and , },
title = {Mapping spatial and social inequities of long COVID across the United States: a retrospective cohort study.},
journal = {Lancet regional health. Americas},
volume = {56},
number = {},
pages = {101401},
pmid = {41732704},
issn = {2667-193X},
abstract = {BACKGROUND: Long COVID affects a substantial portion of the U.S. population. The emergence of the Omicron variant and persistent sociodemographic disparities may contribute to temporal and regional variation in long COVID risk. However, such spatiotemporal variation and related social determinants remain poorly characterized. This study aimed to examine spatiotemporal patterns of county-level long COVID incidence and to identify sociodemographic factors associated with these patterns before and after the emergence of the Omicron variant.

METHODS: This retrospective study utilized data from the National COVID Cohort Collaborative (N3C), covering 5,652,474 COVID-19 cases from 2020 to 2024 and 41,694 long COVID cases across 1063 U.S. counties from 2021 to 2024. Temporal patterns of long COVID were analyzed before and after the Omicron variant's emergence, and spatial patterns were assessed using Moran's I and Getis statistics. Bayesian spatial random effect models were employed to evaluate the associations between long COVID incidence and sociodemographic factors such as economic vulnerability, healthcare access, and mobility.

FINDINGS: Among 4,070,879 COVID-19 cases analyzed, quarterly long COVID incidence ranged from 0.015% to 14.29%. Before the emergence of the Omicron variant, incidence was 204 cases per 10,000 COVID-19 cases, compared with 248 cases per 10,000 COVID-19 cases after Omicron emergence (p < 0.001). Based on the Local Moran's I statistic, 48.8% (328 of 673) of counties showed significant spatial correlation (p < 0.05) after Omicron's emergence, up from 43.5% (293 of 673) prior. High-risk areas became more concentrated in inland regions, while low-risk areas clustered along the East Coast. Long COVID incidence was significantly associated with economic vulnerability, limited healthcare access, and mobility constraints, with these sociodemographic disparities consistently driving its spatial disparities over time. Subregional analyses revealed distinct regional differences in social drivers.

INTERPRETATION: These findings highlight pronounced spatiotemporal and regional disparities in long COVID incidence across the United States. Targeted public health interventions, particularly in economically and geographically vulnerable regions, are essential to ensure equitable access to diagnosis, care, and resource allocation.

FUNDING: National Center for Advancing Translational Sciences; National Institutes of Health; National Science Foundation.},
}

@article {pmid41732619,
year = {2026},
author = {Manoukian, G and Kundukulam, S and Asatorian, G and Johnson, DM and Masood, MH and Venugopal, A and Manoukian, M and Aswathappa, S},
title = {Post-COVID Syndrome in Patients With Comorbid Hypertension or Diabetes: A Narrative Review of Long-Term Outcomes.},
journal = {Cureus},
volume = {18},
number = {1},
pages = {e102117},
pmid = {41732619},
issn = {2168-8184},
abstract = {Post-COVID syndrome (PCS), or long COVID, refers to a cluster of enduring symptoms that extend beyond the acute phase of the initial SARS-CoV-2 infection. Acute infection predominantly impacts the respiratory tract, but there is growing evidence for the multisystem involvement, such as cardiovascular, metabolic, and neurological, to be responsible for the prolonged presentation in PCS. Underlying cardiometabolic vulnerability may contribute to a high degree of susceptibility in patients with comorbidities like hypertension (HTN) and diabetes mellitus (DM). This narrative review summarizes current literature regarding PCS in patients with HTN and/or DM, focusing on proposed pathophysiological mechanisms, clinical manifestations, and reported long-term outcomes. In these populations, PCS has been linked across studies to processes including endothelial dysfunction, chronic low-grade inflammation, autonomic imbalance, and potential dysregulation of the renin-angiotensin-aldosterone system (RAAS). Persistent cardiovascular, metabolic, and neurocognitive symptoms are reported, but the magnitude and patterns of risk vary across studies, while comparative findings across HTN and DM remain heterogeneous. Symptoms reported frequently include fatigue, cognitive impairment ("brain fog"), and psychological distress, supporting the multisystem complexity of PCS. Although, previous work has indicated that cardiometabolic comorbidities could interact and moderate PCS severity and persistence, there is an important shortfall of both causality and prognosis, as well as the management of PCS. Longitudinal studies are needed for future research regarding risk stratification, disease course, and targeted interventions in individuals with PCS with comorbid high blood pressure and diabetes.},
}

@article {pmid41732199,
year = {2026},
author = {Smith, AB and Greenwood, DC and Milne, R and Ormerod, M and Sivan, M},
title = {The EQ-5D-5L and Minimal Important Change in Long COVID.},
journal = {Advances in rehabilitation science and practice},
volume = {15},
number = {},
pages = {27536351261423961},
pmid = {41732199},
issn = {2753-6351},
abstract = {INTRODUCTION: The EQ-5D-5L is the most commonly used patient-reported outcome measure in Long COVID (LC). Despite its frequent use, there have been few studies reporting LC-specific metrics to identify and interpret meaningful change. The aim of the study was therefore to determine the Minimal Clinically Important Difference (MCID) and Minimal Important Difference (MID) measures for the EQ-5D-5L in LC.

METHODS: Data were collected from a national study (LOCOMOTION) evaluating LC services in the UK, involving participants completing the EQ-5D-5L on at least 2 occasions. The EQ-5D domains were categorised using Paretian classification of health states, and the probability of superiority was used to determine changes in health states over time. EQ-5D-5L profile scores were converted into health utilities using the UK-specific algorithm. The MCID was derived using 0.5 standard deviation and the MID by a 0.2 effect size.

RESULTS: A total of 423 people (283 females, 67%) with LC completed the EQ-5D at 2 time points (median time interval: 196 days). Most participants reported problems in at least 1 EQ-5D domain. Only around 25% of participants noted some improvement. The MCID estimates were 0.11 for the EQ-5D-5L and 10.6 for the EQ-5D-5L VAS. The MID for the EQ-5D-5L was 0.03. Some differences in the change metrics were observed depending on baseline health states and timing of the follow-up assessment.

CONCLUSION: Long COVID specific estimates of the MCIDs and MIDs were derived for the EQ-5D-5L and EQ-5D VAS. The MCIDs will facilitate the evaluation and interpretation of meaningful change in patient health states in LC, both at the individual level and more broadly in health economic assessments of LC management, intervention and rehabilitation programmes.},
}

@article {pmid41730996,
year = {2026},
author = {Doni Jayavelu, N and Samaha, H and Wimalasena, ST and Hoch, A and Gygi, JP and Gabernet, G and Ozonoff, A and Liu, S and Milliren, CE and Levy, O and Baden, LR and Melamed, E and Ehrlich, LIR and McComsey, GA and Sekaly, RP and Cairns, CB and Haddad, EK and Schaenman, J and Shaw, AC and Hafler, DA and Montgomery, RR and Corry, DB and Kheradmand, F and Atkinson, MA and Brakenridge, SC and Agudelo Higuit, NI and Metcalf, JP and Hough, CL and Messer, WB and Pulendran, B and Nadeau, KC and Davis, MM and Geng, LN and Fernandez Sesma, A and Simon, V and Krammer, F and Kraft, M and Bime, C and Calfee, CS and Erle, DJ and Langelier, CR and , and Guan, L and Maecker, HT and Peters, B and Kleinstein, SH and Reed, EF and Augustine, AD and Diray-Arce, J and Becker, PM and Rouphael, N and Altman, MC},
title = {Author Correction: Machine learning models predict long COVID outcomes based on baseline clinical and immunologic factors.},
journal = {Communications medicine},
volume = {6},
number = {1},
pages = {},
doi = {10.1038/s43856-026-01425-9},
pmid = {41730996},
issn = {2730-664X},
}

@article {pmid41730994,
year = {2026},
author = {Strasser-Kirchweger, B and Kutil, RH and Zimmermann, G and Borgelt, C and Trutschnig, W and Hutzler, F},
title = {Machine-actionable criteria chart the symptom space of mental disorders.},
journal = {NPJ digital medicine},
volume = {},
number = {},
pages = {},
doi = {10.1038/s41746-026-02451-6},
pmid = {41730994},
issn = {2398-6352},
support = {20102-F2101312-FPR//Salzburger Landesregierung/ ; 20102-F2101312-FPR//Salzburger Landesregierung/ ; 20102-F2101312-FPR//Salzburger Landesregierung/ ; 20102-F2101312-FPR//Salzburger Landesregierung/ ; 20102-F2101312-FPR//Salzburger Landesregierung/ ; 20102-F2101312-FPR//Salzburger Landesregierung/ ; },
abstract = {Diagnostic rules are codified in consensus manuals such as DSM-5, yet they remain written in narrative form and cannot be computationally interrogated. Here, a deterministic framework is presented that translates diagnostic criteria into a machine-actionable representation of the full symptom space, which can be charted, navigated, and systematically analyzed. Unlike probabilistic models that infer patterns from large textual corpora, this framework directly interrogates explicit consensus criteria, providing a transparent and reproducible means of assessing conceptual coherence. Its potential is demonstrated by charting schizophrenia-spectrum disorders, which remain conceptually distinct despite substantial symptom overlap, and by evaluating the current National Academies' definition of Long COVID, which is largely subsumed by depressive and anxiety disorders. By making diagnostic consensus computable, the framework provides a reproducible foundation for evaluating delineation properties of existing and candidate diagnostic constructs and for developing interpretable, regulatory-compliant diagnostic support tools.},
}

@article {pmid41729896,
year = {2026},
author = {Elgner, M and Binneböse, M and Großmann, J and Frank, T and Bruckmann, P and Lahmann, C and Giel, KE and Allwang, C and Junne, F and Wallis, H},
title = {How to cope with Long COVID - A qualitative interview study on stressors and coping strategies of people affected by long-term consequences of COVID-19.},
journal = {PloS one},
volume = {21},
number = {2},
pages = {e0343115},
doi = {10.1371/journal.pone.0343115},
pmid = {41729896},
issn = {1932-6203},
mesh = {Humans ; *COVID-19/psychology/complications/epidemiology ; *Adaptation, Psychological ; Female ; Male ; Middle Aged ; *Stress, Psychological/psychology ; Adult ; Aged ; Quality of Life ; Qualitative Research ; SARS-CoV-2/isolation & purification ; Pilot Projects ; Coping Skills ; },
abstract = {Long COVID, a multi-system-disease characterized by persistent somatic and mental symptoms following a SARS-CoV-2 infection, can severely impair health and quality of life of those affected. In the absence of adequate therapeutic approaches and a fragmented care landscape, our focus is on identifying individual stressors, the resulting needs and strategies people use to cope with the ongoing burden of the disease and its long-term stressors. This qualitative interview study is part of a pilot multicenter study addressing psychosocial needs in patients with Long COVID. The surveyed sample (n = 40) consists of affected people, who suffer from persistent symptoms and psychosocial stress after a SARS-CoV-2 infection. Based on the Transactional Stress Model according to Lazarus and Folkman and the Brief COPE by Carver, the qualitative analysis of semi-structured interviews focused on the various and individual coping attempts of the interviewees. Participants reported a wide range of persistent physical and mental complaints. Fatigue-associated complaints, cognitive impairments, fears and worries were mentioned frequently and perceived as particularly stressful. Job insecurity and financial worries, lack of recognition, stigmatization, lack of treatment and therapy approaches, withdrawal and social isolation were reported as stressors. In most cases, we identified an interplay between emotion-oriented (such as emotional support, self-care and positive thinking) and problem-oriented coping strategies (such as planning/pacing, self-help, withdrawal and avoidance). Emotional support as the most frequently mentioned strategy and as a fundamental resource in coping with this disease should be strengthened. These findings offer a valuable insight into the diverse stressors and coping patterns in dealing with post-viral symptoms of COVID-19. The analysis reveals that complaints and attempts to cope vary significantly among the participants. This underlines the importance of providing tailored support to those affected to help them manage their symptoms, improve their quality of life and enable them to participate in social life again.},
}

Humans
*COVID-19/psychology/complications/epidemiology
*Adaptation, Psychological
Female
Male
Middle Aged
*Stress, Psychological/psychology
Adult
Aged
Quality of Life
Qualitative Research
SARS-CoV-2/isolation & purification
Pilot Projects
Coping Skills

@article {pmid41728426,
year = {2026},
author = {Christoforou, ME and van Campen, LC and Visser, FC and Lee, CK and Lemmon, SL and Rowe, PC and Azola, AM},
title = {A Continuous Oral Regimen of High-Dose Cromolyn Sodium Is Effective for Some Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Patients With Mast Cell Activation Syndrome.},
journal = {Cureus},
volume = {18},
number = {1},
pages = {e102064},
pmid = {41728426},
issn = {2168-8184},
abstract = {Our clinical experience in the last four years using oral cromolyn in patients with mast cell activation syndrome (MCAS) suggests that a continuous oral regimen of high-dose cromolyn may enhance compliance with the medication. The five patients described in this retrospective case series were given instructions to take oral cromolyn using a continuous dosing regimen, placing the entire day's dose in an opaque bottle that is then filled with water, and sipping the solution throughout the day. If a conventional maximum dose of eight vials daily (800 mg) was tolerated but ineffective after a week, the patients were instructed to increase to 1600-2400 mg daily until reaching an optimal effect. We report that a cromolyn dose of 1600-2400 mg daily, administered using the continuous oral dosing regimen during the day, was effective in controlling signs and symptoms of mast cell activation. All five patients benefitted from a dose of cromolyn that is higher than usual and customary recommendations, but within the safety guidelines of the original Food and Drug Administration (FDA) application. The continuous oral regimen has some theoretical advantages over four discrete doses per day, though further study is needed.},
}

@article {pmid41727490,
year = {2026},
author = {Miano, L and Sinopoli, E and Cherubini, A and Suffritti, C and Pelusi, S and Rahmeh, F and Lamorte, GE and Peyvandi, F and Blasi, F and Grasselli, G and Bandera, A and Gualtierotti, R and Prati, D and Valenti, LVC},
title = {Association of SARS-CoV-2 infection with long-lasting increase in circulating IL-32 levels.},
journal = {Frontiers in immunology},
volume = {17},
number = {},
pages = {1739258},
pmid = {41727490},
issn = {1664-3224},
mesh = {Humans ; *COVID-19/blood/immunology/epidemiology ; Male ; Female ; *Interleukins/blood ; Middle Aged ; *SARS-CoV-2/immunology ; Retrospective Studies ; Adult ; Biomarkers/blood ; Aged ; },
abstract = {BACKGROUND & AIMS: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has a wide spectrum of clinical presentations ranging from asymptomatic viral replication to hyper-inflammatory syndrome and respiratory failure and can trigger immune disorders and long-COVID. Interleukin-32 (IL-32) is a pro-inflammatory cytokine induced during viral infections and chronic pulmonary disease.

AIM: Aim of this study was to investigate the impact of the SARS-CoV-2 pandemic and severe COVID-19 on circulating IL-32 levels.

STUDY DESIGN: Observational retrospective biomarker study.

PATIENTS & METHODS: We analyzed 949 healthy blood donors (pre-pandemic and pandemic-era) and 212 patients hospitalized due to severe COVID-19 during the first five infection waves. IL-32 levels were measured by ELISA.

