The weekly research round-up includes recent publications about ME/CFS and Long Covid. We highlight the studies that have particularly caught our interest and follow these with the full list of publications together with their abstracts (summaries).
Its been another extremely busy week with a large range of research topics this week, although few biomedical studies. There have been twelve new ME/CFS studies and twenty new Long Covid studies this week.
The ME Association maintains a comprehensive index of published research on ME/CFS and Long Covid that is free to use and updated weekly.
Audio Commentary by Dr Katrina Pears
We have highlighted one of the ME/CFS studies in more detail below:
Paper nine (9) this week follows young people with ME/CFS who have had infectious mononucleosis from Epstein-Barr Virus (EBV/ EBV-IM). This study was conducted in Germany, and included many well-known researchers in the field including Carmen Scheibenbogen.
This study conducted a one-year follow-up of 25 young people (under 25 years of age) who had been diagnosed at an outpatients service, inclusion for the study included post-exertional malaise and with documented EBV-IM as the triggering event. Information was recorded at the initial visit as well as follow-ups at 6 and 12 months, which included details of: demographic information, laboratory findings, frequency and severity of symptoms, physical functioning, and health-related quality of life questionnaire (HRQoL).
The main aim of the study was to assess disease trajectories in these young individuals and to explore potential differences between adolescents and young adults within the cohort.
A few points about the study cohort:
- 48% of patients were classed as adolescents (under 18 years of age), and 52% were classed as young adults (18 to 25 years of age).
- 80% of the cohort was female.
- The youngest patient was 14-years old.
The principle finding of this study shows that young adults with ME/CFS experience more severe symptoms and have poorer physical and mental functioning compared to adolescents. Adolescents have a better prognosis (although their condition can fluctuate), with improvements in physical functioning, and health-related quality of life. Other findings included:
- After one year, 54% adolescents no longer met the diagnostic criteria for ME/CFS, indicating partial remission.
- All young adults continued to fulfil the Canadian consensus criteria for ME/CFS after one-year.
- Improvement in adolescents was evident in physical functioning, symptom frequency and severity, and HRQoL. While young adults had little improvement.
- EBV serology and EBV DNA load did not correlate with distinct clinical features of ME/CFS, and clinical chemistry showed no evidence of inflammation.
- No EBV DNA could be found in the plasma of any of the patients, but EBV DNA was found in the peripheral blood cells of 40% of the patients and in 66% following throat washes. All patients showed anti-EBV VCA IgG as an indicator of previous EBV infection.
This was a unique study as it compared young adults and adolescents, which is not something that is often captured in studies. The study does provide a clear insight into ME/CFS in young people, which used rigorous methods, including:
- Diagnosis of ME/CFS used a multidisciplinary board, for those over 18 (adults) this used the CCC diagnosis criteria. Adolescents had to fulfil the CCC or the less strict criteria of the CDW-R. In all cases, PEM had to last for more than 14 hours after mild exertion. This is a stricter diagnosis criteria than the majority of paediatric studies conducted, which have not required presence of PEM.
- The study only included those with a confirmed EBV infection onset and not those with a probable infection, giving a very well-defined cohort.
There are a few limitations of this study, such as:
- Patients only came from one clinic in Germany, meaning there was a selection bias. This also resulted in the inclusion of only patients with mild to moderate ME/CFS who could travel to the clinic.
- The drop out rate was 20%, which could also introduce bias into the results and effects the representativeness of the sample. This would be due to improvements seen or being too unwell to continue.
- There was no control group, this for example effects questions that were asked which are non-specific to ME/CFS and common in the general population, so no comparisons could be made.
- The study as always was limited by sample size, which could be improved upon by expanding the clinics involved in the study. Small sample sizes affect the statistical power and make it different to compare groups, which could make results inaccurate.
- This study followed the patients over the course of 1-year, therefore, further longitudinal studies would help to see the prognosis in this group of young people.
You may be interested in reading some of the previously seen work on infectious mononucleosis from the US by Jason’s et al. research group which have looked at:
- the risk of developing ME/CFS after infectious mononucleosis in college students (Jason et al., 2020),
- predictors for developing severe ME/CFS following infectious mononucleosis (Jason et al., 2022a and 2021 IACFS/ME conference report).
