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Rehab Elanwar,1 Mona Hussein,2 Rehab Magdy,3 Ragaey A Eid,4 Ahmed Yassien,5 Ahmed S Abdelsattar,6 Laila A Alsharaway,7 Wael Fathy,8 Amr Hassan,9 Yasmine S Kamal9,10 1Clinical Neurophysiology, Neurodiagnostic Research Center, Beni-Suef University, Beni-Suef, Egypt; 2Department of Neurology, Beni-Suef University, Beni-Suef, Egypt; 3Department of Neurology, Cairo University, Cairo, Egypt; 4Department of Tropical Medicine, Beni-Suef University, Beni-Suef, Egypt; 5Department of Critical Care Medicine, Beni-Suef University, Beni-Suef, Egypt; 6Department of Internal Medicine, Beni-Suef University, Beni-Suef, Egypt; 7Department of Chest Diseases, Beni-Suef University, Beni-Suef, Egypt; 8Department of Anaesthesia, Surgical ICU and Pain Management, Beni-SuefUniversity, Beni-Suef, Egypt; 9Department of Neurology, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt; 10Department of Neurology, Rashid Hospital, Dubai, United Arab EmiratesCorrespondence: Mona HusseinDepartment of Neurology, Beni-Suef University, Salah Salem Street, Beni-Suef, 62551, EgyptTel +20-10-0513-1318Email mona.neuro@yahoo.comPurpose: Much effort has been directed toward studying COVID-19 symptoms; however, the post–COVID-19 phase remains mysterious. The aim of this work was to conduct a clinical and neurophysiological evaluation of physical and mental fatigue in COVID-19 long-haulers and to study whether markers of COVID-19 severity are able to predict the likelihood of developing postinfectious fatigue syndrome (PIFS) in such patients.Patients and Methods: This case–control study was conducted on 46 COVID-19 long-haulers who met the criteria for PIFS and 46 recovered COVID-19 subjects without any residuals. Clinical assessment of fatigue was done using a fatigue questionnaire. Repetitive nerve stimulation and single-fiber electromyography were done after excluding neuropathy and myopathy.Results: The median value for physical fatigue was 4 (IQR 2– 7), while that for mental fatigue was 2 (IQR 0– 3). Each day’s increase in the period of COVID-19 illness increased the odds of PIFS in COVID-19 long-haulers 1.104-fold, and each unit increase in ferritin increased the odds of PIFS 1.006-fold. A significant decrement in at least one muscle was observed in 50% of patients. Patients with PIFS had significantly higher mean consecutive difference (MCD) in the extensor digitorum communis than the control group. There were statistically significant positive correlations between MCD values and physical, mental, and total fatigue scores.Conclusion: Higher ferritin levels and prolonged COVID-19 infection were independent predictors of PIFS in COVID-19 long-haulers. There was electrophysiological evidence of abnormalities in the peripheral portion of the motor unit in COVID-19 long-haulers with PIFS.Keywords: COVID-19, fatigue, COVID-19 long-haulers, single-fiber EMG, ferritin |
