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BackgroundThe global prevalence of PASC is estimated to be present in 0{middle dot}43 and based on the WHO estimation of 470 million worldwide COVID-19 infections, corresponds to around 200 million people experiencing long COVID symptoms. Despite this, its clinical features are not well defined. MethodsWe collected retrospective data from 140 patients with PASC in a post-COVID-19 clinic on demographics, risk factors, illness severity (graded as one-mild to five-severe), functional status, and 29 symptoms and principal component symptoms cluster analysis. The Institute of Medicine (IOM) 2015 criteria were used to determine the ME/CFS phenotype. FindingsThe median age was 47 years, 59{middle dot}0% were female; 49{middle dot}3% White, 17{middle dot}2% Hispanic, 14{middle dot}9% Asian, and 6{middle dot}7% Black. Only 12{middle dot}7% required hospitalization. Seventy-two (53{middle dot}5%) patients had no known comorbid conditions. Forty-five (33{middle dot}9%) were significantly debilitated. The median duration of symptoms was 285{middle dot}5 days, and the number of symptoms was 12. The most common symptoms were fatigue (86{middle dot}5%), post-exertional malaise (82{middle dot}8%), brain fog (81{middle dot}2%), unrefreshing sleep (76{middle dot}7%), and lethargy (74{middle dot}6%). Forty-three percent fit the criteria for ME/CFS. InterpretationsMost PASC patients evaluated at our clinic had no comorbid condition and were not hospitalized for acute COVID-19. One-third of patients experienced a severe decline in their functional status. About 43% had the ME/CFS subtype. FundingThe study did not received funding.
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A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether performing cryoablative procedures during concomitant cardiac surgical procedures is effective for the treatment of atrial fibrillation (AF). Altogether 291 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All studies showed that cryoablation during concomitant surgery had a significant effect on return to sinus rhythm (SR) conversion rate. One study showed that cryoablation was significantly more effective than mitral valve surgery alone at a 12-month follow-up (73.3% vs. 42.9%, respectively, P=0.013). The use of a concomitant cryoablative procedure has also been shown to be far superior to subsequent catheter based cryoablation in returning patients to SR at a 12-month follow-up (82% and 55.2%, respectively, P<0.001). Another study showed a significant return to AF over a three-year period (91.8% and 84.1% at discharge and three years, respectively). Return to SR was significantly decreased in those patients suffering from permanent rather than paroxysmal AF (47% vs. 85%, P<0.001). Paucity of level 1 evidence was a major limitation to this analysis. All nine papers were either small randomised controlled trials or retrospective studies with small sample sizes (57-521) and varied follow-up regimens. Six of nine studies suggested that cryoablation is most successful in patients suffering from paroxysmal rather than permanent AF. A lack of 24-h monitoring in seven of nine studies prevented effective elucidation of the rate of paroxysmal AF following cryoablation. Only one study suggested an increased complication rate from cryoablation, however, none suggested any negative impact on mortality or morbidity. We conclude that cryoablation during concomitant surgery is a safe and acceptable intervention for the treatment of AF with an SR conversion rate of between 60% and 82% at 12-months postsurgery.