Abstract
Objectives. To study the prevalence and clinical manifestations of postcovid syndrome (PCS) in out-patients and to assess the efficacy of treatment with the drug Cortexin at doses of 10 and 20 mg i.m. for 10 days. Materials and methods. A total of 979 patients with PCS from regions of the Russian Federation, Azerbaijan, Kyrgyzstan, and Kazakhstan were studied; mean age was 54.6 ± 4.5 years; duration of COVID-19 was from one month upwards. Investigations involved three visits. The first was on the day of consultation (assessment of complaints, analysis of scale indicators, prescription of drug Cortexin at a dose of 10 or 20 mg i.m. for 10 days). The second visit (telephone consultation) was on day 10–14. The third visit was on day 30 of out-patient treatment. Assessment of patients’ status used an asthenia assessment scale (MFI-20), a brief mental state assessment scale (MMSE), the Schulte test, and the Subjective Treatment Quality Assessment Scale. Results. The proportion of patients with PCS was up to 30% of all neurological admissions. The commonest manifestations were: fatigue, general weakness, decreased memory and concentration of attention, vertigo, sleep impairment, irritability, and aggression; less frequent were breathlessness, pain, increased sweating, anosmia, hyposmia, dysgeusia, paresthesia, hair loss, degradation of vision, tachycardia, allergic reactions, menstrual cycle impairments, erectile dysfunction, panic attacks, suicidal ideation, depression and refusal to eat meat. Conclusions: No associations were found between clinical symptomatology and the severity of COVID-19, the volume of lung tissue affected, or different periods of postcovid syndrome. Cortexin was found to be effective at doses of 10 and 20 mg for correcting the cognitive and asthenic manifestations of PCS. Cortexin was found to have anti-anxiety, antidepressant, and anxiolytic effects, which were more marked at the 20-mg dose.
Keywords: SARS-CoV-2, COVID-19, postcovid syndrome, prevalence, fatigue, cognitive impairment, olfactory impairment, Cortexin
Footnotes
Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 122, No. 1, Iss. 1, pp. 84–90, January, 2022.
References
- 1.Shah W, Hillman T, Playford ED, Hishmeh L. Managing the long-term effects of COVID-19: a summary of the recommendations NICE and RCGP. BMJ. 2021;372:136–140. doi: 10.1136/bmj.n13. [DOI] [PubMed] [Google Scholar]
- 2.Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220–232. doi: 10.1016/S0140-6736(20)32656-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Chopra B, Flanders SA, O’Malley M. Sixty-day results among patients hospitalized with COVID-19. Ann. Intern. Med. 2021;174:576–578. doi: 10.7326/M20-5661. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Crook H, Raza S, Nowell J, et al. Long covid – mechanisms, risk factors, and management. BMJ. 2021;374:n1648. doi: 10.1136/bmj.n1648. [DOI] [PubMed] [Google Scholar]
- 5.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat. Med. 2021;27(4):601–615. doi: 10.1038/s41591-021-01283-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Russian Federation Ministry of Health Clinical Guidelines for the Prevention, Diagnosis, and Treatment of the New Coronavirus Infection COVID-19, version 13 (4.19.2021), p. 238, https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/058/211/original/BMP-13.pdf.
