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 Table of Contents  
LETTER TO THE EDITOR
Year : 2021  |  Volume : 6  |  Issue : 3  |  Page : 153-154

Chronic noncommunicable diseases and post-COVID 19 syndrome: The need to create specialized centers for primary care


1 Department of Medicine, School of Medicine, Universidad Cooperativa de Colombia, Villavicencio, Colombia
2 Department of Medicine, School of Medicine, Universidad Metropolitana, Barranquilla, Colombia
3 Department of Medicine, School of Medicine, Universidad del Sinú, Cartagena, Colombia
4 Department of Medicine, Medical and Surgical Research Center, Universidad de Cartagena; Department of Medicine, Colombian Clinical Research Group in Neurocritical Care, Universidad de Cartagena, Cartagena, Colombia

Date of Submission18-Aug-2021
Date of Decision03-Sep-2021
Date of Acceptance04-Sep-2021
Date of Web Publication22-Nov-2021

Correspondence Address:
Dr. Ivan David Lozada-Martinez
Medical and Surgical Research Center, University of Cartagena, Cartagena 130004
Colombia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_48_21

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How to cite this article:
Castro-Vera WA, Fernandez-De La Rosa SE, Villarreal-Escorcia JR, Lozada-Martinez ID. Chronic noncommunicable diseases and post-COVID 19 syndrome: The need to create specialized centers for primary care. Int J Non-Commun Dis 2021;6:153-4

How to cite this URL:
Castro-Vera WA, Fernandez-De La Rosa SE, Villarreal-Escorcia JR, Lozada-Martinez ID. Chronic noncommunicable diseases and post-COVID 19 syndrome: The need to create specialized centers for primary care. Int J Non-Commun Dis [serial online] 2021 [cited 2021 Dec 7];6:153-4. Available from: https://www.ijncd.org/text.asp?2021/6/3/153/330914



Sir,

We read with great interest the article published by Thankappan et al.[1] entitled “The coronavirus disease-2019 pandemic and noncommunicable diseases-need for primary health care system strengthening,” where the author highlights the need to strengthen primary health systems, considering that patients with chronic noncommunicable diseases are at higher risk of developing the severe phenotype of COVID-19 and die.[1] Furthermore, the political and security modifications that caused the confinement and restrictions impacted negatively both directly and indirectly on chronic noncommunicable diseases, probably adversely modifying their prognosis.[1] We thank the authors for their comments. However, we would like to discuss an idea closely related to the topic, but which is associated with post-COVID 19 syndrome, and consists of the need to create specialized centers and rehabilitation in primary care for patients with post-COVID 19 syndrome, and patients with chronic decompensated diseases.

Post-COVID 19 syndrome consists of the persistence of signs and/or symptoms following the acute phase of COVID-19, in patients who have developed any phenotype of this disease and that compromises the functional capacity of the affected person.[2],[3] Depending on the target organ injury during the acute phase of COVID-19, which may or may not be symptomatic,[4] phenotypes of post-COVID 19 syndrome have been described, such as post-COVID 19 neurological syndrome,[5] which may occur in patients who did not even present neurological manifestations during the acute phase, nor have any previous neurological disorder.[5] One of the most important questions at present and about this syndrome is the prognosis and mortality risk in patients with chronic noncommunicable diseases such as diabetes mellitus type II, hypertension, chronic kidney disease, heart failure, coronary artery disease, dementia, or neurovascular disease, where the systemic inflammatory process can cause decompensation of the chronic condition and adversely modify the functional prognosis or final outcome of the patient.