- metabolites and metabolic pathways from those who did and did not recover after infectious mononucleosis (Jason et al., 2022b and previous research roundup coverage)
There has also been a review published this week on what we know about infectious mononucleosis (Paper 12), unfortunately, this is behind a paywall so we cannot read the full text.
ME/CFS Research References and Abstracts (13 – 19 June)
Muhaissen SA, Abu Libdeh A, ElKhatib Y, Alshayeb R, Jaara A, Bardaweel SK.
Curr Med Res Opin. 2023 Jul 28:1-24. [Epub ahead of print.]
Objectives: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic systemic disease that leads to neurological, immunological, autonomic, and energy metabolism dysfunction. COVID-19 has been reported to cause similar symptoms to ME/CFS. The study aims to investigate the prevalence of myalgic encephalomyelitis in patients post-COVID-19 infection by assessing acute and long-term COVID-19 symptoms.
Methods: A cross-sectional questionnaire was developed based on the ME/CFS diagnostic criteria, as specified by the IOM clinical diagnostic criteria, and administered to participants with confirmed COVID-19 who are more than 18 years old and have BMI below 40 Kg/m2. Data from 437 participants were completed.
Results: The current study results revealed that 8.1% of the study participants met the ME/CFS diagnostic criteria. Interestingly, 2.8 of the study participants were classified to have COVID-19 related to ME/CFS. While 4.6% of participants were determined to have disease-related fatigue, 0.7% of participants showed ME/CFS that was not related to COVID-19, and 3.7% of participants were considered to have long COVID-19. Almost one-fourth of the study participants had a family history of ME/CFS. The current study demonstrated that the prevalence of ME/CFS is similar to slightly higher than reported in the literature.
Conclusion: The presence of a relationship between ME/CFS and COVID-19 has been supported by the results of our study. Follow-up of COVID-19 patients is strongly recommended to ensure proper management of ME/CFS symptoms.
Kaylin Huitsing, Tara Tritsch, Francisco J. Carrera Arias, Fanny Collado, Kristina Aenlle, Lubov Nathason, Mary Ann Fletcher, Nancy G. Klimas, and Travis Craddock.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating illness associated with a constellation of other symptoms. While the most common symptom is unrelenting fatigue, many individuals also report suffering from rhinitis, dry eyes and a sore throat.
Mucin proteins are responsible for contributing to the formation of mucosal membranes throughout the body. These mucosal pathways contribute to the body’s defense mechanisms involving pathogenic onset. When compromised by pathogens the epithelium releases numerous cytokines and enters a prolonged state of inflammation to eradicate any particular infection.
Based on genetic analysis, and computational theory and modeling we hypothesize that mucin protein dysfunction may contribute to ME/CFS symptoms due to the inability to form adequate mucosal layers throughout the body, especially in the ocular and otolaryngological pathways leading to low grade chronic inflammation and the exacerbation of symptoms.
Huang S-F, Duan H-Y. Study on Sports, Extracurricular Activities, Electronic Device Usage Factors Associated with Chronic Fatigue Syndrome in Taiwanese Preschoolers. Children. 2023; 10(8):1278.
Under the impact of the pandemic, electronic device usage has become the primary tool for learning. Due to social distancing restrictions, many sports facilities have been forced to close, resulting in changes in daily activities for preschool children.
This research aimed to investigate the sports, extracurricular activities, and electronic device usage factors associated with chronic fatigue syndrome among Taiwanese preschoolers.
Five-year-old preschoolers were randomly selected using a stratified multi-stage random cluster sampling method. The parents of the preschoolers completed the questionnaires, which contained items related to the symptoms of fatigue, extracurricular activities, and electronic device usage of their preschoolers.
A total of 1536 valid questionnaires were returned. The data were then analyzed using descriptive statistics and the chi-square test.
The following results were obtained: (
1) the preschoolers who exercised at least three times per week, engaged in sweating exercise for at least 30 min at a time, had a continuous rhythmic exercise habit, and participated in a variety of exercise types experienced a lower degree of fatigue;
(2) the preschoolers who engaged in extracurricular activities every day exhibited a higher degree of fatigue;
(3) the preschoolers who watched television or used smartphones to pass the time due to boredom, watched television or used smartphones on holidays, played video games or surfed the Internet due to boredom, and played video games or surfed the Internet on holidays displayed a higher degree of fatigue.