- 7.M. V. Putilina, N. V. Teplova, and K. I. Bairova, et al., “Efficacy and safety of Cytoflavin in the rehabilitation of patients with postcovid syndrome: results of the CITADEL prospective randomized study,” Zh. Nevrol. Psikhiatr., 121, No. 10, 39–45 (2021), 10.17116/jnevro202112110139. [DOI] [PubMed]
- 8.M. V. Putilina, “Asthenic disorders as a manifestation of chronic fatigue syndrome,” Zh. Nevrol. Psikhiatr., 121, No. 8, 119–124 (2021), 10.17116/jnevro2021121081119. [DOI] [PubMed]
- 9.Soudy R, Kimura R, Patel A. Short amylin receptor antagonist peptides improve memory deficits in Alzheimer’s disease mouse model. Sci. Rep. 2019;9:10942. doi: 10.1038/s41598-019-47255-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.M. V. Putilina and D. V. Grishin, “SARS-CoV-2 (COVID-19) as a predictor of neuroinflammation and neurodegeneration,” Zh. Nevrol. Psikhiatr., 120, No. 8, 58–64 (2020), 10.17116/jnevro202012008258. [DOI] [PubMed]
- 11.Zhou X, Smith QR, Liu X. Brain-penetrating peptides and peptide-drug conjugates for overcoming the blood–brain barrier and combating diseases of the central nervous system. WIRES Nanomed. Nanobiotechnol. 2021;6:e1695. doi: 10.1002/wnan.1695. [DOI] [PubMed] [Google Scholar]
- 12.Lee J, Kim C. Peptide materials for smart therapeutic applications. Macromol. Res. 2021;29:2–14. doi: 10.1007/s13233-021-9011-x. [DOI] [Google Scholar]
- 13.Lee J, Zheng M, Shimoni O, et al. Development of new therapeutics aimed at blood–brain barrier: from barrier to carrier. Adv. Sci. 2021;8:21–28. doi: 10.1002/advs.202101090. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Yakovlev AA, Gulyaeva NV. Molecular partners of Cortexin in the brain. Neirokhimiya. 2017;33(1):91–96. doi: 10.1134/S1819712416040164. [DOI] [Google Scholar]
- 15.Nesterenko AN, Onufriev MV, Gulyaeva NV, et al. Effects of Cortexin on free radical oxidation and inflammatory processes in rats with normal and accelerated aging. Neirokhimiya. 2018;2(35):187–198. doi: 10.7868/S1027813318020127. [DOI] [Google Scholar]
- 16.Tsygan VN. Chronic fatigue syndrome and its correction with Cortexin. Ross. Med. Zh. 2010;16:1004–1008. [Google Scholar]
- 17.Ludewig P, Winneberger J, Magnus T. The cerebral endothelial cell as a key regulator of inflammatory processes in sterile inflammation. J. Neuroimmunol. 2019;326:38–44. doi: 10.1016/j.jneuroim.2018.10.012. [DOI] [PubMed] [Google Scholar]
- 18.D. Kurkin, D. Bakulin, and E. Morkovin, et al., “Neuroprotective action of Cortexin, Cerebrolysin and Actovegin in acute or chronic brain ischemia in rats,” PLoS One, 16, No. 7, E0254493 (2021), 10.1371/journal.pone.0254493. [DOI] [PMC free article] [PubMed]
- 19.M. V. Putilina, V. I. Vechorko, D. V. Grishin, and L. V. Sidel’nikova, “Acute cerebrovascular accidents associated with SARS-CoV-2 coronavirus infection (COVID-19),” Zh. Nevrol. Psikhiatr., 120, No. 12, 109–118 (2020), 10.17116/jnevro2020120121109. [DOI] [PubMed]
- 20.Putilina MV, Soldatov MA. Cerebral stroke in old age. Features of the clinical picture, course, and treatment. Vrach. 2006;5:29–34. [Google Scholar]
- 21.Serebrovska ZO, Chong EY, Serebrovska TV. Hypoxia, HIF-1α, and COVID-19: from pathogenic factors to therapeutic targets. Acta Pharmacol. Sin. 2020;41:1539–1546. doi: 10.1038/s41401-020-00554-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.A. Pavli, M. Theodoridou, and H. C. Maltezou, “Post-COVID syndrome: Incidence, clinical spectrum, and challenges for primary healthcare professionals,” Arch. Med. Res., 2021, S0188–4409(21)00081-3 (2021), 10.1016/j.arcmed.2021.03.010. [DOI] [PMC free article] [PubMed]
- 23.Putilina MV, Baranova OA. Results of the GLOBUS multicenter clinical-epidemiological observation program (determination of the prevalence of headache and assessment of treatment schemes at the out-patient level) Zh. Nevrol. Psikhiatr. 2014;114(5):33–38. [PubMed] [Google Scholar]
- 24.Zhang J, Zhou Y. 14-3-3 Proteins in glutamatergic synapses. Hindawi Neural Plasticity. 2018;23:23–29. doi: 10.1155/2018/8407609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.M. V. Putilina, N. V. Teplova, and G. V. Poryadin, “Perspectives for pharmacological conditioning of neurovascular units in conditions of neurotropic virus infections,” Zh. Nevrol. Psikhiatr., 121, No. 5, 89–95 (2021), 10.17116/jnevro2021121051144. [DOI] [PubMed]
- 26.A. I. Fedin, G. N. Bel’skaya, O. V. Kurushina, et al., “Dose-dependent effects of Cortexin in chronic cerebral ischemia (results of a multicenter randomized controlled study,” Zh. Nevrol. Psikhiatr., 118, No. 9, 35–42 (2018), 10.17116/jnevro201811809135. [DOI] [PubMed]