Alves et al.[6] conducted a systematic review and meta-analysis, where they found that patients with dementia, diabetes, hypertension, and chronic kidney disease, during their hospital stay or during the post-COVID phase, have a cumulative case fatality of 27.68 (95% confidence interval; 15.66–41.57).[6] Another very interesting study, which even demonstrated target organ injury without immediate manifestation, was that of Drakos et al.,[4] who evaluated coronary microvascular disease in COVID-19 patients by cardiovascular magnetic resonance imaging, showing that patients who had COVID-19 had significantly reduced global myocardial perfusion reserve (2.73 [2.10–4.15-11] vs. 4.82 [3.70–6. 68], P = 0.005), significantly increased coronary sinus flow at rest (1.78 ml/min [1.19–2.23 ml/min] vs. 1.14 ml/min [0.91–1.32 ml/min], P = 0.048), and reduced coronary sinus flow during stress activity (3.33 ml/min [2.76–4.20 ml/min] vs. 5.32 ml/min [3.66–5.52 ml/min], P = 0.05), compared to controls.[4] Based on the above, the authors concluded that there is cardiac microvascular injury in COVID-19 patients, which may trigger major cardiovascular events in the post-COVID-19 phase, and this is one of the reasons that would explain the persistence of fatigue and dyspnea during this phase.[4]

Many of these silent pathophysiological mechanisms may be responsible for the autonomic dysfunction and symptoms of fatigue and dyspnea (most prevalent [>60% of patients]) in post-COVID 19 syndrome,[2],[3] mainly due to involvement of the cardiovascular system, which may be intensified in patients with previous heart disease. In this order of ideas, one of the objectives that need to be raised and developed in the short- and long-term, is the rehabilitation process of these patients,[7] in order to recover and maintain functional capacity and perform strict monitoring to control morbidity and mortality rates.[7] To this end, we suggest the creation of specialized post-COVID 19 centers, which should be promoted especially in low- and middle-income countries, where there are greater difficulties in accessing quality health services.

Acknowledgments

The research was totally funded by the researchers.

Financial support and sponsorship

The research was totally funded by the researchers

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Thankappan KR, Dawa N, Narain JP. The coronavirus disease-2019 pandemic and noncommunicable diseases-need for primary health care system strengthening. Int J Noncommun Dis 2021;6:53-5.  Back to cited text no. 1
    
2.
Ståhlberg M, Reistam U, Fedorowski A, Villacorta H, Horiuchi Y, Bax J, et al. Post-Covid-19 Tachycardia Syndrome: A distinct phenotype of Post-acute Covid-19 Syndrome. Am J Med. 2021;S0002-9343(21)00472-1.  Back to cited text no. 2
    
3.
Buoite Stella A, Furlanis G, Frezza NA, Valentinotti R, Ajcevic M, Manganotti P. Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: A prospective multidomain observational study. J Neurol 2021. p. 1-10.  Back to cited text no. 3
    
4.
Drakos S, Chatzantonis G, Bietenbeck M, Evers G, Schulze AB, Mohr M, et al. A cardiovascular magnetic resonance imaging-based pilot study to assess coronary microvascular disease in COVID-19 patients. Sci Rep 2021;11:15667.  Back to cited text no. 4
    
5.
Camargo-Martínez W, Lozada-Martínez I, Escobar-Collazos A, Navarro-Coronado A, Moscote-Salazar L, Pacheco-Hernández A, et al. Post-COVID 19 neurological syndrome: Implications for sequelae's treatment. J Clin Neurosci 2021;88:219-25.  Back to cited text no. 5
    
6.
Alves VP, Casemiro FG, Araujo BG, Lima MA, Oliveira RS, Fernandes FT, et al. Factors associated with mortality among elderly people in the COVID-19 pandemic (SARS-CoV-2): A systematic review and meta-analysis. Int J Environ Res Public Health 2021;18:8008.  Back to cited text no. 6
    
7.
Ortega-Sierra MG, Durán-Daza RM, Carrera-Patiño SA, Rojas-Nuñez AX, Charry-Caicedo JI, Lozada-Martínez ID. Neuroeducation and neurorehabilitation in the neurosurgical patient: programs to be developed in Latin America and the Caribbean. J Neurosurg Sci 2021.  Back to cited text no. 7
    




 

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