This research verified that regular exercise with various sports, extreme extracurricular activities, and laissez-faire electronic device usage are factors associated with fatigue syndrome in preschoolers. It is suggested to develop children’s regular exercise habits, avoid excessive extracurricular activities, and guide their electronic device usage.
Doctor of Philosophy (PhD), University of Miami
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating disorder characterized by persistent fatigue that is unresponsive to rest. Despite extensive intervention research, no gold standard treatment for ME/CFS has yet been identified, although Cognitive-Behavioral Therapy (CBT)-based intervention approaches have shown some promise.
This dissertation evaluated Cognitive Behavioral Stress Management (CBSM) for patients diagnosed with CFS and their partners. CBSM is based on a neuroimmune model of CFS, in which symptoms are seen as prompting distress reactions and cyclically intensifying symptoms. CBSM is intended to facilitate the development of stress management skills to interrupt this cycle.
Previous trials of CBSM for patients diagnosed with CFS have yielded mixed results. We explored whether symptomatic and intervention-specific heterogeneity influenced CBSM efficacy.
First, variations in ME/CFS case definitions yield a heterogeneous patient group. Notably, despite that post-exertional malaise (PEM) is considered a cardinal feature of the disorder, it is not a required symptom according to the commonly applied 1994 Centers for Disease Control and Prevention case definition for CFS. We considered whether patients' PEM status moderated effects of CBSM.
Second, therapist adherence and competence in terms of delivering interventions are likely to impact outcomes. We adapted a fidelity rating system for audio recordings of group CBT to video recordings of group CBSM, with sessions double-coded to assess interrater reliability. We then evaluated whether adherence and competence variables were associated with patient outcomes at follow-up.
Xia Tian, Huang Sheng, Yang Liuxin, et al.
Chin J Integr Tradit West Med Dig, 2023, 31(7): 573-576.
QIAN Yi's theory of “spleen governs Kun” originated from Huangdi Neijing and has influenced future generations. This theory mainly focuses on the concept of “Spleen Shi syndrome” which is increasingly common nowadays, but has not been widely applied in clinical treatment.
The pathogenesis of chronic fatigue syndrome(CFS) corresponds with “Spleen Shi syndrome”, and its treatment should focus on dispelling pathogenic factors, resolving stagnation, and regulating Qi and blood flow.
“Wind medicine” in the treatment of CFS play a vital role in elevating the clear Yang, promoting liver and spleen function, and dispelling dampness. By analyzing the role of “wind medicine” in treating CFS, the guiding significance of the “spleen governs Kun” theory is explained further, which can also provide insights for the clinical treatment of “Spleen Shi syndrome”.
Cui JH, Hu B, Wang XC, Li MZ, Ma QL.
Zhen Ci Yan Jiu. 2023 Jul 25;48(7):718-26. [Article in Chinese.]
Objective: To analyze the current status of animal experiments of acupuncture in intervening chronic fatigue syndrome, so as to search formethods to improve the quality of animal experiment reports.
Methods: From the databases, such as CNKI, VIP, Wanfang, SinoMed, PubMed, Web of Science, Embase and Cochrane Library, the literature of animal experiment on acupuncture treatment for chronic fatigue syndrome was searched from January 1st, 2011 to April 2nd, 2022. Data were extracted according to the animal research reporting in vivo experiment (ARRIVE) guidelines 2.0 and gold standard publication checklist (GSPC), and statistical analysis was performed using Excel 2019.
Results: A total of 16 studies were finally included. The satis-faction rate of essential items in the ARRIVE guidelines 2.0 is 41.76%，while the satisfaction rate of recommended items is only 27.73% and of the GSPC is 25.89%. Out of 16 studies, 13 of them explained the reasons for animal exclusion in the experiment, 8 provided specific randomized methods, 8 described detailed information on animal species, strains, and quantities, 3 basically indicated that they had passed ethical review, 7 explained the limitations of the research. All 16 studies reported the main findings and elucidated their potential clinical or scientific value.
Conclusion: Current animal studies on acupuncture in intervening the chronic fatigue syndrome are of certain limitation. Descriptions of multiple items are incomplete or missing, which prevents rea-ders from assessing reliability and authenticity of the animal experiment. It is recommended that in future research, experimental design, execution and report should be carried out according to the report guidelines for animal experiment to improve research quality.