RESULTS: Pandemic-era blood plasma donors showed a +0.78 ± 0.09 log10 pg/ml mean increase in IL-32 (pandemic-era 2.91 ± 0.05 vs. pre-pandemic 2.14 ± 0.07 log10 pg/ml, p<0.0001). COVID-19 patients exhibited a similar elevated IL-32 compared to unexposed controls (+0.29 ± 0.11 log10 pg/ml, p=0.016; 2.43 ± 0.08 hospital admission vs. pre-pandemic). Among patients, mean IL-32 was higher in first-wave patients (2.68 ± 0.11 log10 pg/ml) than later waves (2.12 ± 0.11 log10 pg/ml). In setting of severe COVID-19, IL-32 levels were associated with corticosteroids administration (estimate1.99 ± 0.50; p<0.0001), whereas decreased during the later waves of infection (-0.56 ± 0.16; p=0.0005) and with age (estimate -0.01 ± 0.01; p=0.020). No links were found with sex, Intensive care unit admission, comorbidities, or mortality. A subset of the COVID patient cohort was tested for pro-inflammatory biomarkers: IL-32 displayed an inverse correlation with patients' neutrophil-to-lymphocyte ratio (NLR) (estimate -0.23 ± 0.81; p=0.005) and not with IL-6 and biomarkers of endothelial dysfunction (n=42, p=NS). In patients with available follow-up (n=96), IL-32 remained stable up to one-year post-discharge (+0.03 ± 0.12 log10 pg/ml, p=0.970; 2.55 ± 0.15 hospital admission vs. follow-up 3-12 months 2.58 ± 0.15 log10 pg/ml).

CONCLUSIONS: IL-32 levels increased following COVID-19, especially during the initial severe wave, and correlated with some markers of inflammation. IL-32 remained elevated up to one-year post-discharge, suggesting ongoing inflammation and supporting its potential as a biomarker for long-term sequelae.},
}

Humans
*COVID-19/blood/immunology/epidemiology
Male
Female
*Interleukins/blood
Middle Aged
*SARS-CoV-2/immunology
Retrospective Studies
Adult
Biomarkers/blood
Aged

@article {pmid41727403,
year = {2025},
author = {Watson, LS and Toubouti, Y and Gray, SM and Guillén, N and Pérez-Millan, A and Rami, L and Sanchez-Valle, R and Johannesen, JK},
title = {Evaluating contributions of neuropsychological, psychiatric, and inflammatory processes to the expression of cognitive symptoms in post-acute COVID-19 syndrome.},
journal = {Frontiers in psychiatry},
volume = {16},
number = {},
pages = {1668380},
pmid = {41727403},
issn = {1664-0640},
abstract = {INTRODUCTION: Post-acute COVID-19 syndrome (PACS) has been widely associated with cognitive symptoms, however, the nature and severity of effects on cognitive function have been difficult to establish amid other aspects of PACS symptomatology. The current study used a regression modeling approach to parse unique and combined contributions of neuropsychological test performance, psychiatric symptoms, and inflammatory cytokine levels in predicting cognitive symptom severity, as measured by questionnaire responses from patient and observer perspectives.

METHODS: Forty-one patients presenting to a university medical center neurology clinic with cognitive complaints ≥ 4 months after COVID-19 symptom onset were included in the analysis.

RESULTS: Although pre-morbid cognitive status was estimated to be at or above-average across participants, nearly 50% performed below expectation on three or more neuropsychological tests. Subjective Cognitive Decline Questionnaire (SCD-Q) ratings were clinically elevated, both from patient (MyCog) and observer (TheirCog) perspectives, yet bivariate relationships with neuropsychological and other measures of PACS symptomatology were non-significant. When combined in regression models, 36% of variance in MyCog score was explained by measures of anxiety, premorbid intelligence, and current neuropsychological test performance. TheirCog scores were explained by a unique set of neuropsychological tests, accounting for 33% of variance cumulatively. Measures of depression, fatigue, and inflammatory cytokines concentrations did not enter either model.

DISCUSSION: Taken together, cognitive sequelae of PACS appear to be rooted in changes in brain function that are detectable by objective neuropsychological testing. Although comorbidities associated with PACS can contribute to the experience of cognitive symptoms, we find cognitive symptoms, whether self-reported or observed, to be more directly associated with neuropsychological test performance than ongoing fatigue, psychiatric symptoms, or inflammatory processes.},
}

@article {pmid41726954,
year = {2026},
author = {Toppa, PH and Rushmore, RJ and Haggerty, K and Papadimitriou, G and Dougherty, D and Kubicki, M and González-Mora, JL and Pallanti, S and Castañeyra-Perdomo, A and Yeterian, E and Makris, N},
title = {Neuroanatomy of substantia nigra and ventral tegmental area dopaminergic, and dorsal raphe serotonergic circuits in the human brain using T1-weighted and diffusion magnetic resonance imaging: A morphometric pilot study with estimate of reliability.},
journal = {bioRxiv : the preprint server for biology},
volume = {},
number = {},
pages = {},
doi = {10.64898/2026.02.12.705574},
pmid = {41726954},
issn = {2692-8205},
abstract = {INTRODUCTION: We present here a methodology for morphometric analysis of the substantia nigra (SN), the ventral tegmental area (VTA), the dorsal raphe nucleus (DRN) and their respective structural brain circuits.

METHODS: Our analyses were based on multimodal T1-weighted MRI and diffusion MRI (dMRI) segmentation and tractography in 12 human subjects drawn from the Human Connectome Project (HCP) repository.

RESULTS: We were able to demonstrate strong connections of the SN, VTA and DRN with several brain regions, in particular the dorsolateral prefrontal cortex (DLPFC) and the cerebellum. More specifically, we created comprehensive visualizations of the SN and VTA dopaminergic as well as the DRN serotonergic structural circuits in the human brain, which, although preliminary, demonstrate the potential of multimodal neuroimaging to investigate these circuits quantitatively in clinical conditions. Finally, we created a pilot dataset for the most frequently observed structural connections, specifically those that were present more than 92% of the time among all subjects. Discussion This pilot morphometric report examines the structural circuits of the SN, VTA and DRN, which are critically involved in several biobehaviors and clinical conditions such as addiction, stress, Parkinson's disease (PD), schizophrenia, obsessive-compulsive disorder, post-traumatic stress disorder, attention deficit hyperactivity disorder, mood disorders, COVID-19 and long COVID. Importantly, the strong structural connectivity of the DLPFC and cerebellum with the SN, VTA and DRN is expected to be a potential target of noninvasive neuromodulation treatments in neuropsychiatry. Our findings demonstrate the potential of current clinical multimodal neuroimaging to delineate the dopaminergic (DA) and serotonergic (5-HT) circuits in the human brain in clinical conditions.},
}

@article {pmid41725650,
year = {2026},
author = {Ertzgaard, P and Wärdig, A and Duchen, K and Angelhoff, C},
title = {Psychosocial impact of pediatric long COVID: a dyadic analysis of persistent symptoms, sleep, and self-esteem in parents and children.},
journal = {Frontiers in psychology},
volume = {17},
number = {},
pages = {1769305},
pmid = {41725650},
issn = {1664-1078},
abstract = {BACKGROUND: Pediatric long COVID can lead to persistent symptoms that affect the child's daily functioning and may influence family dynamics. Parents of children with chronic conditions may be at risk of experiencing challenges related to their own health, sleep, and self-esteem. Exploring the parent-child dyad may provide a deeper understanding of how long COVID impacts both individuals and their relationship. The aim of this study was to describe health, sleep quality, insomnia symptoms, and self-esteem in parents of children with long COVID, and to see how these factors are affected by the child´s disability exploring child-parent dyads and triads.

METHODS: This cross-sectional study, part of the interdisciplinary project POCOKIDS, included 35 parents and 26 children who completed questionnaires on long COVID symptoms, sleep quality, insomnia, and self-esteem.

RESULTS: Parents with persistent symptoms reported poorer sleep, higher insomnia scores, and greater worry about finances, employment, social life, and their child's education than those without symptoms. Notably, parents without persistent symptoms reported lower self-esteem. Most children reported poor sleep quality, and nearly half met criteria for insomnia symptoms, with girls experiencing more sleep-related difficulties than boys. Children's self-esteem was less affected than their parents'.

DISCUSSION: The findings reveal a shared psychosocial burden and underscore the need for individualized support addressing both children's and caregivers' health and emotional needs.},
}

@article {pmid41722813,
year = {2026},
author = {Smadja, DM and Günther, S and Rancic, J and Lellouch, A and Renaud, B and Diehl, JL and Philippe, A},
title = {Soluble ST2 Fails to Reflect Persistent Endothelial Dysfunction or Symptoms in post-acute sequelae of COVID-19.},
journal = {Annales pharmaceutiques francaises},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.pharma.2026.02.008},
pmid = {41722813},
issn = {2772-803X},
abstract = {BACKGROUND: Soluble ST2 (sST2), the circulating decoy receptor of interleukin-33 (IL-33), has been validated as a prognostic biomarker of disease severity and vascular injury during acute COVID-19. However, its relevance in the context of post-acute sequelae of SARS-CoV-2 infection (PASC or long COVID) remains unclear.

METHODS: We analyzed the association between plasma sST2 concentrations and clinical or vascular features in a prospective cohort of 137 long COVID patients (median age: 55 years; 49.6 % male), encompassing 194 follow-up visits conducted 3 to 24 months after infection. Fatigue and dyspnea were systematically assessed, alongside full pulmonary function testing (PFTs), including diffusing capacity of the lung for carbon monoxide (DLCO). Plasma concentrations of sST2, VEGF-A, von Willebrand factor antigen (VWF: Ag) and circulating endothelial cells (CECs) were measured.

RESULTS: sST2 concentrations were significantly elevated in hospitalized patients during the acute phase of COVID-19 compared to healthy controls (p < 0.001), but returned to baseline concentrations during the post-acute phase and remained stable across follow-up timepoints (3, 6, 12, and 24 months; p = 0.11). sST2 was not associated with initial COVID-19 severity (p = 0.13), nor with persistent symptoms including fatigue (p = 0.11) or dyspnea (p = 0.49), or with reduced DLCO (p = 0.32) or abnormal PFTs (p = 0.55). No correlation was found with VEGF-A, CECs, VWF: Ag, or D-dimers.

CONCLUSION: Although sST2 is a robust biomarker of acute COVID-19 severity, it does not reflect persistent endothelial dysfunction or symptom burden in long COVID. These findings suggest IL-33/sST2-independent mechanisms may underlie chronic vascular injury in PASC.},
}

@article {pmid41722320,
year = {2026},
author = {Alves Costa Silva, C and Pinheiro Bomfim, A and Dutra Medeiros, J and de Jesus Silva, J and Cazé-Ceron, AB and Cerqueira-Silva, T and Khouri, R and Barral, A and Barral-Netto, M and da Rocha Fernandes, G and Gomes Barbosa, C and S Boaventura, V},
title = {Corrigendum to "Nasal microbiota and clinical features in acute flu-like illness: COVID-19 status and long COVID follow-up" [International Journal of Infectious Diseases 162 (2026) 108196 https://doi.org/10.1016/j.ijid.2025.108196].},
journal = {International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases},
volume = {165},
number = {},
pages = {108441},
doi = {10.1016/j.ijid.2026.108441},
pmid = {41722320},
issn = {1878-3511},
}

@article {pmid41720282,
year = {2026},
author = {Fudim, M and Novak, P and Taub, PR and Chung, T and Zimmerman, KO and Moy, OV and Fissler, HZ and Wen, J and Freeman, NLB and O'Brien, S and Marti, H and Cook, D and Low, P and Kim, DY and Rosenberg, Y and Granger, CB and Shibao, CA},
title = {Design and rationale of RECOVER-AUTONOMIC: a randomized platform trial evaluating interventions for Long COVID postural orthostatic tachycardia syndrome.},
journal = {American heart journal},
volume = {},
number = {},
pages = {107384},
doi = {10.1016/j.ahj.2026.107384},
pmid = {41720282},
issn = {1097-6744},
abstract = {BACKGROUND: Post‑acute sequelae of SARS‑CoV‑2 infection (Long COVID) affect a substantial proportion of individuals, and among the many reported symptom clusters, autonomic dysfunction, particularly postural orthostatic tachycardia syndrome (POTS), represents an important subset. The Researching COVID to Enhance Recovery Clinical Trials (RECOVER-CT) initiative developed by the National Institutes of Health included a platform trial (RECOVER-AUTONOMIC) designed to assess the safety, tolerability, and efficacy of three interventions - (1) coordinated nonpharmacologic care, (2) pharmacotherapy with intravenous immunoglobulin (IVIG), and (3) pharmacotherapy with ivabradine - in treating POTS in adults with Long COVID.

METHODS: RECOVER-AUTONOMIC is a multicenter, randomized, double-blinded, placebo-controlled, platform trial employing a flexible, adaptive design. Participants are randomized to IVIG or ivabradine with matching placebo, and (in a factorial design) to either coordinated nonpharmacologic care or usual care. The primary endpoint is the change in orthostatic intolerance symptoms measured by the Orthostatic Hypotension Questionnaire/Orthostatic Intolerance Questionnaire from baseline to the end of intervention. Secondary endpoints include quality of life, functional performance, symptom burden, and safety. Exploratory endpoints include autonomic function testing, wearable sensor data, and longitudinal biomarker profiling.

DISCUSSION: RECOVER-AUTONOMIC seeks to determine the benefits and risks of IVIG and of ivabradine, as well as of coordinated nonpharmacologic care, for the treatment of POTS in Long COVID. Results from this trial will offer the largest source of evidence to help guide the medical care of this population.

TRIAL REGISTRATION: ClinicalTrials.gov - Platform: NCT06305780; Appendix A (intravenous immunoglobulin): NCT06305793; Appendix B (ivabradine): NCT06305806. Protocol available at https://trials.recovercovid.org/autonomic.},
}

@article {pmid41718988,
year = {2026},
author = {Wang, Y and Gandy, S},
title = {Golgi Fragmentation as a Potential Link Between SARS-CoV-2 Infection and Alzheimer's Disease: Mechanisms and Implications for Neurodegeneration in Long COVID.},
journal = {Sub-cellular biochemistry},
volume = {111},
number = {},
pages = {463-482},
pmid = {41718988},
issn = {0306-0225},
mesh = {Humans ; *Alzheimer Disease/pathology/metabolism/virology ; *COVID-19/pathology/complications/metabolism/virology ; *Golgi Apparatus/pathology/metabolism/virology ; *SARS-CoV-2/metabolism ; Animals ; },
abstract = {The COVID-19 pandemic has impacted millions of people worldwide, and recent studies have shown that SARS-CoV-2 infection can lead to an Alzheimer's-like neuropathological and biomarker phenotype, as well as clinical symptoms of "brain fog". This raises an intriguing question: "How and where might the molecular pathways underlying SARS-CoV-2 infection and Alzheimer's disease (AD) converge?" One common feature of both SARS-CoV-2 infection and AD is the alteration of the endomembrane system, particularly the fragmentation of the Golgi apparatus. In this review article, we summarize the existing literature on SARS-CoV-2 infection biology and speculate about the potential mechanisms linking Golgi defects, SARS-CoV-2 infection, and neurodegeneration.},
}

Humans
*Alzheimer Disease/pathology/metabolism/virology
*COVID-19/pathology/complications/metabolism/virology
*Golgi Apparatus/pathology/metabolism/virology
*SARS-CoV-2/metabolism
Animals

@article {pmid41720041,
year = {2026},
author = {Nakase, T and Takano, Y and Nomura, S and Baek, HW and Takayama, S and Ono, R and Abe, M and Ishii, T and Tatewaki, Y and Taki, Y},
title = {Association of symptoms of neuropsychological long COVID with imaging and plasma biomarkers.},
journal = {Journal of the neurological sciences},
volume = {483},
number = {},
pages = {125808},
doi = {10.1016/j.jns.2026.125808},
pmid = {41720041},
issn = {1878-5883},
abstract = {BACKGROUND: Some patients recovered from COVID-19 may experience cognitive and psychological symptoms, such as "brain fog" or neuropsychological long COVID, and its mechanism is unclear.

OBJECTIVE: This study aimed to investigate the mechanism of brain damage in neuropsychological long COVID using imaging and blood biomarkers.

