Page 38 - IDF Journal 2023

IDF – Study Weekend IDF News – Spring 2023
COVID-19 diagnosis to study enrolment REFERENCES
was 333 days. 38 participants (73.1%) commenced treatment, 2 of whom (5.3%) defaulted from the regime due to the onset of diarrhoea and fatigue. In total
36 (69.2%) participants completed the questionnaire at the end of the treatment period. Improvement was reported in 6 of 7 parameters measured - recovery from COVID-19, limitation in activities of daily living, energy levels, pain levels, levels
of concentration and sleep disturbance. There was a trend towards improvement in mood but this was not statistically significant. The study concluded that LDN is safe in patients with LC and has the potential to improve well-being and reduce symptomatology in patients14.
In addition to supporting the neurological and neuropsychiatric problems associated with LC, it is evident that COVID-19 affects the immune system, and possibly the mitochondria, as some patients with LC have recurrent infections (including reactivation of previously latent herpes viruses-HSV, VZV, EBV, CMV). While ‘graded exercise’ has historically been recommended (inappropriately),
for the management of ‘chronic fatigue’, such a recommendation is contrary
to what LC patients need. Any type of stress, physical, mental, intellectual in nature, can lead to ‘crashing’ in these patients and can hinder recovery. Thus, rather than ‘pushing’, a ‘pacing’ protocol should be advised to patients.
In summary, a multidisciplinary approach needs to be taken to support the very complex symptoms that patients with LC present with. Brain inflammation and inflammation of the nerves coming out of the brain (including vagus, sympathetic/ parasympathetic systems) is triggering many of the signs and symptoms ‘downstream’. Interventions to decrease inflammation and to repair the immune system, including the use of LDN, and ‘neuro-rehab’ aimed at retraining the brain, similar to patients who have experienced a closed head injury, should be a part of any reparative LC plan
for recovery from this very debilitating condition.
1. England N, Improvement N. National Guidance for post-COVID syndrome assessment clinics. NHS England and NHS Improvement https://www england nhs uk/coronavirus/wpcontent/uploads/ sites/52/2020/10/C0840_PostCOVID_ assessment_clinic_guidance_5_ Nov_2020 pdf [accessed 2020 Nov 17]. 2020.
2. NHS. Long-term effects of coronavirus (long COVID). 2021.
3. CDC. Late Sequelae of COVID-19. 2020.
4. Bodenheimer T, Wagner EH, Grumbach
K. Improving primary care for patients with chronic illness. Jama. 2002;288(14):1775-9.
5. Leijten FR, Struckmann V, van Ginneken E, Czypionka T, Kraus M, Reiss M, et
al. The SELFIE framework for integrated care for multi-morbidity: development and description. Health policy. 2018;122(1):12- 22.
6. Broughan J, McCombe G, Avramovic G, Crowley D, Downey C, Downey O’Sullivan J, Fawsitt R, McHugh T, O’Connor E, Perrotta C, Cotter AG, Lambert JS, Cullen W. General practice attendances among patients attending a post-COVID-19 clinic: a pilot study. BJGP Open. 2021 May 11:BJGPO.2021.0016. doi: 10.3399/ BJGPO.2021.0016.
7. Cullen W, Avramovic G, Broughan J, Burke M-C, Cotter A, Crowley D, et al. Study Protocol: Prospective, observational,
cohort study o f COVID-19 in General Practice (North Dublin COVID-19 Cohort [‘ANTICIPATE’] Study)[version 1; peer review: awaiting peer. 2020.
8. https://epi-covid-19-hpscireland.hub.arcgis. com/ [accessed 05 July]. 2022.
9. Lund L, Hallas J, Nielsen H, Koch A, Mogensen S.H, Brun N.C, Christiansen C.F, Thomsen R.W, Pottegård A, Post-acute effects of SARS-CoV-2 infection in individuals not requiring hospital admission: a Danish population-based cohort study, The Lancet Infectious Diseases, 2021, https://doi. org/10.1016/S1473-3099(21)00211-5.
10.Yong SJ. Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ACS Chem Neurosci. 2021 Feb 17;12(4):573-580. doi: 10.1021/acschemneuro.0c00793. Epub 2021 Feb 4. PMID: 33538586; PMCID: PMC7874499.
11.Avramovic G, McHugh T, Connolly SP, Cullen W, Lambert JS. Anticipate study protocol: Baseline profile and care outcomes of patients attending Mater Misericordiae University Hospital with COVID-19 infection. HRB Open Res. 2021 Jan 18;3:52. doi: 10.12688/hrbopenres.13091.2.
12.O’Kelly B, Vidal L, Avramovic G, Broughan J, Connolly SP, Cotter AG, Cullen W, Glaspy S, McHugh T, Woo J, Lambert
JS. Assessing the impact of COVID-19
at 1-year using the SF-12 questionnaire: Data from the Anticipate longitudinal cohort study. Int J Infect Dis. 2022 May;118:236- 243. doi: 10.1016/j.ijid.2022.03.013. Epub 2022 Mar 14. PMID: 35301101; PMCID: PMC8920113.
13.Broughan J, McCombe G, O’Kelly B, Avramovic G, Fawsitt R, Glaspy S, Higgins M, McHugh T, Woo J, Vidal L, Lambert JS, Cullen W (In review), Mental health and alcohol use among patients attending a post-COVID-19 follow-up clinic: A cohort study. HRB Open Research, 2022.
14.Brendan O’Kelly, Louise Vidal, Tina McHugh, James Woo, Gordana Avramovic, John
S. Lambert, Safety and efficacy of low
dose naltrexone in a long covid cohort; an interventional pre-post study, Brain, Behavior, & Immunity - Health, 2022, 100485, ISSN 2666-3546,https://doi.org/10.1016/j. bbih.2022.100485.
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Professor John Lambert MD PHD
Professor of Medicine and Consultant in infectious diseases, UCD School of Medicine and The Mater and Rotunda Hospitals, Dublin, Ireland
Currently running a Long COVID clinic in Edinburgh monthly
Patients looking for more information, please see below
E: admin@iddoctor.eu T: +353 1716 4530