Yamamoto Y, Otsuka Y, Tokumasu K, Sunada N, Nakano Y, Honda H, Sakurada Y, Hasegawa T, Hagiya H, Otsuka F.
Journal of Clinical Medicine. 2023; 12(14):4737.
Objective: The most common symptom of post-acute coronavirus disease 2019 (COVID-19) is fatigue, and it potentially leads to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); however, a specific prognosticator is lacking. We aimed to elucidate the clinical characteristics of patients who developed ME/CFS after COVID-19.
Methods: In this retrospective observational study, patients who visited Okayama University Hospital for long COVID between February 2021 and March 2022 were investigated.
Results: Of the 234 patients, 139 (59.4%) had fatigue symptoms. Fifty patients with fatigue symptoms (21.4%) met the criteria for ME/CFS (ME/CFS group), while the other 89 patients did not (non-ME/CFS group); 95 patients had no fatigue complaints (no-fatigue group). Although the patients’ backgrounds were not significantly different between the three groups, the ME/CFS group presented the highest scores on the self-rating symptom scales, including the Fatigue Assessment Scale (FAS), EuroQol, and the Self-Rating Depression Scale (SDS).
Furthermore, serum ferritin levels, which were correlated with FAS and SDS scores, were significantly higher in the ME/CFS group (193.0 μg/L, interquartile range (IQR): 58.8–353.8) than in the non-ME/CFS group (98.2 μg/L, 40.4–251.5) and no-fatigue group (86.7 μg/L, 37.5–209.0), and a high serum ferritin level was prominent in female patients.
Endocrine workup further showed that the ME/CFS group had higher thyrotropin levels but lower growth hormone levels in serum and that insulin-like growth factor-I levels were inversely correlated with ferritin levels (R = −0.328, p < 0.05).
Conclusions: Serum ferritin level is a possible predictor of the development of ME/CFS related to long COVID, especially in female patients.
van Eeden C, Redmond D, Mohazab N, Larché MJ, Mason AL, Cohen Tervaert JW, Osman MS.
International Journal of Molecular Sciences. 2023; 24(15):12057.
Symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are common in rheumatic diseases, but no studies report the frequency of these in early systemic sclerosis. There are no known biomarkers that can distinguish between patients with ME/CFS, although mitochondrial abnormalities are often demonstrated.
We sought to assess the prevalence of ME/CFS in limited cutaneous SSc (lcSSc) patients early in their disease (<5 years from the onset of non-Raynaud’s symptoms) and to determine if alterations in mitochondrial electron transport chain (ETC) transcripts and mitochondrial DNA (mtDNA) integrity could be used to distinguish between fatigued and non-fatigued patients.
All SSc patients met ACR/EULAR classification criteria. ME/CFS-related symptoms were assessed through validated questionnaires, and the expression of ETC transcripts and mtDNA integrity were quantified via qPCR.
SSc patients with ME/CFS could be distinguished from non-fatigued patients through ETC gene analysis; specifically, reduced expression of ND4 and CyB and increased expression of Cox7C. ND4 and CyB expression correlated with indicators of disease severity.
Further prospective and functional studies are needed to determine if this altered signature can be further utilized to better identify ME/CFS in SSc patients, and whether ME/CFS in early SSc disease could predict more severe disease outcomes.
Rafael Pricoco, Paulina Meidel, Tim Hofberger, Hannah Zietemann, Yvonne Mueller, Katharina Wiehler, Kaja Michel, Johannes Paulick, Ariane Leone, Matthias Haegele, Sandra Mayer-Huber, Katrin Gerrer, Kirstin Mittelstrass, Carmen Scheibenbogen, Herbert Renz-Polster, Lorenz Mihatsch, Uta Behrends.
Background: Infectious mononucleosis, caused by the Epstein-Barr Virus (EBV-IM), has been linked to the development of myalgic encephalomyelitis/chronic fatigue-syndrome (ME/CFS) in children, adolescents, and young adults. Our study presents the first cohort of young individuals in Germany who were diagnosed with ME/CFS following EBV-IM.