METHODS: Patients who met the criteria on the "brain fog" screening questionnaire and provided informed consent were enrolled in this study (n = 33; mean age 38.5 years). All participants were examined using magnetic resonance imaging, single-photon emission computed tomography (assessment of regional cerebral blood flow [rCBF]), and blood biomarkers. Neuropsychological tests (Montreal Cognitive Assessment-Japanese version [MoCA-J], Trail Making Test [TMT], Frontal Assessment Battery, Digital Symbol Coding [DSC] test, State-Trait Anxiety Inventory [STAI], and Self-Rating Depression Scale [SDS]) were performed simultaneously.

RESULTS: Significant correlations were observed between the MoCA-J score and decreased rCBF in the left occipital lobe and increased rCBF in the right occipital lobe (p < 0.05), between the STAI score and decreased rCBF in the right parietal lobe (p < 0.05), and between the SDS score and decreased rCBF in the right parietal lobe (p < 0.05). The MoCA-J and DSC scores were correlated with plasma levels of neurofilament light chain (p < 0 0.05). The TMT time correlated with plasma glial fibrillary acidic protein levels (p < 0.01).

CONCLUSION: This study was a cross-sectional and could not distinguish pathological abnormalities. However, as correlations of neuropsychological long COVID with specific brain regions and plasma biomarkers have been elucidated, conducting a case-control analysis may be worthwhile.},
}

@article {pmid41718450,
year = {2026},
author = {Ribatti, RM and Lanciano, T and Curci, A},
title = {Detecting Malingered COVID-19 Symptoms Using the Verifiability Approach.},
journal = {Brain and behavior},
volume = {16},
number = {2},
pages = {e71278},
doi = {10.1002/brb3.71278},
pmid = {41718450},
issn = {2162-3279},
mesh = {Humans ; *COVID-19/diagnosis/psychology ; *Malingering/diagnosis/psychology ; Female ; Male ; Adult ; Middle Aged ; Deception ; Young Adult ; Surveys and Questionnaires ; SARS-CoV-2 ; },
abstract = {INTRODUCTION: The COVID-19 pandemic has heightened concerns about malingering, particularly given its recognition as an occupational disease in several regions. This study evaluated the applicability of the Verifiability Approach (VA), a credibility assessment tool based on the principle that liars provide fewer verifiable details than truth tellers, to distinguish between honest reporters and malingerers of COVID-19 infection.

METHODS: A total of 410 participants (51.5% female) completed an online survey via Google Forms. Participants who reported previous COVID-19 infection (n = 205) were assigned to either an informed honest (n = 104) or not-informed honest (n = 101) group, while those without prior infection (n = 205) were assigned to informed malingerers (n = 105) or not-informed malingerers (n = 100) conditions. Participants in the informed condition were briefed about the VA before writing their reports.

RESULTS: Informed honest participants provided significantly more verifiable details than both uninformed honest participants and malingerers. The number of verifiable details and the ratio of verifiable details to total details were strongly associated with honesty when participants were informed about the VA, indicating that the information Protocol enhanced diagnostic accuracy. Perceived success was higher among honest participants, particularly those informed about the VA. No significant effects emerged for reported long COVID or fabricated symptoms, likely due to limited variability and low symptom familiarity.

CONCLUSION: The findings support the VA's validity in distinguishing genuine from feigned symptom reports in health-related contexts. However, the fully online design, lack of factual verification, and potential for misreporting represent key limitations. Future studies should replicate these results in face-to-face or ecologically valid settings and extend the VA framework to the study of symptom dissimulation.},
}

Humans
*COVID-19/diagnosis/psychology
*Malingering/diagnosis/psychology
Female
Male
Adult
Middle Aged
Deception
Young Adult
Surveys and Questionnaires
SARS-CoV-2

@article {pmid41717886,
year = {2026},
author = {Cucunawangsih, C and Ansori, ANM and Vatvani, AD and Hariyanto, TI},
title = {Impact of nirmatrelvir/ritonavir on the risk of long COVID in outpatients: a systematic review and meta-analysis.},
journal = {Expert review of anti-infective therapy},
volume = {},
number = {},
pages = {},
doi = {10.1080/14787210.2026.2636175},
pmid = {41717886},
issn = {1744-8336},
abstract = {BACKGROUND: This study systematically synthesized existing evidence to evaluate whether outpatient treatment with nirmatrelvir/ritonavir during the acute phase reduces the incidence of long COVID.

METHODS: We conducted a systematic search of Europe PMC, Medline, Scopus, and the Cochrane Library from inception to 15 September 2025. Eligible studies compared COVID-19 outpatients prescribed nirmatrelvir/ritonavir during the acute phase with those who did not receive the drug. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

RESULTS: Nineteen studies met inclusion criteria. Overall, nirmatrelvir/ritonavir use during acute infection was associated with a significant reduction in the likelihood of developing post-COVID-19 condition (OR 0.85; 95% CI: 0.80-0.91; p < 0.00001; I[2] = 99%). Protective effects were consistently observed across multiple clinical domains, including cardiovascular (arrhythmia, ischemic disease, heart failure), pulmonary (dyspnea, COPD), thromboembolic (DVT, PE), neurological (stroke, cognitive impairment, headache), psychiatric (depression), gastrointestinal, metabolic (new-onset diabetes), renal (AKI), and general symptoms (malaise and fatigue). Conversely, no significant differences were noted for cough, asthma, dysautonomia, anxiety, PTSD, sleep disturbances, musculoskeletal pain, or olfactory/gustatory dysfunction.

CONCLUSIONS: Early outpatient treatment with nirmatrelvir/ritonavir may mitigate the risk of developing several domains of long COVID, though its benefits are not uniform across all symptom categories.},
}

@article {pmid41713328,
year = {2026},
author = {Barboza, APB and Luna-Muschi, A and Faffe, D and Borges, IC and Côrtes, MF and Galliez, R and Mendes, ET and Leal, FE and Manuli, E and Ghilardi, F and Scheid, HT and Lourenço, ABM and Ozatha, M and Sampaio, V and da Costa Ferreira Junior, O and Tanuri, A and Sabino, E and Castiñeiras, TM and Costa, SF},
title = {Protective effect of a second booster dose against long COVID among individuals infected with SARS-CoV-2 in southeastern Brazil.},
journal = {Vaccine},
volume = {77},
number = {},
pages = {128354},
doi = {10.1016/j.vaccine.2026.128354},
pmid = {41713328},
issn = {1873-2518},
abstract = {BACKGROUND: Long COVID is a complex condition with diverse symptoms, lacking specific diagnostic or therapeutic tools. Although vaccination reduces the risk of severe COVID-19, its role in preventing long COVID, particularly through booster doses, remains limited. This study assessed the impact of first and second booster doses and identified long COVID risk factors.

METHODS: We conducted a multicenter observational study with a cross-sectional analysis of participants previously infected with SARS-CoV-2 during the pre-Omicron and Omicron epidemiological periods. Both periods included mixed populations of healthcare workers (HCWs) and non-HCWs, with HCWs representing 86% of all participants. The study included five medical centers in São Paulo and Rio de Janeiro. Clinical data and long COVID symptoms were collected through a single standardized electronic questionnaire sent to all eligible participants. Predictors of long COVID were evaluated using multivariable logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

RESULTS: A total of 2033 participants were included, and 67% (1370) reported long COVID symptoms. Independent risk factors included female sex (OR 2.25, 95% CI 1.81-2.79, p < 0.001), the presence of one, two, or three or more comorbidities (OR 1.74, 95% CI 1.36-2.23, p < 0.001; OR 2.14, 95% CI 1.43-3.20, p < 0.001; and OR 3.10, CI 1.55-6.19, p = 0.001, respectively); the occurrence of one or more reinfections (OR 2.35, 95% CI 1.84-3.01, p < 0.001; and OR 4.22, 95% CI 2.043-7.91, p < 0.001, respectively), and a severe acute illness (OR: 1.91; 95%CI 1.09-3.35; p = 0.02). Vaccination was protective, with the strongest effect observed among those receiving two booster doses (OR: 0.18; 95% CI 0.07-0.46; p < 0.001). In the Omicron period sub-analysis, only the second booster dose was associated with reduced risk compared with a complete primary series (OR 0.50, CI 0.34-0.74, p < 0.001), whereas one booster dose showed no significant effect.

CONCLUSION: COVID-19 vaccination, especially two booster doses, reduced long COVID risk. Female sex, comorbidities, reinfections, and severe acute illness were independent risk factors for developing long-lasting symptoms.},
}

@article {pmid41712280,
year = {2026},
author = {Izquierdo-Pujol, J and Pedreño-Lopez, N and Pidkova, T and Nevot, M and Urrea, V and Laguía, F and Muñoz-López, F and Dalmau, J and Gonzalez-Aumatell, A and Carreras-Abad, C and Méndez, M and Rodrigo, C and Massanella, M and Blanco, J and Carrillo, J and Trinité, B and Martinez-Picado, J and Morón-López, S},
title = {Pediatric long COVID is characterized by myeloid CCR6 suppression and immune dysregulation.},
journal = {JCI insight},
volume = {},
number = {},
pages = {},
doi = {10.1172/jci.insight.201111},
pmid = {41712280},
issn = {2379-3708},
abstract = {The biological mechanisms underlying long COVID in the pediatric population are poorly understood. Our study aimed to characterize the immune pathophysiology of long COVID in children and young people (CYP). We analyzed major immune cell compartments in PBMCs, as well as specific SARS-CoV-2 antibody response in CYP with (n=99) and without (n=18) long COVID at three months following acute infection. Our findings indicate that pediatric long COVID is associated with a dysregulated immune response characterized by altered innate immunity and overactivated T-, B- and NK-cell responses. Furthermore, CYP with long COVID had an impaired humoral response to SARS-CoV-2 marked by a dysregulated B-cell compartment and lower levels of anti-RBD IgG and IgA. This correlated with reduced neutralizing capacity against SARS-CoV-2. Random forest analysis identified CCR6 expression on myeloid cells as the most relevant biomarker that distinguishes long COVID from control individuals with 79% accuracy.},
}

@article {pmid41712028,
year = {2026},
author = {Chakraborty, C and Bhattacharya, M and Chatterjee, S and Lee, SS},
title = {Long COVID-associated neurological symptoms and brain fog: Understanding the mechanism of neuroinflammation, BBB disruption, diagnostics, and therapeutics.},
journal = {Molecular biology reports},
volume = {53},
number = {1},
pages = {401},
pmid = {41712028},
issn = {1573-4978},
mesh = {Humans ; *Blood-Brain Barrier/pathology/metabolism/virology ; *COVID-19/complications/diagnosis/therapy ; *Neuroinflammatory Diseases/diagnosis/therapy/virology ; SARS-CoV-2 ; Animals ; Brain/pathology/virology ; *Nervous System Diseases/diagnosis/therapy/etiology ; Post-Acute COVID-19 Syndrome ; },
abstract = {Long COVID affects at least 10% of those with severe disease, and many experience neurological symptoms and brain fog. More than 200 symptoms are reported, yet a detailed understanding remains limited. This article summarizes current knowledge of neurological symptoms, brain fog, molecular mechanisms, neuroinflammation, blood-brain barrier disruption, diagnostics, and available therapeutics. Our review highlights the lack of diagnostics and treatments for these patients. We catalog the ongoing clinical trials, identify the urgent need for further therapeutics, and stress that advances in understanding pathophysiology will drive new treatments. We urge prioritizing animal model studies and improving diagnostics to accelerate the discovery and delivery of effective treatments for long COVID neurological symptoms.},
}

Humans
*Blood-Brain Barrier/pathology/metabolism/virology
*COVID-19/complications/diagnosis/therapy
*Neuroinflammatory Diseases/diagnosis/therapy/virology
SARS-CoV-2
Animals
Brain/pathology/virology
*Nervous System Diseases/diagnosis/therapy/etiology
Post-Acute COVID-19 Syndrome

@article {pmid41709214,
year = {2026},
author = {Ryu, S and Patel, A and Chyu, C and Buszkiewicz, JH and Ahmed, S and Fleischer, NL},
title = {Prospective associations between Long COVID and mental health: evidence from a population-based study with a nearly three-year follow-up.},
journal = {BMC public health},
volume = {},
number = {},
pages = {},
doi = {10.1186/s12889-026-26659-z},
pmid = {41709214},
issn = {1471-2458},
support = {6 NU50CK000510-02-04/CC/CDC HHS/United States ; },
abstract = {BACKGROUND: Many adults with Long COVID experience adverse mental health outcomes, but the long-term persistence of these associations remains unclear. We examined the prospective associations of Long COVID with depressive and anxiety symptoms three years after initial infection.

METHODS: We used a population-based cohort of Michigan adults with PCR-confirmed COVID-19, excluding respondents with baseline symptoms (resulting analytic samples: n = 2,431 for depressive symptoms; n = 2,301 for anxiety symptoms). Long COVID was defined as symptoms lasting ≥ 90 days after initial infection, assessed at baseline (median 4.4 months post-infection). Depressive and anxiety symptoms were evaluated 1.5 years (follow-up 1) and 3 years (follow-up 2) after infection. We used modified Poisson regression models to estimate risk ratios (RR) for each outcome and multinomial logistic regression models to examine Long COVID and mental health outcomes measured across two follow-up periods.

RESULTS: Long COVID was associated with higher risks of depressive symptoms (aRR:1.86, 95% CI:1.34-2.57) and anxiety symptoms (aRR:1.60, 95% CI:1.18-2.16) after 3 years of follow-up. Adults with Long COVID, compared to adults without Long COVID, had a 2.64 times higher risk of depressive symptoms at follow-up 2 (95% CI:1.60-4.35) relative to no depressive symptoms at either follow-up and a 2.48 times higher risk of anxiety symptoms at both follow-ups (95% CI:1.38-4.47) relative to no anxiety symptoms at either follow-up.

CONCLUSION: Our findings that Long COVID is associated with higher depressive and anxiety symptoms after 3 years of follow-up highlight the need to monitor the mental health of adults with Long COVID.},
}

@article {pmid41708407,
year = {2026},
author = {Maji, C and Kokiwar, PR and Biradar, A and Jauhari, R},
title = {Comment on "Prevalence and trajectories of post-COVID-19 neuromuscular conditions: A systematic-review and meta-analysis".},
journal = {Journal of the neurological sciences},
volume = {},
number = {},
pages = {125811},
doi = {10.1016/j.jns.2026.125811},
pmid = {41708407},
issn = {1878-5883},
}

@article {pmid41707177,
year = {2026},
author = {Zhang, TM and Sharp, SP and Scott, JD and Taren, D and Samaniego, JC and Unger, ER and Bertolli, J and Lin, JS and Ramers, CB and Godino, JG},
title = {Correction: Characterization of Post-Viral Infection Behaviors Among Patients With Long COVID: Prospective, Observational, Longitudinal Cohort Analyses of Fitbit Data and Patient-Reported Outcomes.},
journal = {JMIR formative research},
volume = {10},
number = {},
pages = {e92848},
doi = {10.2196/92848},
pmid = {41707177},
issn = {2561-326X},
abstract = {[This corrects the article DOI: 10.2196/77644.].},
}

@article {pmid41705124,
year = {2025},
author = {Wirth, KJ and Steinacker, JM},
title = {The potential causes of myasthenia and fasciculations in severely ill ME/CFS patients: the role of disturbed electrophysiology.},
journal = {Frontiers in physiology},
volume = {16},
number = {},
pages = {1693589},
pmid = {41705124},
issn = {1664-042X},
abstract = {Patients with severe myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are bedridden and suffer from hypersensitivities to light and noise, severe orthostatic intolerance reducing cerebral blood flow, and skeletal muscle symptoms, including loss of force, fatigue, pain, fasciculations, and cramps. Because neurological investigations exclude neuronal causes of myasthenia, we hypothesize a muscular pathomechanism. In previous articles, we considered insufficient activity of the Na[+]/K[+]-ATPase to be the main cause of mitochondrial damage via high intracellular sodium that reverses the transport mode of the sodium-calcium-exchanger to import calcium, causing calcium overload. Low Na[+]/K[+]-ATPase activity also causes sarcolemmal depolarization, leading to less effective action potential propagation and loss of force. Depolarization brings the membrane potential closer to the threshold potential, causing hyperexcitability that explains fasciculations and cramps. These increase sodium influx during excitation to further increase the workload of Na[+]/K[+]-ATPase. Thereby, depolarization causes further depolarization. Higher intracellular sodium favors calcium overload and mitochondrial damage, which lowers the energy supply of Na[+]/K[+]-ATPase and increases the reactive oxygen species, further inhibiting Na[+]/K[+]-ATPase. The muscle is in a state of depolarization even at rest. Depolarization and mitochondrial damage reinforce each other. Thus, dysfunction of Na[+]/K[+]-ATPase as a single mechanism can explain the different skeletal muscle symptoms of severely ill ME/CFS patients, comprising loss of force, fatigue, and fasciculations.},
}

@article {pmid41704685,
year = {2026},
author = {Andus, I and Büttner, J and Bochow-Fitzner, B and Tacke, F and Jochum, C},
title = {Intestinal permeability correlated with chronic fatigue in a patient with long COVID-A case report and overview of the literature.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1725242},
pmid = {41704685},
issn = {2296-858X},
abstract = {BACKGROUND: Long COVID is a complex condition characterized by persistent symptoms such as chronic fatigue, cognitive impairment, and autonomic dysfunction. Emerging evidence suggests that the gut may play a role in the pathophysiology of long COVID, potentially contributing to systemic inflammation and symptom severity. Prior studies indicate intestinal permeability (IP) alteration in patients with long COVID. To date, there have been no reports on the assessment of intestinal permeability via carbohydrate absorption in individuals with long COVID.