Methods: We conducted a one-year follow-up of 25 young people diagnosed with ME/CFS at our specialized tertiary outpatient service by clinical criteria requiring post-exertional malaise and with documented EBV-IM as the triggering event. Demographic information, laboratory findings, frequency and severity of symptoms, physical functioning, and health-related quality of life (HRQoL) were assessed at first visit as well as 6 and 12 months later at follow-up visits.
Results: The physical functioning and HRQoL of the cohort were significantly impaired, with young adults displaying more severe symptoms, as well as worsening of fatigue, physical and mental functioning, and HRQoL throughout the study, compared to adolescents.
After one year, we found that 6/12 (54%) adolescents no longer met the diagnostic criteria for ME/CFS, indicating partial remission, while all young adults continued to fulfill the Canadian consensus criteria.
Improvement in children was evident in physical functioning, symptom frequency and severity, and HRQoL, while young adults had little improvement.
EBV serology and EBV DNA load did not correlate with distinct clinical features of ME/CFS, and clinical chemistry showed no evidence of inflammation. Remarkably, the median time from symptom onset to ME/CFS diagnosis was 13.8 (IQR: 9.1–34.9) months.
Conclusions: ME/CFS following EBV-IM in young people is a severely debilitating disease with diagnoses protracted longer than one year in many patients and only limited responses to conventional symptom-oriented medical care. Although younger children may have a better prognosis, their condition can fluctuate and significantly impact their HRQoL.
Our data emphasize that biomarkers and effective therapeutic options are also urgently needed for this very young age group to better manage their medical condition and pave the way to recovery.
Thomas Briese, Rafal Tokarz, Lucinda Bateman, Xiaoyu Che, Cheng Guo, Komal Jain, Vishal Kapoor, Susan Levine, Mady Hornig, Alexandra Oleynik, Phenix-Lan Quan, Wai H. Wong, Brent L. Williams, Suzanne D. Vernon, Nancy G. Klimas, Daniel L. Peterson, Jose G. Montoya, Walter Ian Lipkin.
Journal of Medical Virology, Volume 95, Issue 8: e28993.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is estimated to affect 0.4%–2.5% of the global population. Most cases are unexplained; however, some patients describe an antecedent viral infection or response to antiviral medications.
We report here a multicenter study for the presence of viral nucleic acid in blood, feces, and saliva of patients with ME/CFS using polymerase chain reaction and high-throughput sequencing.
We found no consistent group-specific differences other than a lower prevalence of anelloviruses in cases compared to healthy controls. Our findings suggest that future investigations into viral infections in ME/CFS should focus on adaptive immune responses rather than surveillance for viral gene products.
Meeri Keurulainen, Juha Holma, Elina Wallenius, Mikko Pänkäläinen, Jukka Hintikka, Markku Partinen.
Health Expert [Epub ahead of print].
Objectives: To explore myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients' experiences of a health psychological group intervention and its usefulness, non-usefulness or harmfulness for illness management and adjustment.
Design: A qualitative longitudinal study using inductive content analysis.
Methods: Semistructured interviews were conducted with 10 adults. Interviews were conducted before the 16-week intervention, immediately after its completion, and at 3 months after completion.
Results: Participants reported that the intervention was useful and not harmful. The model improved their ability to cope with ME/CFS by providing them with useful information about the illness along with peer support and professional guidance. Participants reported improved illness management and adjustment, which they perceived as an outcome of achieving new ways of thinking, feeling and acting.
Conclusions: Participants viewed the health psychological approach to group intervention as meeting their needs. To achieve better illness management and adjustment, more consideration should be given to supportive interactional processes with peers and healthcare professionals.
Patient or Public Contribution: The intervention was developed to meet patients' needs of finding ways to manage their illness. The research team consulted eight patients with ME/CFS and three clinical centres working with ME/CFS treatment and rehabilitation at the intervention planning stage. Their comments influenced the planning and content of the intervention as well as ethical issues that should be considered, such as potential harm to participants. All participants were informed about the theoretical foundations of the study and the principles guiding the intervention. Participants were not involved in the data analysis.
Alexander K.C. Leung, Joseph M. Lam and Benjamin Barankin.
Current Pediatric Reviews [Epub ahead of print].
Background: Infectious mononucleosis is common among adolescents and young adults. Although the majority of cases resolve spontaneously, life-threatening manifestations, and complications have been recognised.
Objective: The purpose of this article is to familiarize clinicians with the clinical manifestations, evaluation, diagnosis, and management of infectious mononucleosis.
Methods: A search was conducted in October 2022 in PubMed Clinical Queries using the key terms “infectious mononucleosis” OR “Epstein-Barr virus” OR “EBV”. The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the aforementioned search was used in the compilation of the present article.
Results: Infectious mononucleosis, caused by Epstein-Barr virus, most commonly affects adolescents and adults aged 15 to 24 years. Epstein-Barr virus is transmitted primarily in saliva. Infectious mononucleosis is characterized by a triad of fever, tonsillar pharyngitis, and lymphadenopathy. Fatigue may be profound but tends to resolve within three months.
Periorbital and/or palpebral edema, typically bilateral, occurs in one-third of patients. Splenomegaly and hepatomegaly occur in approximately 50% and 10% of cases, respectively. A skin rash, which is usually widely scattered, erythematous, and maculopapular, occurs in approximately 10 to 45% of cases.
Peripheral blood leukocytosis is observed in most patients; lymphocytes make up at least 50% of the white blood cell differential count. Atypical lymphocytes constitute more than 10% of the total lymphocyte count.
The classic test for infectious mononucleosis is the demonstration of heterophile antibodies. The monospot test is the most widely used method to detect the serum heterophile antibodies of infectious mononucleosis. When confirmation of the diagnosis of infectious mononucleosis is required in patients with mononucleosis-like illness and a negative mono-spot test, serologic testing for antibodies to viral capsid antigens is recommended.
Infectious mononucleosis is a risk factor for chronic fatigue syndrome.
Spontaneous splenic rupture occurs in 0.1 to 0.5% of patients with infectious mononucleosis and is potentially life-threatening.
Treatment is mainly supportive. Reduction of activity and bed rest as tolerated are recommended. Patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present. Most patients have an uneventful recovery.
Conclusion: Infectious mononucleosis is generally a benign and self-limited disease. Prompt diagnosis is essential to avoid unnecessary investigations and treatments and to minimize complications. Splenic rupture is the most feared complication.
As avoiding exposure to EBV is almost impossible, the most effective way to prevent EBV infection and infectious mononucleosis is the development of an effective, safe, and affordable EBV vaccine that can confer life-long immunity.
Long-COVID Research References
- Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis
- Host genetic polymorphisms involved in long-term symptoms of COVID-19
- First insights from patients presenting with long/post-COVID syndrome in primary care: an exploratory report
- Challenges to delivering evidence-based management for long COVID
- Epidemiology, clinical presentation, pathophysiology, and management of long COVID: an update
- Myocarditis and Myocardial Injury in Long COVID Syndrome: A Comprehensive Review of the Literature
- A retrospective cohort analysis leveraging augmented intelligence to characterize long COVID in the electronic health record: A precision medicine framework
- Periodontal Disease Markers among Patients with Long COVID: A Case-control Study
- Amino acids, post-translational modifications, nitric oxide, and oxidative stress in serum and urine of long COVID and ex COVID human subjects
- Long COVID-19 and Insulin Autoimmune Syndrome: A Case Report
- Long Covid – A Comprehensive Review of Post-Acute Sequelae of Covid-19
- Clinical and Biomarker Profile Responses to Rehabilitation Treatment in Patients with Long COVID Characterized by Chronic Fatigue
- Persistent endothelial dysfunction in post-COVID-19 syndrome and its associations with symptom severity and chronic inflammation
- A Clinical Qualification Protocol Highlights Overlapping Genomic Influences and Neuro-Autonomic Mechanisms in Ehlers-Danlos and Long COVID-19 Syndromes
- Applying Lessons from Rheumatology to Better Understand Long COVID
- Increased SARS-CoV-2 reactive low avidity T cells producing inflammatory cytokines in pediatric post-acute COVID-19 sequelae (PASC)
- Modeling Long Covid Disease Network in Pediatric Population
- Exercise Capacity and Vascular Function in Long-COVID Sufferers
- Antihistamines improve cardiovascular manifestations and other symptoms of long-COVID attributed to mast cell activation
- Role of Janus Kinase inhibitors in the management of pulmonary involvement due to Long COVID-19 disease: A case control study
Dr Katrina Pears,
The ME Association.