CASE PRESENTATION: We present a 60-year-old female with long COVID who exhibited chronic fatigue and autonomic dysfunction for more than 3 years following SARS-CoV-2 infection. IP was assessed at five time points using a carbohydrate absorption test. Results revealed significantly elevated lactulose/mannitol (L/M) ratios during episodes of symptom exacerbation, including a second SARS-CoV-2 infection. Notably, clinically observed improvement in fatigue correlated with a reduction in IP. A probiotic regimen with Bacillus coagulans and Bacillus subtilis, combined with a second intervention using medicinal clay, led to further clinical improvement.

CONCLUSIONS: This case report demonstrates a correlation between intestinal permeability alterations and long COVID symptom severity. Notably, to our knowledge, this is the first report assessing intestinal permeability in a long COVID patient using a carbohydrate absorption-based permeability test. It reinforces the emerging link between gut barrier integrity and long COVID pathophysiology and emphasizes the need for further studies to assess IP as a potential disease marker. Furthermore, the observed improvement with probiotic therapy highlights the need for further research into microbiome-targeted interventions for long COVID management. Larger studies are required to explore the mechanistic link between gut permeability and long COVID pathophysiology.},
}

@article {pmid41703367,
year = {2026},
author = {Nanthakumar, P and Law, JX and Ng, SF},
title = {Fibroblast-derived small extracellular vesicles loaded with tacrolimus enhances dermal delivery and alleviates cytokine-overdriven skin inflammation.},
journal = {Drug delivery and translational research},
volume = {},
number = {},
pages = {},
pmid = {41703367},
issn = {2190-3948},
support = {FRGS/1/2022/SKK16/UKM/02/5//Kementerian Pendidikan Malaysia/ ; },
abstract = {Long COVID has been increasingly linked to chronic inflammatory skin conditions driven by cytokine overproduction. Topical tacrolimus, a calcineurin inhibitor, is commonly used to manage such conditions due to its immunosuppressive properties. However, due to poor dermal penetration, tacrolimus oftens produce to suboptimal efficacy and adverse effects such as local irritation and burning sensation. Effective management of chronic inflammatory skin conditions linked to long COVID necessitates targeted, controlled drug delivery into deeper skin layers to modulate excessive cytokine production and attenuate localized inflammation. This study explores fibroblast-derived small extracellular vesicles (sEVs) as a new controlled delivery vehicle for tacrolimus. The sEVs were isolated using sucrose-cushioned density ultracentrifugation and characterized by TEM, NTA, Dot blot, and MicroBCA assay, confirming their successful isolation and purity. Tacrolimus was encapsulated into sEVs via sonication, with successful drug loading confirmed by morphological and physicochemical characterization. The resulting Tac-sEVs exhibited an encapsulation efficiency of 79.19% ± 0.01. Franz diffusion studies revealed a rapid initial release within the first 10 h, followed by sustained higher release over time. Tape-stripping demonstrated significantly deeper dermal penetration of tacrolimus loaded sEVs (Tac-sEVs) compared with commercial tacrolimus ointment and free drug. Both tacrolimus and Tac-sEVs downregulated IFN-γ, GCS-F, IL-2, and IL-4 expression, indicating potent suppression of SARS-CoV-2 spike glycoprotein-induced cytokine overproduction. PKH-26 fluorescence labelling confirmed efficient cellular uptake, while cytotoxicity assays (Alamar Blue, CCK-8) showed high cell viability for both formulations. In summary, these results position Tac-sEVs as a safe and promising therapeutic platform for cytokine-driven inflammatory skin diseases associated with long COVID, meriting further clinical investigation.},
}

@article {pmid41701690,
year = {2026},
author = {Martínez-Borba, V and Rodríguez-Márquez, AE and Garcés-Arilla, S and Peris-Baquero, Ó and Navarro-Haro, MV and Del Corral-Beamonte, E and Osma, J},
title = {Effectiveness and acceptability of the unified protocol for the transdiagnostic treatment of emotional disorders in people with long COVID-19: Study protocol for a randomized controlled trial.},
journal = {PloS one},
volume = {21},
number = {2},
pages = {e0342908},
doi = {10.1371/journal.pone.0342908},
pmid = {41701690},
issn = {1932-6203},
mesh = {Humans ; *COVID-19/psychology/complications ; Adult ; Female ; SARS-CoV-2/isolation & purification ; Male ; Hydrocortisone/analysis ; Randomized Controlled Trials as Topic ; Middle Aged ; Treatment Outcome ; Depression/therapy ; Emotions ; Neuropsychological Tests ; },
abstract = {BACKGROUND: Long COVID-19 is a medical condition associated with persistent physical, cognitive, and emotional symptoms. Despite its significant impact, there are still few psychological interventions-especially with transdiagnostic approaches- that have been rigorously tested in this population. The aim of the present protocol is to describe a randomized controlled trial to examine the effectiveness and acceptability of the online, group-delivered Unified Protocol (UP) for improving emotional, and cognitive outcomes in adults with long COVID-19. We expect greater improvements in emotional and cognitive outcomes for the UP group compared to controls. Additionally, exploratory analyses will assess changes in neurocognitive performance and hair cortisol/cortisone levels as potential correlates of treatment response.

METHODS: 90 individuals diagnosed with long COVID-19 will be randomized to an experimental group or a waiting-list control group (1:1 ratio). Participants in the experimental group will receive the UP across 12 online group sessions. Longitudinal assessments (pre-treatment, post-treatment and 3, 6 and 12 months follow-ups) will include psychological (e.g., anxiety and depressive symptoms) and cognitive outcomes (e.g., memory failures). Participants in the experimental group will also complete neuropsychological tests and will provide hair samples for the assessment of cortisol/cortisone levels.

DATA ANALYSES: Baseline characteristics will be described using descriptive statistics, and linear mixed-effects models will evaluate the effects of time, group, and their interaction on psychological and cognitive outcomes. Neuropsychological performance and hair cortisol levels will be analyzed over time in the experimental group. Associations between cortisol and psychological or cognitive measures will be explored through correlational analyses.

CONCLUSIONS: We expect positive outcomes after the intervention in acceptability and in emotional symptoms and cognitive complaints in individuals living with long COVID-19, the maintenance of the benefits in all follow-ups, and statistically significant changes in favor of the UP condition in comparison with the waiting-list control group. If effective, the UP could provide an accessible and evidence-based psychological treatment for this population, improving the quality of healthcare to individuals with long COVID-19.

TRIAL REGISTRATION: clinicatrials.gov (registration identifier: NCT06928480; May 22, 2025).},
}

Humans
*COVID-19/psychology/complications
Adult
Female
SARS-CoV-2/isolation & purification
Male
Hydrocortisone/analysis
Randomized Controlled Trials as Topic
Middle Aged
Treatment Outcome
Depression/therapy
Emotions
Neuropsychological Tests

@article {pmid41700293,
year = {2026},
author = {Meyahnwi, D and Issaka, Y and Okorigba, EM and Agberien, VO and Joshi, S and Port, Z},
title = {Short- and Long-Term Prognosis of COVID-19-Associated Versus Non-COVID-19 Takotsubo Cardiomyopathy: A Propensity-Matched Nationwide Study.},
journal = {Cureus},
volume = {18},
number = {1},
pages = {e101631},
pmid = {41700293},
issn = {2168-8184},
abstract = {BACKGROUND: Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy with transient left ventricular dysfunction, often triggered by acute illness. Coronavirus disease 2019 (COVID-19) has been implicated as a precipitant, but comparative outcome data for COVID-19-related versus non-COVID-19 TCM remain largely limited to the early pandemic, when few effective treatments existed.

METHODS: We conducted a retrospective cohort study using the TriNetX database, identifying US adults hospitalized between March 2020 and March 2025 with TCM and created two cohorts: patients with TCM and laboratory-confirmed COVID-19 and patients with TCM without COVID-19, both diagnosed within 14 days of admission. The primary outcome was 30-day all-cause mortality, with secondary 30-day outcomes and one-year mortality also assessed. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated.

RESULTS: Of 16,649 patients (6,367 COVID-19 TCM and 10,282 non-COVID-19 TCM), 5,955 per group remained after propensity score matching. Baseline demographics and comorbidities were well balanced (mean age 66.8 years; 76.8% female). Thirty-day mortality did not differ significantly between COVID-19 and non-COVID-19 TCM (12.0% vs. 11.1%; HR 1.07, 95% CI 0.97-1.19). However, COVID-19 TCM was associated with higher risks of heart failure with reduced ejection fraction (HFrEF) (HR 1.18, 95% CI 1.10-1.26), cardiogenic shock (HR 1.25, 95% CI 1.08-1.46), and ventricular arrhythmias (HR 1.37, 95% CI 1.14-1.64). One-year mortality was significantly higher in the COVID-19 cohort (22.0% vs. 18.3%; HR 1.19, 95% CI 1.10-1.29).

CONCLUSION: COVID-19-associated TCM is not linked to excess short-term mortality but carries higher risks of acute complications and significantly worse one-year survival, highlighting the persistent effects of COVID-19 after an acute infection.},
}

@article {pmid41699766,
year = {2026},
author = {Das, V},
title = {Trends in Financial Hardship by COVID-19 Infection History, Long COVID Status, and Day-to-Day Activity Limitations: A National Study of US Adults.},
journal = {Family & community health},
volume = {49},
number = {2},
pages = {122-130},
pmid = {41699766},
issn = {1550-5057},
mesh = {Humans ; *COVID-19/economics/epidemiology ; United States/epidemiology ; Male ; Female ; Adult ; Middle Aged ; *Financial Stress/epidemiology/economics ; SARS-CoV-2 ; *Health Status ; Aged ; *Activities of Daily Living ; Logistic Models ; Young Adult ; Adolescent ; },
abstract = {BACKGROUND AND OBJECTIVE: This study investigated whether the association between COVID-19 health status and financial hardship changed over time.

METHODS: Weighted logistic regression analyses were conducted using data from 1 367 829 adults surveyed in the US Census Bureau's Household Pulse Survey (October 2022-September 2024) to estimate the average marginal effects of COVID-19 health status on financial hardship.

RESULTS: Adjusted logistic regression estimates showed that financial hardship was, on average, 27 percentage points higher for those reporting long COVID with severe activity limitations and 9 points higher for those with mild limitations, compared to never-infected adults. The differences in financial hardship across groups with different COVID-19 health status remained largely stable throughout the 2-year study period.

CONCLUSIONS: The persistent link between activity-limiting long COVID and financial hardship underscores the need for integrated policy responses.},
}

Humans
*COVID-19/economics/epidemiology
United States/epidemiology
Male
Female
Adult
Middle Aged
*Financial Stress/epidemiology/economics
SARS-CoV-2
*Health Status
Aged
*Activities of Daily Living
Logistic Models
Young Adult
Adolescent

@article {pmid41699511,
year = {2026},
author = {Engl, K and Feddern, S and Grüne, B and Haberstock, L and Kossow, A and Nießen, J and Rost, S and Wiesmüller, GA and Schmidt, N and Joisten, C},
title = {Prevalence, symptoms, and associated factors of long COVID: a retrospective cohort study based on data from two major German health authorities.},
journal = {BMC infectious diseases},
volume = {},
number = {},
pages = {},
doi = {10.1186/s12879-026-12785-x},
pmid = {41699511},
issn = {1471-2334},
}

@article {pmid41699192,
year = {2026},
author = {Whong, Z and Malik, A and Calder, AN and Armstrong, MF and Schuman, TA},
title = {COVID-19 Infection Increases the Risk of Subsequent Diagnosis of Chronic Rhinosinusitis.},
journal = {The Laryngoscope},
volume = {},
number = {},
pages = {},
doi = {10.1002/lary.70444},
pmid = {41699192},
issn = {1531-4995},
abstract = {OBJECTIVES: To analyze the impact of COVID-19 infection on the diagnosis of chronic rhinosinusitis (CRS).

METHODS: TriNetX, a large international database of anonymized health records, was queried for adults with either positive or negative SARS-CoV-2 polymerase chain reaction (PCR) tests between March 1, 2020 and December 31, 2024. Patients with cancer or immunodeficiency before the COVID-19 diagnosis were excluded. Propensity score matching was used to create comparable exposure and control groups. Relative risk ratios and Cox proportional hazards regression analysis of CRS diagnosis were calculated 3 months after PCR testing. Sub-analyses were completed to investigate the effects of prior COVID-19 infection on subsequent CRS development stratified by prior vaccination status and by variant-dominant time periods (pre-Delta, Delta, and Omicron).

RESULTS: Propensity score-matched COVID-19+ and COVID-19- cohorts each consisted of 2,135,446 patients. Rate of diagnosis of CRS increased following a positive COVID-19 PCR test (RR = 2.13, 95% CI [2.10-2.16]) and varied across variant-dominant periods, with risk ratios of 1.44 (95% CI [1.41-1.47]) during pre-Delta, 1.20 (95% CI [1.15-1.25]) during Delta, and 2.10 (95% CI [2.07-2.13]) during Omicron. Prior COVID-19 vaccination did not modify the risk of CRS among patients with a positive COVID-19 PCR (RR = 0.98, 95% CI [0.92-1.05]).

CONCLUSIONS: COVID-19 infection was found to increase the risk of subsequent diagnosis of CRS. Further studies are needed to better understand the relationship between COVID-19 and the development of sinonasal inflammatory pathology.},
}

@article {pmid41566340,
year = {2026},
author = {Virga, F and Taverna, D and Ferrero, G and Leclercq, M and El Hachem, N and Godoy-Tena, G and Jacobs, C and Tarallo, S and Pardini, B and Naccarati, A and Wauters, J and Lauwers, HM and Wauters, E and Close, P and Orso, F and Mazzone, M},
title = {Transcriptome changes in circulating immune cells of critical COVID-19 patients predict a specific metabolic and epigenetic imprint.},
journal = {Journal of translational medicine},
volume = {24},
number = {1},
pages = {247},
pmid = {41566340},
issn = {1479-5876},
abstract = {BACKGROUND: The progression to critical COVID-19 arises predominantly from a dysregulated host immune response although the underlying regulatory mechanisms still remain partially elusive. This limits a prompt prediction of the disease progression, reduces the therapeutic options and restrains our understanding of “long COVID”.

METHODS: Here, we analyzed the transcriptome of peripheral blood mononuclear cells (PBMCs) collected from COVID-19 patients experiencing different degrees of the disease (mild and critical), and control patients enrolled in the clinical trial COntAGIouS as well as independent bulk RNA-seq, single-cell RNA-seq and proteomic datasets.

RESULTS: In critical COVID-19 patients, the integrative analysis of transcriptomic data revealed an altered regulatory network involving microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and coding genes that control mRNA translation-related genes, epigenetics, and metabolism. In parallel, we observed an upregulation of tRNA aminoacylation genes in critical COVID-19 patients by the analysis of either bulk or single-cell RNA-seq data from publicly available independent cohorts. Additionally, we found increased expression of coding genes enriched for the cognate amino acids (glycine, alanine, isoleucine and tyrosine), all related to protein localization, post-translational modifications, and cell metabolism in our cohort. Similar alterations in amino acid frequency were found in an independent proteomic dataset.

CONCLUSIONS: Collectively, our findings indicate a broad perturbation of the gene expression landscape that characterizes the aberrant host immune response in critical COVID-19 patients and is potentially coordinated by miRNA and tRNA metabolism alterations.

TRIAL REGISTRATION: COntAGIouS, NCT04327570. Registered 26 March 2020, https://clinicaltrials.gov/ct2/show/NCT04327570.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12967-025-07665-y.},
}

@article {pmid41697443,
year = {2026},
author = {Camara, B and Buonsenso, D},
title = {Biomarkers of long COVID in children and young adults: a scoping review.},
journal = {European journal of pediatrics},
volume = {185},
number = {3},
pages = {132},
pmid = {41697443},
issn = {1432-1076},
mesh = {Humans ; *COVID-19/complications/diagnosis ; Child ; *Biomarkers/blood ; Adolescent ; Young Adult ; Post-Acute COVID-19 Syndrome ; SARS-CoV-2 ; },
abstract = {UNLABELLED: Following the SARS-CoV-2 pandemic, a significant percentage of people are now experiencing long-term symptoms, despite a continuing lack of concrete documentation of physiological and risk profiles that hinders diagnosis and treatment, particularly in pediatric contexts. This review aims to highlight the existing evidence for measurable physiological markers for post-acute sequelae of SARS-CoV-2 infection (long COVID) in children, adolescents, and young adults. Titles providing data related to measurable biomarkers distinguishing young long COVID patients from controls were compiled and analyzed. Results were displayed in table and diagram form for optimal qualitative evaluation of the relationship between markers and symptomatology within the context of each organ system. Only human studies published in English, Italian, Portuguese, German, and Spanish between the 5th of February 2025 and the 31st of December 2025 were considered, and no other time constraints were applied. Following search and criteria evaluation, nine studies were included, totaling 41 occurrences identified in diseased patients with statistically significant variation from healthy controls. Markers suggest the presence of organic manifestations based on published literature, although more data and future studies will be necessary to establish clear connections.

CONCLUSION: The data compiled for this review adds to the body of evidence indicating a physiological manifestation of long COVID and its consequences. Further investigation into potential risk factors, pre- and post-pubescent manifestations, and specific inflammatory and immune pathways will be necessary for a more concrete understanding of long COVID and its effects on children, adolescents, and young adults.

WHAT IS KNOWN: • Long COVID is estimated to affect a significant population of patients, despite the lack of concrete physiological diagnostic and prognostic measures. • Pediatric incidence of the disease is still largely debated, and published data are scarce.

WHAT IS NEW: • A total of 41 biomarker occurrences were identified by selected studies, which were consistent with expected physiology behind reported symptoms. • The body of data discussed suggests the presence of physiological phenomena behind the long-term symptoms experienced by pediatric long- COVID patients.},
}

Humans
*COVID-19/complications/diagnosis
Child
*Biomarkers/blood
Adolescent
Young Adult
Post-Acute COVID-19 Syndrome
SARS-CoV-2

@article {pmid41696720,
year = {2026},
author = {Ohira, M and Osada, T and Kimura, H and Sano, T and Takao, M},
title = {Clinical Characteristics of Patients Initially Suspected of Long COVID: A Case Series From a Specialized Outpatient Clinic.},
journal = {Journal of general and family medicine},
volume = {27},
number = {1},
pages = {e70081},
pmid = {41696720},
issn = {2189-7948},
abstract = {BACKGROUND: Sequelae of the acute phase of coronavirus disease 2019 (COVID-19), termed long COVID, are characterized by a variety of symptoms, including neurological manifestations. Diagnosing long COVID requires excluding alternative conditions that could explain the symptoms. The role of primary care physicians is considered essential in managing long COVID, particularly during the initial screening phase.

METHODS: This observational, retrospective, single-center study was conducted at an outpatient clinic from 1 June 2021 to 31 December 2024. We confirmed final diagnoses for patients suspected of having long COVID and included those ultimately diagnosed with other conditions. Clinical data-including symptoms, demographic characteristics, results of clinical examinations, and final diagnoses-were collected.

RESULTS: In total, 44 patients were diagnosed with alternative conditions. Of these, 30 were classified as having post-acute sequelae of SARS-CoV-2 mimic, and 14 patients (2.2% of those who believed they had long COVID and visited our clinic) were diagnosed with other diseases. The median age at the time of their clinic visit was 48 years (range, 42.5-61.5). Diagnoses included collagen diseases (5 patients, 35.7%) and central nervous system disorders (5 patients, 35.7%), among others. Weakness was the most common symptom. In contrast to long COVID, fatigue was less frequently reported in this group.

CONCLUSIONS: We identified a variety of alternative diagnoses among patients suspected of having long COVID. We recommend that primary care physicians exercise caution when diagnosing long COVID, particularly in patients who do not report fatigue.},
}

@article {pmid41695601,
year = {2026},
author = {O'Hanlon, J and Sullivan, K and Muehling, LM and Canderan, G and Sun, J and Woodfolk, JA and Wilson, JM and Luke, RA},
title = {A Probabilistic Modeling Analysis of the Longitudinal Immune Response to Infection and Vaccination Across Demographic Groups and Pulmonary Symptoms.},
journal = {Spora : a journal of biomathematics},
volume = {12},
number = {},
pages = {59-75},
pmid = {41695601},
issn = {2473-5493},
abstract = {Antibody and cytokine kinetics describe the dynamic response to immune events such as infection and vaccination. These dynamics are not fully understood, and mathematical characterization may help explain variability across demographic groups and pulmonary symptoms post-acute infection. We fit time-dependent probability models to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) data to obtain distributions of longitudinal antibody response and cytokine values. To assess differences between groups, an overlap metric is applied to the modeled response curves. Our antibody models suggest significant differences between male and female populations and demonstrate deficient antibody responses of less-healthy groups such as smokers. Our cytokine models suggest that those with pulmonary symptoms post-acute infection have elevated responses over time. Further, we find that the cytokine response increases and then decays more rapidly than the antibody response. These results are consistent with clinical observations.},
}

@article {pmid41695180,
year = {2026},
author = {Popović, B and Lesac Brizić, A and Ljubotina, A and Zavidić, T and Tudor Špalj, V and Marković Štimac, R and Fišić Jurković, M and Bašić Marković, N and Diminić Lisica, I and Vučak, J and Radošević Quadranti, N},
title = {Long-term health effects of COVID-19 among patients in Croatian primary care settings.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1740432},
pmid = {41695180},
issn = {2296-858X},
abstract = {INTRODUCTION: The COVID-19 pandemic has left lasting effects that extend beyond the acute phase of infection, with increasing evidence of long-term health consequences. This study aimed to assess the prevalence of post-COVID symptoms and conditions and to identify associated risk factors, including pre-existing chronic diseases, COVID-19 vaccination status, and severity of acute infection.

METHODS: This retrospective cross-sectional study was conducted in 10 family medicine practices in Croatia. The data collected from medical records included demographics, COVID-19 vaccination status, SARS-CoV-2 infection history and severity, and documented health conditions before and after infection. Descriptive statistics were used to summarize the data. Group differences were analyzed using the independent samples t-test or χ[2] test. Variables significant in univariate analyses (p < 0.05) were included into multivariate regression models. Multiple linear regression was used to identify predictors of COVID-19 severity, and binary logistic regression was applied to determine factors associated with post-COVID conditions. Results are presented as regression coefficients (β) or odds ratios (OR) with 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant.

RESULTS: The study included 1,423 participants (58.0% female; mean age 52.6 ± 17.2 years), of whom 82.4% had confirmed SARS-CoV-2 infection and 32.3% were unvaccinated. At least one chronic disease was present in 28.1% of participants. The most frequently reported post-COVID conditions were brain fog (4.9%), neurological disorders (4.7%), cardiovascular diseases (2.9%), shortness of breath (2.8%), obesity (2.7%) and mental health disorders (2.6%). Greater COVID-19 severity was independently associated with pulmonary disease (β = 0.22; p = 0.031) and older age, particularly 51-65 years (β = 0.31; p < 0.001) and ≥66 years (β = 0.50; p < 0.001). COVID-19 vaccination was associated with milder disease (β = -0.21; p < 0.001). Previous cardiovascular and musculoskeletal diseases significantly increased the risk of thromboembolism. Diabetes, obesity, and number of vaccine doses were predictors of brain fog, while neurological comorbidities predicted post-COVID mental health disorders.

CONCLUSION: Post-COVID symptoms and conditions represent an important long-term public health challenge. Family medicine physicians play a key role in early recognition, monitoring, and management of post-COVID sequelae, contributing to improved long-term patient outcomes.},
}

@article {pmid41695044,
year = {2026},
author = {Wang, X and Velásquez, E and Saydah, S and Koumans, EH and Rochlin, I and Romano, S and Rehkopf, DH and Ford, ND},
title = {Post-COVID-19 conditions identified by ICD-10-CM code in a cohort of U.S. primary care patients, 2021 - 2023.},
journal = {Journal of multimorbidity and comorbidity},
volume = {16},
number = {},
pages = {26335565261422426},
pmid = {41695044},
issn = {2633-5565},
abstract = {OBJECTIVES: Describe patient characteristics, healthcare utilization, and Post-COVID-associated conditions among primary care patients with an ICD-10-CM diagnosis code for Post COVID-19 Condition (U09.9).

METHODS: Using electronic health record (EHR) data from the American Family Cohort, a U.S. national primary care dataset, we identified patients with a U09.9 diagnosis documented October 1, 2021-June 1, 2023. Patient data were categorized into three periods: pre-pandemic (2016-2019), pandemic pre-index (2020 to the first U09.9 diagnosis, or 'index' date), and post-index (index date to the last observation). Post-COVID-associated conditions were aggregated a priori into 12 body systems.

RESULTS: We identified 10,265 patients with a U09.9 diagnosis code; 81.9% were ≥40 years, 63.3% female, 74.4% White, and 70.5% resided in metropolitan counties. Patients averaged 12.7 primary care encounters in the year before the index U09.9 diagnosis, compared to 9.2 encounters annually in the post-index period. Over 68% of patients who had ≥1 pre-pandemic encounters had ≥1 underlying medical conditions. The prevalence of conditions across 9 out of 12 body systems increased from the pre-pandemic to the pandemic pre-index period for patients who had ≥1 conditions. Prevalence of respiratory and musculoskeletal conditions had the largest decrease from the pandemic pre-index to the post-index period.

CONCLUSIONS: Compared to adults who self-report Long COVID in nationally representative population-based surveys, patient characteristics in this cohort highlight a potential diagnosis gap - particularly for patients with rural residence or high county-level socioeconomic deprivation. Given frequent healthcare utilization and clinical complexity, primary care may require additional resources to meet patient needs.},
}

@article {pmid41694691,
year = {2026},
author = {Mallinson, PA and Birk, N and Henderson, AD and Lewin, A and Shah, AS and Mehrkar, A and Goldacre, B and Babu, GR and Banjara, SK and , and Tomlinson, LA and Kinra, S and Mathur, R},
title = {Ethnic differences in Long COVID diagnosed in primary care in England (2020-2022): an observational cohort study using OpenSAFELY.},
journal = {The Lancet regional health. Europe},
volume = {63},
number = {},
pages = {101605},
pmid = {41694691},
issn = {2666-7762},
abstract = {BACKGROUND: Long COVID continues to affect millions of adults and contribute to substantial economic burden across Europe. Ethnic inequalities in Long COVID, and the reasons underlying these, are poorly understood. We aimed to investigate ethnic differences in the incidence of diagnosed Long COVID in England using linked national primary care data.

METHODS: With approval from NHS England, we used linked health record data from England, 2020-2022, accessed through the OpenSAFELY platform. We applied Cox regression to compare incidence of diagnosed Long COVID in primary care across self-reported ethnicity in five groups. We explored potential explanations for these differences by 1) adjusting for sociodemographic and health-related factors, 2) restricting to those tested or hospitalised with COVID-19, 3) stratifying into 16 ethnic sub-groups.

FINDINGS: Our sample comprised 17,848,825 adults, of whom 16,970 (0.1%) had a diagnosis of Long COVID recorded in primary care. Hazard ratios (95% confidence intervals) for Long COVID compared with the white group were 1.04 (0.98-1.11) for the South Asian group, 0.84 (0.75-0.94) for the Black group, 0.97 (0.84-1.13) for the Mixed Ethnicity group, and 0.63 (0.55-0.72) for Other ethnic groups, which remained similar when adjusting for sociodemographic and health-related factors and among those tested or hospitalised for COVID-19. Disaggregating into 16 ethnic sub-groups revealed heterogeneity within groups, for example, compared with the White British group, hazard ratios were 1.21 (1.00-1.47) for the Bangladeshi group and 1.09 (0.99-1.21) for the Pakistani group, but 0.77 (0.70-0.86) for the Indian group; and 1.15 (0.95-1.40) for the Black Caribbean group but 0.61 (0.51-0.72) for the Black African group.

INTERPRETATION: Differences in Long COVID diagnoses across broad ethnic groups mask important sub-group inequalities, offering insight into underlying mechanisms and approaches to better target Long COVID services.

FUNDING: The OpenSAFELY platform is principally funded by grants from: NHS England [2023-2025]; The Wellcome Trust (222097/Z/20/Z) [2020-2024]; MRC (MR/V015737/1) [2020-2021]. Additional contributions to OpenSAFELY and this analysis have been funded by grants from: MRC via the National Core Study programme, Longitudinal Health and Wellbeing strand (MC_PC_20030, MC_PC_20059) [2020-2022] and the Data and Connectivity strand (MC_PC_20058) [2021-2022]; NHS England via the Primary Care Medicines Analytics Unit [2021-2024]; NIHR and MRC via the CONVALESCENCE programme (COV-LT-0009, MC_PC_20051) [2021-2024] and MRC (MR/V040235/1) [2021-24].},
}

@article {pmid41693716,
year = {2026},
author = {Trbojević, T and Kovačević, A and Kukuruzović, M and Šeparović, I and Bašić Kes, V and Malenica, M},
title = {Neurological Symptoms as (Post) Pandemic Burden in Children and Adolescents-Single Tertiary Center Experience from Croatia.},
journal = {Iranian journal of child neurology},
volume = {20},
number = {1},
pages = {63-69},
pmid = {41693716},
issn = {1735-4668},
abstract = {OBJECTIVES: Although COVID-19 primarily affects the respiratory system, the central and peripheral nervous system may be involved. Neurological manifestations of COVID-19 infection occur in acute or post-acute stages and may persist as long-lasting symptoms known as "long-COVID" or "post-COVID-19". This study aimed to investigate the clinical profile, outcomes, and management of neurological manifestations after COVID-19 infection in children.

MATERIALS & METHODS: A retrospective chart review was conducted of all pediatric patients admitted to our tertiary pediatric center with neurological symptoms following COVID-19, meeting criteria for long COVID-19/post-COVID-19, from December 2020 through the end of 2021, with a one-year follow-up period.

RESULTS: Eighty-four patients were included (median age 12.7 years; range, 0.5-18 years). Girls were more affected than the boys (female n = 51; 60.7%, χ2 = 3, 86; p = 0,049). The most common neurological manifestation were headache (n = 47; 55.95%), dizziness (n = 19; 22.6%), visual disturbances (n = 9; 10.7%), afebrile seizures (n = 6; 7.1%), and anosmia/hyposmia (n = 4; 4.7%). Overall, 19 (22.6%) patients required psychological support, of whom 4 (4.8%) patients required psychiatric consultation due to suspected mental disorder. The most significant number of patients with neurological symptoms after COVID-19 was observed between October 2020 and March 2021 (n=44, 52.4%).

CONCLUSION: The obtained findings align with the results from similar studies and show that neurological manifestations after COVID-19 infection appear more frequently in school-aged children, predominantly in female patients. Neurological post-COVID-19 symptoms require medical attention to exclude more severe conditions.},
}

@article {pmid41690938,
year = {2026},
author = {Walders, J and Wetz, S and Costa, AS and Hofmann, A and Schulz, JB and Reetz, K and Dadsena, R},
title = {Longitudinal modeling of Post-COVID-19 condition over three years: A machine learning approach using clinical, neuropsychological, and fluid markers.},
journal = {Scientific reports},
volume = {16},
number = {1},
pages = {6517},
pmid = {41690938},
issn = {2045-2322},
abstract = {Post-COVID-19 condition (PCC) manifests with prolonged, heterogeneous symptoms challenging both, diagnosis and therapeutic management. This three-year longitudinal study analyzed data from 93 adults (mean age of 48.9 ± 14.0, 60 female) after confirmed SARS-CoV-2 infection. Every follow-up visit included clinical, neuropsychological, and laboratory assessments, capturing multidimensional indicators of patient health. A machine learning framework was implemented to classify temporal stage of patient health status, identify visit-specific predictive markers, and manage incomplete data using both native handling in tree-based models and explicit imputation techniques. Gradient boosting methods consistently achieved the best performance across all visit comparisons, achieving F1-scores close to or above 90%. Classification performance improved with greater time intervals between visits, suggesting progressive divergence in patient phenotypes over time. For discriminating follow-up stages, inflammatory markers emerged as the most informative predictors, followed by SARS-CoV-2 antibody levels and neuropsychiatric measures for fatigue and cognitive performance. Interpretability analyses using SHAP and LIME confirmed the contribution of these features, while revealing shifts in feature relevance across years. These findings highlight the utility of machine learning in characterizing follow-up stage separability in PCC and offer clinically interpretable insights that prioritize immune and neuropsychological measures for monitoring and risk-stratified follow-up.},
}

@article {pmid41687822,
year = {2026},
author = {Zhou, T and Zhang, B and Zhang, D and Jhaveri, R and Chen, J and Becich, MJ and Castro, L and Chen, Y and Chilukuri, N and Herring, S and Lei, Y and Li, L and Lu, Y and Hornig, M and Khalsa, AS and Liebovitz, D and Mosa, ASM and Taylor, BW and Tedla, Y and Thodeson, D and Tong, J and Wu, Q and Forrest, CB and Chen, Y},
title = {Pre-COVID-19 Body Mass Index and Postacute Cardiovascular, Gastrointestinal, and Neuropsychiatric Outcomes Among Children and Young Adults With SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Initiative.},
journal = {The Journal of infection},
volume = {},
number = {},
pages = {106702},
doi = {10.1016/j.jinf.2026.106702},
pmid = {41687822},
issn = {1532-2742},
abstract = {OBJECTIVES: Post-acute sequelae of SARS-CoV-2 infection (PASC) can affect multiple organ systems, but the role of preinfectional body mass index (BMI) in these outcomes among children and young adults remains unclear. We aimed to evaluate the association between pre-COVID-19 BMI status and post-acute cardiovascular, gastrointestinal, and neuropsychiatric outcomes in children and young adults.

METHODS: We conducted a retrospective cohort study using data from 139320 individuals aged 5 to 20 years with confirmed SARS-CoV-2 infection between March 2020 and September 2023 across 20 U.S. pediatric health systems participating in the RECOVER initiative. Pre-infection BMI was defined using measurements obtained within 18 months before the index date and categorized as healthy weight, overweight, obesity, or severe obesity; when multiple values were available, the most recent measurement was selected. We assessed incident postacute cardiovascular, gastrointestinal, and neuropsychiatric symptoms and conditions occurring 28 to 179 days post-infection. Adjusted relative risks (RRs) were estimated using modified Poisson regression models, comparing elevated BMI categories to the healthy weight.

FINDINGS: Among 139320 participants (mean [SD] age, 13.0 [4.3] years; 51.6% female), severe obesity was associated with a higher risk of cardiovascular disorders (adjusted RR 2.56; 95% CI 1.93-3.41), particularly hypertension (adjusted RR 3.68; 95% CI 2.65-5.11). Severe obesity was also linked with increased risks of diarrhea (adjusted RR 1.34; 95% CI 1.10-1.64) and gastroesophageal reflux disease (adjusted RR 1.29; 95% CI 1.06-1.58). Associations between BMI and neuropsychiatric outcomes were heterogeneous, with inverse associations observed for some conditions, including anxiety and major depression.

INTERPRETATION: In this cohort study, pre-COVID-19 BMI status was associated with the risk and pattern of postacute cardiovascular and gastrointestinal outcomes among children and young adults. Association between pre-infection BMI and neuropsychiatric outcomes was more variable and should be interpreted with caution. These findings suggest BMI-stratified post-COVID-19 monitoring strategies may help inform long-term care in youth.},
}

@article {pmid41685877,
year = {2026},
author = {Fichera, A and Biancareddu, E and Bozzo, M and Ezenwa, M and Ongarini, EP and Ferrari, FG and Prefumo, F and Odicino, FE},
title = {Long COVID following SARS-CoV-2 infection during pregnancy: An observational study in a large Italian hospital during the COVID-19 pandemic.},
journal = {Acta obstetricia et gynecologica Scandinavica},
volume = {},
number = {},
pages = {},
doi = {10.1111/aogs.70127},
pmid = {41685877},
issn = {1600-0412},
abstract = {INTRODUCTION: Despite mounting evidence on Long COVID, data regarding its impact on women infected during pregnancy remains scarce. This study aimed to assess the development of Long COVID in women who had been infected with SARS-CoV-2 during pregnancy, focusing on possible risk factors and potential protective elements associated with its development.

MATERIAL AND METHODS: We analyzed a cohort of 348 pregnant women with laboratory-confirmed SARS-CoV-2 infection admitted to ASST-Spedali Civili (Brescia, Italy) between March 2020 and May 2022. Data collection included demographics, comorbidities, COVID-19 severity markers, and vaccination status. To assess the possible association between the analyzed risk factors and Long Covid, beyond standard multivariable models, we employed inverse probability weighting techniques (IPTW) and calculated e-values to assess unmeasured confounding.

RESULTS: Among study participants, 27.0% (94/348) developed Long COVID. Risk factors included preexisting respiratory comorbidities (adjusted OR = 3.171, 95% CI 0.99-10.1), pneumonia at admission (adjusted OR = 4.48, 95% CI 2.16-9.28), and earlier pregnancy stage at infection (adjusted OR = 0.96 per week, 95% CI 0.93-0.99). COVID-19 vaccination was associated with a significantly lower risk of Long COVID (15.5% in vaccinated vs. 31.8% in unvaccinated women; IPTW-adjusted OR = 0.38, 95% CI: 0.20-0.71, p-value: 0.003). The most common symptoms were fatigue (46.8%) and memory impairment (38.3%), with unvaccinated patients exhibiting a higher prevalence of neuropsychiatric symptoms.

CONCLUSIONS: Our data suggest that one in four pregnant women hospitalized with COVID-19 develop persistent symptoms. The most frequently affected women had preexisting respiratory disease, pneumonia at admission, and infection earlier in pregnancy. COVID-19 vaccination appears to reduce risk and alter symptom presentation. These findings underscore the importance of vaccination throughout pregnancy and highlight the need for targeted surveillance in high-risk subgroups.},
}

@article {pmid41685290,
year = {2025},
author = {Jimenez, M and Lopez, M and Miller, J and Okubadejo, NU and Hurtado, C and Singh, AK and Ojo, OO and Rojas-Gualdron, DF and Akase, I and Agabi, OP and Kumar, K and Tomar, BS and Nathiya, D and Jules, R and Liotta, EM and Koralnik, IJ},
title = {A cross-continental comparative analysis of the neurological manifestations of Long COVID.},
journal = {Frontiers in human neuroscience},
volume = {19},
number = {},
pages = {1760173},
pmid = {41685290},
issn = {1662-5161},
abstract = {OBJECTIVE: To compare demographics, comorbidities, neurologic symptoms, quality of life, and cognitive outcomes among adult individuals with neurologic manifestations of post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) across countries with varying income levels: the United States (U.S.), Colombia, Nigeria, and India.

METHODS: In this multi-country observational study, participants were evaluated in hospital clinics and recruited from institutional databases between 2020 and 2025. Patients were categorized as post-hospitalization Neuro-PASC (PNP) or non-hospitalized Neuro-PASC (NNP). Cognitive assessments were performed using the NIH Toolbox (U.S. and Colombia), the Montreal Cognitive Assessment (Nigeria), or the Mini-Mental State Examination (India).

RESULTS: A total of 3,157 participants were enrolled (652 PNP; 2,505 NNP). PNP patients were predominantly male except in the US, while NNP patients were predominantly female, except in India. The most frequent neurologic symptoms were brain fog, myalgia, dizziness, headache, and sensory disturbances, with frequency highest in the U.S. and lowest in India. There were significant differences for most neurologic and non-neurologic symptoms of PASC, driven by higher frequencies in U.S. and Colombia in both PNP and NNP cohorts. In addition, cognitive impairment measured with different instruments varied across countries for both PNP and NNP groups. Multiple correspondence analysis showed clustering of symptom burden between U.S./Colombia and Nigeria/India.

CONCLUSION: Neuro-PASC presents globally but symptom burden, and psychological distress vary across regions, likely influenced by sociocultural factors, healthcare access, and diagnostic tools. These findings highlight the need for culturally-adapted screening and post-COVID care worldwide.},
}

@article {pmid41683839,
year = {2026},
author = {Chen, JJ and Hsu, CW and Wang, HY and Stubbs, B and Chen, TY and Liang, CS and Chen, YW and Zeng, BS and Tseng, PT},
title = {Audiovestibular Dysfunction Related to Long COVID-19 Syndrome: A Systematic Review of Characteristics, Pathophysiology, Diagnosis, and Management.},
journal = {International journal of molecular sciences},
volume = {27},
number = {3},
pages = {},
doi = {10.3390/ijms27031417},
pmid = {41683839},
issn = {1422-0067},
mesh = {Humans ; *COVID-19/complications/physiopathology/diagnosis ; SARS-CoV-2 ; *Vestibular Diseases/diagnosis/therapy/physiopathology/etiology ; Post-Acute COVID-19 Syndrome ; },
abstract = {Long COVID-19 syndrome (or so-called post-COVID-19) is indicated by miscellaneous symptoms, usually starting 3 months from the COVID-19 infection and lasting for at least 2 months, which cannot be explained by an alternative diagnosis. There has been more and more reports addressing the audiovestibular dysfunction related to long COVID-19 syndrome. Emerging evidence suggests that the linkage between audiovestibular dysfunction and long COVID-19 syndrome might rely on (a) direct inner ear system damage related to viral invasion and consequent inflammation, (b) micro thromboembolic events, which might result from the COVID-19-induced autoimmune reaction against endothelial cells, and consequent transient-ischemia and hypoxia of the auditory pathways, (c) the disturbed nerve conduction in vestibulocochlear nerves due to viral invasion, and finally (d) altered auditory cortex function, either imbalanced central gain or neurotransmitter disturbance. However, most of the aforementioned mechanism remained hypothetic and still needed further studies to approve or refute. This systematic review synthesizes current evidence on the characteristics, pathophysiology, diagnostic approaches, and management of audiovestibular dysfunction related to long COVID-19 syndrome. Literature searches across PubMed, Embase, ClinicalKey, Web of Science, and ScienceDirect (up to 15 December 2025) were conducted in accordance with PRISMA guidelines. Through this systematic review, we provided a schematic diagram of the physiopathology of long COVID-19 syndrome-related audiovestibular dysfunction. Further, we summarized the currently available diagnostic tools to explore the audiovestibular function in such patients. The currently available treatment, either pharmacotherapy or nonpharmacotherapy, mainly tackles idiopathic audiovestibular dysfunction but not specifically long COVID-19 syndrome-related audiovestibular dysfunction. Timely recognition and intervention may prevent progression to permanent hearing loss or vestibular disability, improving quality of life. Trial registration: PROSPERO CRD420251265741.},
}

Humans
*COVID-19/complications/physiopathology/diagnosis
SARS-CoV-2
*Vestibular Diseases/diagnosis/therapy/physiopathology/etiology
Post-Acute COVID-19 Syndrome

@article {pmid41683343,
year = {2026},
author = {Kodama, S and Nakata, M and Konishi, N and Yoshino, M and Fujisawa, A and Naganuma, M and Kobayashi, Y and Hirai, Y and Kitagawa, A and Miyokawa, M and Mishima, R and Teramukai, S and Fukushima, M},
title = {Vitamin D in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome After COVID-19 or Vaccination: A Randomized Controlled Trial.},
journal = {Nutrients},
volume = {18},
number = {3},
pages = {},
doi = {10.3390/nu18030521},
pmid = {41683343},
issn = {2072-6643},
support = {n/a//Japanese Society for Vaccine Related Complications/ ; },
mesh = {Humans ; *Fatigue Syndrome, Chronic/etiology/drug therapy/blood ; *Vitamin D/blood/administration & dosage/therapeutic use/analogs & derivatives ; Male ; Female ; *Vitamin D Deficiency/drug therapy/complications/blood ; *COVID-19/complications/prevention & control ; Middle Aged ; Adult ; Dietary Supplements ; SARS-CoV-2 ; *Vaccination/adverse effects ; *COVID-19 Vaccines/adverse effects ; Treatment Outcome ; },
abstract = {Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can develop as post-vaccination syndrome (PVS) or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). In our prior retrospective study, most patients with PVS who developed ME/CFS had vitamin D insufficiency or deficiency. We evaluated the efficacy of vitamin D replacement therapy guidance for ME/CFS symptom improvement in patients with vitamin D insufficiency or deficiency. Methods: This open-label randomized controlled trial enrolled 91 participants with ME/CFS as PVS or PASC and serum 25(OH) vitamin D < 30 ng/mL across five clinical sites. Participants were randomized 1:1 to intervention (active vitamin D preparation plus vitamin D replacement therapy guidance: 25 μg daily supplementation, dietary counseling, sun exposure, and exercise) or control (active vitamin D preparation alone) for 12 weeks. The primary endpoint was the change in ME/CFS symptom count from screening to Week 12. Results: Mean symptom change was -6.7 in the intervention group versus -1.2 in the control group (between-group difference -5.6; 95% CI: -7.2, -3.9; p < 0.001). Serum 25(OH) vitamin D improved from 18.6 to 27.1 ng/mL in the intervention group, while the control group showed a decreasing trend (between-group difference 10.2 ng/mL; 95% CI: 7.9, 12.5). Achievement of <8 symptoms (i.e., no longer meeting ME/CFS diagnostic criteria) was significantly higher in the intervention group, with 16 participants achieving this threshold compared to 1 in the control group (p < 0.001). Subgroup analyses showed consistent benefit in both PVS (n = 56) and PASC (n = 29) cohorts. Conclusions: Vitamin D replacement therapy guidance significantly reduced ME/CFS symptoms along with improvement of serum 25(OH) vitamin D levels in patients with vitamin D insufficiency or deficiency who developed ME/CFS as PVS or PASC.},
}

Humans
*Fatigue Syndrome, Chronic/etiology/drug therapy/blood
*Vitamin D/blood/administration & dosage/therapeutic use/analogs & derivatives
Male
Female
*Vitamin D Deficiency/drug therapy/complications/blood
*COVID-19/complications/prevention & control
Middle Aged
Adult
Dietary Supplements
SARS-CoV-2
*Vaccination/adverse effects
*COVID-19 Vaccines/adverse effects
Treatment Outcome

@article {pmid41682777,
year = {2026},
author = {Oz, A and Yildirim, T},
title = {Association Between Post-COVID-19 Infection and Fibromyalgia: A Controlled Case-Control Study.},
journal = {Journal of clinical medicine},
volume = {15},
number = {3},
pages = {},
doi = {10.3390/jcm15031098},
pmid = {41682777},
issn = {2077-0383},
abstract = {Background: Persistent musculoskeletal pain has been increasingly reported following COVID-19 infection. However, the association between post-COVID-19 infection and fibromyalgia diagnosed using standardized criteria remains incompletely understood. Objective: This study aimed to investigate the association between post-COVID-19 infection and fibromyalgia diagnosed according to the 2016 American College of Rheumatology (ACR) criteria. Methods: In this case-control study, individuals with post-COVID-19 infection were compared with COVID-19-negative controls. Fibromyalgia was diagnosed using the ACR 2016 criteria. Clinical assessments were performed under standardized conditions. Patients with ongoing symptoms compatible with long COVID were excluded based on clinical evaluation. Results: The prevalence of fibromyalgia was significantly higher in participants with post-COVID-19 infection compared with controls. Individuals in the post-COVID group demonstrated higher odds of meeting ACR 2016 fibromyalgia criteria and exhibited greater symptom burden across clinical measures. These findings indicate a robust association between post-COVID-19 infection and subsequent fibromyalgia diagnosis. Conclusions: Post-COVID-19 infection was associated with an increased likelihood of fibromyalgia diagnosed using standardized criteria. While causality cannot be inferred due to the observational design, the findings highlight the importance of considering fibromyalgia in patients presenting with persistent musculoskeletal pain after COVID-19 and support further longitudinal and mechanistic research. These findings should be interpreted in light of the observational design and potential selection bias inherent to the case-control methodology.},
}

@article {pmid41676584,
year = {2026},
author = {Song, Y and Mehl, F and No, T and Livingston, L and Quintero Barbosa, JS and Hayashi, J and Serrero, G and Bortz, PS and Wilson, JM and Crowe, JE and Ho, DD and Yin, MT and Tan, J and Zeichner, SL},
title = {ACE-2-like Enzymatic Activity in Anti-SARS-CoV-2 Spike Protein Monoclonal Antibodies.},
journal = {bioRxiv : the preprint server for biology},
volume = {},
number = {},
pages = {},
doi = {10.64898/2026.02.02.703244},
pmid = {41676584},
issn = {2692-8205},
abstract = {Many people are affected by post-acute sequelae of COVID-19 (PASC/long COVID, LC). LC has severely affected public health. Features of LC including blood pressure dysregulation, coagulopathies, hyperinflammation, and neuropsychiatric complaints. Mechanisms responsible for LC pathogenesis are not clear. The receptor for SARS-CoV-2 is human angiotensin converting enzyme 2 (ACE2), which binds SARS-CoV-2 spike protein receptor-binding domain (RBD) to initiate infection. We hypothesized that some people produce anti-RBD antibodies that sufficiently resemble ACE2 structure to have ACE2-like catalytic activity. Those antibodies, ACE2-like abzymes, may contribute to LC pathogenesis. We previously showed that ACE2-like activity was associated with immunoglobulin in some people with acute and convalescent COVID-19. ACE2-like catalytic activity correlated with blood pressure changes following moderate exercise challenge in convalescents. We screened human monoclonal antibodies (mAbs) against SARS-CoV-2 spike protein from 4 sources. We identified 4 human mAbs with ACE2-like catalytic activity. The activity was not inhibited by MLN-4760, a compound that inhibits native human ACE2, nor by EDTA, unlike native ACE2, a Zinc metalloprotease, but was inhibited by an overlapping pool of Spike peptides. Enzyme kinetic studies showed that the mAbs had lower Vmax and Km values than ACE2. The data suggested that the antibodies cleave angiotensin II via a different mechanism than ACE2. Identification of mAbs with ACE2-like catalytic activity supports the hypothesis that antibodies induced by SARS-CoV-2 infection could help mediate the pathogenesis of COVID-19 and LC, and more generally, the hypothesis that catalytic antibodies induced by infectious agents can contribute to disease pathogenesis.},
}

@article {pmid41675585,
year = {2026},
author = {Boskabadi, AR and Poorzand, H and Vaezi, A and Afshar, S and Tayyebi, M and Morovatdar, N},
title = {Increased Arrhythmia Risk in Long COVID: A Systematic Review and Meta-Analysis.},
journal = {Journal of arrhythmia},
volume = {42},
number = {1},
pages = {e70278},
pmid = {41675585},
issn = {1880-4276},
abstract = {BACKGROUND: COVID-19 infection can cause significant long-term health problems for patients. While there is no universally accepted definition for long COVID, it is usually identified by persistent symptoms that extend past 4 weeks after the initial SARS-CoV-2 infection with no other explanation. The cardiovascular system is one of the most important systems involved in long COVID, and even asymptomatic patients have evidence of cardiovascular injury after COVID-19. This study aims to determine the long-term risk of developing cardiac arrhythmias after SARS-CoV-2 infection.

METHODS: A comprehensive systematic search on Scopus, PubMed, Science Direct, and Web of Science databases was performed on August 24th, 2025. Cohort articles consisting of a healthy control group with no history of COVID-19 infection and individuals who recovered from COVID-19 for at least 30 days were included. Hazard Ratio (HR) and 95% confidence intervals (CI) were estimated using random-effect models.

RESULTS: Fourteen studies were eligible for the meta-analysis. The overall arrhythmia risk was higher in patients with long COVID (HR: 1.74, 95% CI [1.39, 2.10], I [2] = 99.65%). Specific arrhythmias examined included atrial fibrillation (HR: 1.49, 95% CI [1.24, 1.73], I [2] = 98.57%), sinus tachycardia (HR: 1.69, 95% CI [1.21, 2.18], I [2] = 99.51%), sinus bradycardia (HR: 1.58, 95% CI [1.50, 1.66], I [2] = 65.80%), and ventricular arrhythmias (HR: 1.72, 95% CI [1.48, 1.95], I [2] = 96.89%). Patients with a more severe initial infection were at a higher risk of developing arrhythmias.

CONCLUSIONS: The risk of developing cardiac arrhythmias is increased after COVID-19 infection in the long term.},
}

@article {pmid41675440,
year = {2026},
author = {Khurana, MP and Brünnich Sloth, MM and Scheidwasser, N and Curran-Sebastian, J and Morgenstern, C and Banholzer, N and Thein, D and Mortensen, LH and Rasmussen, M and Jokelainen, P and Møller, FT and Stegger, M and Krause, TG and Cameron, E and Duchêne, DA and Katsiferis, A and Bhatt, S},
title = {SARS-CoV-2 reinfections and subsequent risk of hospital-diagnosed post-acute sequelae in Denmark (2020-2022): a nationwide cohort study.},
journal = {The Lancet regional health. Europe},
volume = {63},
number = {},
pages = {101601},
pmid = {41675440},
issn = {2666-7762},
abstract = {BACKGROUND: Post-acute sequelae of COVID-19 (PASC), or long COVID, are a public health concern. While most recover from SARS-CoV-2 infections within weeks, some experience persistent symptoms. Here, we quantified the association between repeated SARS-CoV-2 infections and the risk of hospital-diagnosed PASC.

METHODS: We conducted a nationwide register-based cohort study of all adults in Denmark (≥18 years) with at least one SARS-CoV-2 PCR or antigen test between April 1, 2020, and December 31, 2022. Participants were followed from first test until long COVID diagnosis (ICD-10: B948A), death, emigration, three SARS-CoV-2 infections, or end of study. Risk of long COVID diagnosis was estimated at three timepoints after study entry (180 days, 1 year, 2 years) and the outcomes were assessed during the 180 days after each timepoint. Cause-specific Cox models treated death as a competing risk, with number of infections and vaccination status as time-varying covariates. Absolute risks and differences were estimated using G-computation. Analyses were stratified by sex, income, and vaccination status. Secondary analyses assessed fatigue and headache (ICD-10), excluding individuals with prior diagnoses.

FINDINGS: Of 4,418,544 individuals, 6942 (0.16%) were diagnosed with long COVID. The absolute risk of a diagnosis increased following reinfection (0.73% [95% CI 0.69-0.77] after one infection vs. 1.16% [1.05-1.30] after two infections at 180 days), but differences were small and decreased over time. Risks following reinfection were similar across sex and income strata. Absolute risk decreased with prior vaccinations. Secondary analyses showed no increased risk of fatigue or headache after primary infection. A small increase in fatigue risk was observed after reinfection at 1 year (RD 0.03% [0.01-0.05]), but not for headache.

INTERPRETATION: Reinfection increases long COVID risk; however, the absolute increase after reinfection is smaller than that observed after a primary infection. Vaccination offers substantial protection against long COVID.

FUNDING: Danish National Research Foundation (DNRF).},
}

@article {pmid41674904,
year = {2025},
author = {Chen, J and Guo, D and Guo, X and Zhao, L and Li, G and Liu, H and Wang, S and Lao, Z and Zhu, M},
title = {Broad-spectrum inhibition of SARS-CoV-2 variants by dibutyl phthalate through allosteric disruption of Spike-ACE2 interface.},
journal = {Frontiers in microbiology},
volume = {16},
number = {},
pages = {1610775},
pmid = {41674904},
issn = {1664-302X},
abstract = {INTRODUCTION: The persistent evolution of SARS-CoV-2 has diminished the efficacy of existing vaccines and antibodies, increasing the risks of reinfection and Long COVID. There is a significant need for the development of convenient, broad-spectrum antiviral agents that target the early stage of viral infection. Traditional Chinese Medicine (TCM) volatile oils, with their diverse components and suitability for nasal delivery, demonstrate potential against respiratory viruses. This study aimed to screen bioactive compounds from TCM volatile oils for their ability to inhibit the interaction between the SARS-CoV-2 spike (S) protein and its host receptor, ACE2.

METHODS: A virtual screening of 47 structurally diverse TCM volatile compounds was performed to identify potential inhibitors of the Spike-ACE2 interaction. The top candidate, dibutyl phthalate (DBP), was further evaluated using in vitro assays including Spike-mediated membrane fusion and pseudovirus infection. Its mechanism was investigated through ELISA, surface plasmon resonance (SPR), ACE2 enzymatic activity assays, molecular docking. To evaluate its broad-spectrum potential, membrane fusion assays were further performed using spike proteins from the wild-type (WT), Delta, and Omicron XBB.1.5 variants. Critical binding residues were identified through molecular docking and subsequently confirmed by site-directed mutagenesis of the Spike receptor-binding domain (RBD).

RESULTS: Virtual screening identified ten potential inhibitors, with dibutyl phthalate (DBP) showing the strongest activity. DBP effectively inhibited S protein-mediated membrane fusion (IC 50 = 64.53 μM) and pseudovirus infection (IC 50 = 73.06 μM) with specificity. SPR analysis confirmed that DBP competitively inhibited the binding between the S trimer and ACE2 (increasing the K D from 8.28 nM to 86.7 nM). Mechanistic studies revealed that DBP disrupts the S-ACE2 interaction by targeting the receptor-binding domain (RBD) without affecting ACE2 enzymatic activity. Furthermore, DBP exhibited broad-spectrum inhibitory activity against membrane fusion mediated by the Delta (IC 50 = 49.22 μM) and Omicron XBB.1.5 (IC 50 = 53.70 μM) spike variants. Molecular docking and subsequent site-directed mutagenesis identified Tyr453 and Tyr495 as critical residues for DBP binding and its inhibitory function.

DISCUSSION: This study elucidates for the first time that DBP functions as a broad-spectrum RBD inhibitor. It binds to the RBD-ACE2 interface, dependent on conserved residues Tyr453 and Tyr495, and acts primarily through steric hindrance to block the Spike-ACE2 interaction. Notably, DBP shares critical aromatic and ester groups with other active-site inhibitors. Structure-activity relationship analysis of its derivatives revealed that introducing additional hydrogen-bond acceptors significantly enhances inhibitory activity, providing a clear structure optimization strategy. While DBP has known toxicity, its antiviral potential may be harnessed through strategic delivery approaches or SAR-guided optimization to advance its development against SARS-CoV-2 variants.},
}

@article {pmid41674460,
year = {2026},
author = {McTiernan, K and Hughes, C and Gilheaney, Ó},
title = {Cognitive Communication, Voice and Swallowing Difficulties Experienced by Adults With Long-COVID: A Scoping Review.},
journal = {Health expectations : an international journal of public participation in health care and health policy},
volume = {29},
number = {1},
pages = {e70595},
pmid = {41674460},
issn = {1369-7625},
mesh = {Humans ; *COVID-19/complications ; *Deglutition Disorders/etiology ; *Voice Disorders/etiology ; *Communication ; Adult ; SARS-CoV-2 ; *Communication Disorders/etiology ; },
abstract = {BACKGROUND: Adults with Long-COVID frequently experience impairments in cognitive-communication, voice and swallowing, however, few comprehensive reviews of the existing literature has yet to be conducted to map the current research landscape. To go some way toward addressing this gap, this scoping review collected and analysed relevant published studies to identify reported symptoms related to cognitive communication, voice and swallowing in post COVID-19 patients and the assessments used to identify these difficulties.

OBJECTIVE: This study aimed to systematically map the existing literature on cognitive-communication, voice and swallowing difficulties in individuals living with Long-COVID and the assessments used to identify these difficulties.

METHODS: Four databases were searched to identify original research articles aligned with the study's objectives. Studies meeting the inclusion criteria were selected, and the findings were analysed with a specific focus on three key symptom domains: cognitive-communication, voice and swallowing.

RESULTS: Nineteen studies met the inclusion criteria. A broad range of assessments were used, and a broad range of symptoms were identified related to cognitive-communication, voice and swallowing difficulties in patients with Long-COVID-19. The symptoms reported most frequently in the selected studies included memory deficits, incomplete or inefficient glottic closure, paradoxical vocal fold motion during inspiration, episodes of choking, globus sensation, premature spillage and pyriform sinus residue.

CONCLUSION: Despite limited prior research in this area, the findings underscore the significant impact that COVID-19 infection may have on cognitive communication, voice and swallowing functions. Post-COVID-19 patients report a wide array of challenges in these domains. As a result, further clinical research is essential to develop patient-centred care strategies and to equip healthcare professionals with the expertise required for effective management of this group of patients.},
}

Humans
*COVID-19/complications
*Deglutition Disorders/etiology
*Voice Disorders/etiology
*Communication
Adult
SARS-CoV-2
*Communication Disorders/etiology

@article {pmid41670237,
year = {2026},
author = {Clarke, J and Jha, S and Prociuk, D and Mayer, E and de Lusignan, S and Smith, N and Milne, R and Lee, C and Kock, J and Sivan, M and Delaney, BC and , },
title = {Exploring the Intensity and Continuity of Hospital Care for Patients With Long Covid: Evidence From an English Urban Healthcare System.},
journal = {Health expectations : an international journal of public participation in health care and health policy},
volume = {29},
number = {1},
pages = {e70527},
pmid = {41670237},
issn = {1369-7625},
support = {//This study was supported by the National Institute for Health and Care Research. This work is supported by grants from the National Institute for Health and Care Research (NIHR - Ref: COV-LT2-0016) and NHS England. JC acknowledges funding from the Wellcome Trust (215938/Z/19/Z). The views expressed in this publication are those of the authors and not necessarily those of NIHR, The Department of Health and Social Care, or NHS England./ ; },
mesh = {Humans ; *COVID-19/therapy/epidemiology ; Retrospective Studies ; *Continuity of Patient Care/statistics & numerical data ; Male ; Female ; Middle Aged ; London/epidemiology ; Aged ; Adult ; Secondary Health Care/statistics & numerical data ; SARS-CoV-2 ; Hospitalization/statistics & numerical data ; *Urban Health Services/statistics & numerical data ; },
abstract = {BACKGROUND: Long Covid (LC) is a multisystem condition leading to a wide range of symptoms and often requiring treatment by several different clinical specialties. Patients with LC have reported difficulties in accessing care and a lack of coordination of their care, particularly in a hospital setting.

OBJECTIVE: To determine the extent to which the intensity and continuity of hospital care changes for patients after they receive an LC diagnosis.

DESIGN: Retrospective observational cohort study using a linked primary and secondary care dataset.

SETTING AND PARTICIPANTS: Routine healthcare data from North West London Integrated Care System of patients with a recorded diagnosis of LC who had attended a secondary care hospital Trust from 1 January 2019 to 30 September 2023.

MAIN VARIABLES STUDIED: The intensity of utilisation of secondary care was calculated, and the continuity of care with respect to hospitals and specialties was computed using the sequential continuity score (SeCon) before the Covid-19 pandemic, before and after an LC diagnosis.

RESULTS: 5611 out of 6270 (90.1%) patients diagnosed with LC had a recorded secondary care interaction in the study period. Intensity of secondary care utilisation increased markedly in outpatient, inpatient and Emergency Department pathways after a diagnosis of LC but peaked in the week of diagnosis. Average hospital SeCon fell significantly after an LC diagnosis from 1.00 to 0.83, while specialty SeCon remained unchanged from after diagnosis (0.40) and before the pandemic (0.44). A notable shift in specialty activity was observed with a focus on respiratory medicine as a major hub in a densely connected patient-sharing network with cardiology and other medical and surgical specialties.

DISCUSSION: A recorded LC diagnosis was associated with increases in the intensity of hospital activity and a reduction in hospital-level care continuity, but no change in specialty continuity, which remains low.

CONCLUSION: Collectively, this indicates a significant need to support LC patients as they navigate fragmented secondary care pathways.

This study was co-designed with, conducted with and written in conjunction with people with long Covid.},
}

Humans
*COVID-19/therapy/epidemiology
Retrospective Studies
*Continuity of Patient Care/statistics & numerical data
Male
Female
Middle Aged
London/epidemiology
Aged
Adult
Secondary Health Care/statistics & numerical data
SARS-CoV-2
Hospitalization/statistics & numerical data
*Urban Health Services/statistics & numerical data

@article {pmid41668172,
year = {2026},
author = {Kim, DY and Youn, J and Kang, N and Cho, SI and Ha, IH},
title = {Potential application of brain-gut axis-based treatments in Long COVID and ME/CFS: a case-based systematic review.},
journal = {Journal of translational medicine},
volume = {},
number = {},
pages = {},
doi = {10.1186/s12967-026-07807-w},
pmid = {41668172},
issn = {1479-5876},
abstract = {BACKGROUND: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID share clinical features including persistent fatigue, post-exertional malaise (PEM), and gastrointestinal (GI) dysfunction. Growing evidence implicates brain-gut axis dysregulation, characterized by dysbiosis, neuroinflammation within the central nervous system (CNS), increased intestinal permeability, and microbial translocation in their pathophysiology. However, therapeutic strategies targeting these pathways remain poorly defined.

METHODS: We report a case of post-COVID ME/CFS successfully treated with electroacupuncture (EA)-based deep peroneal nerve stimulation which was employed to potentiate the vagal reflex. Fatigue trajectories were assessed using the Multidimensional Fatigue Inventory over 12 weeks. Based on the case, a systematic review of randomized controlled trials (RCTs) evaluating brain-gut axis-modulating interventions in ME/CFS or Long COVID was conducted.

RESULTS: The patient exhibited a significant reduction in total fatigue, with early improvements in motivation and mental fatigue, and delayed improvement in physical fatigue following transient systemic symptom flares. Across included RCTs (n = 8, 790 participants), four investigated gut microbiome-modulating therapies and four employed nerve stimulation. Synbiotic and herbal interventions demonstrated benefits for fatigue or PEM, accompanied by alterations in specific bacterial populations or CNS metabolisms. Regarding nerve stimulation, transcranial direct current stimulation (tDCS) combined with exercise program improved fatigue, whereas standalone tDCS, auricular or peripheral TENS showed limited efficacy.

CONCLUSION: Brain-gut axis-based interventions may alleviate fatigue in ME/CFS and Long COVID by potentially modulating neuroinflammation, restoring microbiome balance, and improving epithelial barrier function. EA-based vagal stimulation represents a feasible option for patients with severe or treatment-resistant symptoms. Larger mechanistic studies and rigorously designed RCTs are needed to establish therapeutic targets and optimize intervention strategies.},
}

@article {pmid41667155,
year = {2026},
author = {Charlton, BT and Janssen, K and Systrom, DM and Putrino, D and Wüst, RC},
title = {Post-exertional malaise and the myth of cardiac deconditioning: rethinking the pathophysiology of long covid.},
journal = {British journal of sports medicine},
volume = {},
number = {},
pages = {},
doi = {10.1136/bjsports-2025-111387},
pmid = {41667155},
issn = {1473-0480},
}

@article {pmid41666312,
year = {2026},
author = {Kaushal, S and Bhandal, J and Birks, P and Greiner, J and Levin, A and Malbeuf, M and Schwartz, Z},
title = {Use of a Specialist Telephone Consultation Line for Long COVID in Primary Care in British Columbia: Retrospective Descriptive Quality Improvement Study.},
journal = {JMIRx med},
volume = {7},
number = {},
pages = {e57021},
doi = {10.2196/57021},
pmid = {41666312},
issn = {2563-6316},
abstract = {BACKGROUND: Long COVID (post-COVID-19 condition) continues to challenge primary care. To support family physicians in British Columbia, the general internal medicine (GIM) COVID-19 Rapid Access to Consultative Expertise (RACE) line was launched in August 2020 to provide real-time specialist advice.

OBJECTIVE: This quality improvement study aimed to evaluate the implementation and utilization of the GIM-COVID-19 Long-Term Sequelae RACE line in British Columbia. Specifically, it sought to characterize the demographics of patients involved in RACE consultations, identify the most common themes and clinical queries presented by primary care providers, and assess how usage patterns evolved over time during the COVID-19 pandemic.

METHODS: We conducted a retrospective descriptive analysis of 149 RACE line call summaries between August 2020 and June 2021. Six calls were excluded due to insufficient information, such as incomplete documentation or absence of a clear COVID-19-related question. Because the original extraction notes are no longer available, further details about these calls cannot be provided, leaving 143 eligible calls. Data extracted included patient age, sex, geographical location, symptom type, and timing of symptom onset post-COVID-19 infection. Calls were categorized by symptom duration (acute: <2 wk, subacute: 2-12 wk, chronic: >12 wk), thematic content (respiratory, fatigue, neurological, etc), and query type (symptom management, return-to-work, vaccination, etc). Data were coded independently by two reviewers using a standardized spreadsheet and predefined codebook. Discrepancies were resolved through discussion. Descriptive statistics summarized the findings.

RESULTS: Many calls involved female patients (91/143, 64%), with the most common age group being 40-49 years (32/113, 28%). Most calls came from Greater Vancouver (35/83, 42%) and the Fraser Valley (29/83, 35%). Subacute symptoms (52/149, 35%) and vaccination-related concerns (29/149, 19%) were the most common inquiry types. Symptom-related inquiries accounted for 92 of 143 calls (64%), with 253 symptoms documented overall. Respiratory symptoms were most common (100/253, 40%), especially shortness of breath (35 calls), cough (26), and fatigue (23). Call volumes peaked from January to June 2021, coinciding with the provincial vaccine rollout.

CONCLUSIONS: The GIM-COVID-19 Long-Term Sequelae RACE line served as a critical early support system for primary care providers as the long COVID landscape evolved. This quality improvement study emphasizes the value of rapid access and specialist-informed consultation tools during emerging public health challenges. The trends ascertained may inform future health system responses, particularly when designing more scalable, interdisciplinary models to support primary care in managing complex chronic conditions.},
}

@article {pmid41663609,
year = {2026},
author = {Barnden, L and Baraniuk, J and Inderyas, M and Eaton-Fitch, N and Marshall-Gradisnik, S and Thapaliya, K},
title = {Impaired brain intrinsic connectivity in long COVID during cognitive exertion revealed by independent component analysis.},
journal = {Scientific reports},
volume = {},
number = {},
pages = {},
doi = {10.1038/s41598-026-36986-1},
pmid = {41663609},
issn = {2045-2322},
abstract = {Cognitive dysfunction is a symptom of Long COVID. To characterize functional connectivity changes that may contribute to cognitive dysfunction in Long COVID (LCov), two consecutive 450 s functional magnetic resonance imaging (fMRI) scans (Runs 1 and 2) were acquired on a 7 Tesla MRI scanner. During both, the Stroop colour-word task engaged intrinsic brain networks for conflict detection, conflict resolution and response execution. In this exploratory study we acquired data from 19 LCov and 16 healthy control (HC) participants. The aggregate dataset was subjected to independent component analysis (ICA) for each run to isolate 15 components with distinct spatial and temporal signatures. For each component we tested (1) for differences between LCov and HC (inter-network) connectivity to the rest of the brain and (2) for correlation of LCov connectivity with illness duration. Stroop response times (RTs) were slower in LCov than in HC in both Runs (p = 0.001, 0.003). Each ICA component occupied the hubs of a known intrinsic network. LCov had different inter-network connectivity to HC for Salience, Language, Central Executive, Sensorimotor and Visual networks. LCov deficits in Salience inter-network connectivity in Run 2 were deeper and more widespread than in Run 1. In contrast, Run 2 connectivity was greater in LCov for the angular gyrus which integrates visual, motor and language inputs and responses. With longer illness duration, LCov connectivity weakened to critical networks but showed compensatory effects in Lingual gyri. Slower Stroop RTs in both Runs, and Salience, Language and Central Executive inter-network connectivity deficits, and illness duration dependence, support cognitive impairment in LCov with some compensatory connectivity increases.},
}

@article {pmid41663412,
year = {2026},
author = {Wu, SI and Lin, CJ and Lin, YJ and Lin, IC and Hwang, LC and Chen, WL},
title = {Efficacy of heat-treated Lacticaseibacillus paracasei PS23 for individuals with long coronavirus disease-19 syndrome: a double-blinded randomized control pilot study.},
journal = {Scientific reports},
volume = {16},
number = {1},
pages = {5368},
pmid = {41663412},
issn = {2045-2322},
support = {IAC-11302//University-Industry Cooperation Fund, Mackay Memorial Hospital, Taipei, Taiwan/ ; MMH-113-19, MMH-MM-11103, MMH-111-51, MMH-MM-11002, MMH-110-110, MMH-109112, MMH-10914//Department of Medical Research, Mackay Memorial Hospital/ ; },
}

@article {pmid41662153,
year = {2026},
author = {Sirotiak, Z and Amro, HJ and Thomas, EBK},
title = {The lived experience of long COVID: A thematic analysis of an in-depth interview study.},
journal = {PLOS mental health},
volume = {3},
number = {2},
pages = {e0000500},
doi = {10.1371/journal.pmen.0000500},
pmid = {41662153},
issn = {2837-8156},
abstract = {Long COVID is associated with significant physical and mental health burden, resulting in substantial quality of life limitations. The lived experience of individuals with long COVID is a vital consideration in evaluating the impact of the condition. Thirty-four adults with self-reported long COVID participated in a semi-structured in-depth interview study. An interview guide assessed physical and mental health symptoms, changes to plans, goals, and beliefs, and social impacts of long COVID. Participants were an average age of 51.6 years (SD = 17.0), and most identified as female (61.8%), white (97.1%), and not Hispanic or Latino/a/e (97.1%). Two coders read each interview while creating a codebook. The coders individually coded each interview transcript with themes emerging from the coded interviews. Each code reached an agreement level of at least 80%, with a Kappa (RK) score range of 0.90 to 0.98 in each interview, indicating adequate interrater reliability. Five themes emerged from the thematic analysis: decreased autonomy, decreased trust, changes in worldview, social impacts, and uncertainty. Individuals with long COVID reported heterogenous experiences, with often significant changes to daily functional abilities and outlook on life. Considering the unique lived experiences of individuals with long COVID will be important in developing a complete understanding of the condition and its implications.},
}

@article {pmid41657438,
year = {2026},
author = {Tervo, JP and Jacobson, PT and Vilarello, BJ and Saak, TM and Caruana, FF and Gallagher, LW and Gary, JB and Gudis, DA and Joseph, PV and Choo, TH and Devanand, DP and Goldberg, TE and Overdevest, JB},
title = {Interrelatedness of Neurocognitive Domain Functioning Between Unprompted and Prompted Identification Testing With Psychophysical Olfactory Evaluation in a Post-COVID-19 Cohort.},
journal = {World journal of otorhinolaryngology - head and neck surgery},
volume = {12},
number = {1},
pages = {56-65},
pmid = {41657438},
issn = {2589-1081},
abstract = {OBJECTIVE: Assessment of olfactory function with psychophysical testing requires cognitive demand to correctly pair test odors with remembered scents. Individuals suffering from long-Corona Virus Disease 2019 (long-COVID-19) may develop a decline in neurocognitive performance, which may be concurrent with persistent olfactory dysfunction (OD). Given the rigorous cognitive demand of the unprompted identification (UI) olfactory assessment, the goal of this study is to understand whether it could serve as a proxy for specific neurocognitive domains during clinical assessment of olfaction.

METHODS: Participants from our long-COVID cohorts with persistent OD underwent a panel of neurocognitive screening followed by olfactory assessment of threshold followed by unprompted (UI) and prompted identification (PI) tests using Sniffin' Sticks. Hierarchical linear mixed-effect models were used to understand the relative impact of each neurocognitive variable after controlling for demographics and olfactory threshold scores.

RESULTS: Neurocognitive variables demonstrated common correlation trends. Models containing Montreal Cognitive Assessment (MoCA) and digit-span backward scores had statistically significant fits for both UI (MoCA: χ [2] = 10.20, p = 0.001/digit-span backward: χ [2] = 4.27, p = 0.04) and PI (MoCA: χ [2] = 4.51, p = 0.03/digit-span backward: χ [2] = 5.04, p = 0.02) linear mixed-effect models, but UI was further explained by logical memory (χ [2] = 7.84, p = 0.005), verbal fluency (χ [2] = 8.79, p = 0.003), and digit-span forward (χ [2] = 12.30, p = 0.0004). These relationships were statistically significant after controlling for demographic and olfactory threshold covariates.

CONCLUSIONS: UI and PI have interrelated neurocognitive dependence on global cognition (MoCA) and executive function (digit-span backward) among long-COVID participants. As UI draws upon neurocognitive domains of episodic (logical memory), semantic (verbal fluency), and working memory (digit-span forward), the inclusion of a UI task may provide supplementary screening for cognitive impairments in those undergoing clinical olfactory assessment, particularly among those with lingering effects of COVID-19.},
}