Cape City — allAfrica‘s Juanita Williams sat down with Professor Resia Pretorius, Stellenbosch College, who’s been researching how blood clots manufacture and the impact of inflammation for 2 decades. Yesterday Pretorius delivered the keynote address at the 54th Mexican National Congress of Clinical Pathology in Puebla, Mexico, from October 30 to November 2, 2024.
Pretorius has been at the forefront of acute Covid-19 and Long Covid research since 2022, when the professor and her team, first identified inflammatory microclots in blood samples from individuals who contracted Covid-19. Their symptoms persisted for months and, in some cases, even years.
“I’ve been working with my students to understand what molecules are in circulation in the blood that are caused by diseases,” Pretorius said. Her work researches prerequisites such as hypertension, cardiovascular disease, and diabetes, examining how these diseases elevate explicit molecules in the bloodstream.
“If you look at diabetes, you will have too many glucose molecules in circulation inside your blood. We looked at those molecules and how they affect your blood, making it clot abnormally so that your blood becomes more viscous (sticky) and consequently increases your susceptibility to forming blood clots.”
Pretorius and her team focal point on identifying the interactions between these molecules and plasma proteins, which can contrivance off abnormal blood clotting. She describes the normal clotting path of: “For example, you cut yourself and you bleed, and you know that you don’t want to bleed forever; you need to form a little scab so that you can stop the bleeding and you can heal.”
Their symptoms persisted for months and, in some cases, even years
Nonetheless, she said the dangers of abnormal clotting are caused by circulating inflammatory molecules. “You don’t want those molecules to interact with your blood that is soluble inside your body and then form small abnormal clots because inflammatory molecules have bound to the clots.”
Continual inflammation resulting from, for example, cardiovascular disease, diabetes, and rheumatoid arthritis leads to an overload of inflammatory molecules, which can cause pathological clotting. Pretorius offers an example: “Many people will recognize that individuals with diabetes, for example, will get diabetic feet where the feet swell up and the legs are very sore. In some cases, someone with diabetes will get deep vein thrombosis, where they form a clot somewhere in the legs. Some people with diabetes can also die of a heart attack or stroke; they have a much higher propensity of dying than when you are healthy, so that’s all caused by pathological clotting.”
Pretorius’s work underscores the importance of understanding clotting pathology, particularly in the context of chronic inflammatory diseases. Her research aims to command the mechanisms behind abnormal clotting and earn strategies to mitigate the risks associated with these prerequisites. As the medical neighborhood continues to grapple with the complexities of clotting disorders, Pretorius’s contributions provide crucial insights into managing and potentially preventing existence-threatening complications – particularly in the case of acute Covid-19 cases and what is now identified as Long Covid.
It is now not over
The 2023 Nature see, probably the first statistical combination of results from separate reports “exploring prevalence, risk factors and symptomatology of long COVID in Africa”, included 25 reports, more than a thousand papers, and 29 213 patients.
Their findings, that almost half of the of us studied exhibited Long Covid symptoms, and essentially the most typical reason they sought medical back was essentially the most debilitating symptom – fatigue.
This is crucial information that points to the fact that the burden of Covid-19 in Africa and the arena did now not finish with tens of millions of deaths from this fresh coronavirus.
It is now not over.
African governments now face treating about 12 million voters who recovered from the virus but may have ongoing symptoms such as persistent fatigue, shortness of breath, headaches, concentration difficulties, and muscle pain.
These symptoms usually last for months and can severely impact daily functioning and quality of existence (Nature). Many individuals are unable to work, leading to income loss and increased healthcare fees – straining the already overburdened healthcare systems in many international locations.
And these statistics carry out now not include of us who have Covid-19 moral now – acute cases or these with out symptoms – and may later reveal symptoms of Long Covid.
The Heart for Disease in the U.S. defines Long Covid as “a serious illness that can result in chronic conditions requiring comprehensive care. Long Covid – also known as Post-Covid Conditions (PCC) long-haul Covid, Chronic Covid or Post-Acute Sequelae of SARS-CoV-2 infection (PASC) – can include a wide range of ongoing symptoms and conditions that can last weeks, months, or even years after Covid-19”.
Is there any information or guidance available for managing Long Covid symptoms, especially for individuals with pre-existing health prerequisites, savor diabetes and hypertension?
My mother, who contracted Covid-19 in December 2020, initially appeared to recuperate but later skilled severe symptoms, including stomach issues and vomiting bile. Given her underlying health prerequisites, I wonder if there had been any explicit interventions or treatments that may well have been regarded as during her repeated admissions to hospital in 2020 when publish-Covid discussions weren’t as prevalent.
What assets or alternate suggestions are available for individuals dealing with lingering symptoms after recovering from Covid, especially for these with additional health issues?
Unfortunately, whether it is 2020 or 2024, many individuals who contract Covid-19 restful earn Long Covid. Unfortunately, developing effective treatments for various patient prerequisites can be a prolonged and challenging path of.
Currently, a handful of clinicians who understand the disease will search at a patient and carry out a clinician-initiated treatment regime.
Now why? It is that Long Covid and acute Covid-19 are fresh diseases.
So for clinicians to genuinely adapt to and have treatment regimes, they wish to identify treatment alternate suggestions, and then it wants to wade thru clinical trials. We are a very, very, very prolonged way from that! So unfortunately, what we have now is a chosen handful of clinicians who fully understand the disease by now not looking at it as a viral pneumonia, but looking at each patient in entrance of them.
You talked about your mother suffered from TIA’s, which are transient ischaemic attacks, a mini-stroke. So clinicians would now not have looked at treatment for that. They wish to search at treatment of the symptoms because there is no unique treatment for Long Covid. The issue with Long Covid is there are over 200 thoroughly different symptoms. It is a syndrome, it be now not a single-origin symptom disease. So that’s what makes it complicated.
Unfortunately, it be restful very complicated.
Researchers, including myself and collaborators from prestigious institutions savor Yale, Harvard, and Mount Sinai, are working diligently to understand these disease phenotypes (how the disease manifests in patients) and identify biomarkers (measurable indicators) to aid diagnosis.
We think it is a thrombophlebitis. While a tall phrase, “thrombotic clotting,” merely refers to blood clots forming inside your blood vessels. This can be caused by “endothelialitis,” which is inflammation of the lining of your blood vessels (VAs).
This inflammation can lead to problems all thru your physique because it affects the health of your complete vascular gadget. It damages the inside of the blood vessels. It then prevents oxygen from travelling out of your brain to your muscle tissues to your heart adequately, and because you have an issue with oxygen transport, your vasculature doesn’t work effectively, and you have got bought immune dysregulation.
In some individuals, the virus may linger in the physique even after recovering from the initial Covid-19 infection. This is called viral persistence. The virus may well veil in various places, including inside the gut. Many of us complain about gut dysbiosis or irregularities in the gut. Although they may now not constantly really feel ailing, some may well expertise vomiting. This is because the virus can significantly impact the gut. In some individuals, the virus goes and hides in the gut.
The inflammatory molecule that triggers the immune gadget, that triggers the blood clotting is then released slowly … into your physique. It is savor a poisonous small product being secreted by the virus that is perhaps in hiding.
We think that Long Covid is immune-related. It is clotting-related. While viral persistence may well happen in some individuals, it doesn’t necessarily shape the constant release of inflammatory molecules in every person.
What role does impaired blood circulate, particularly resulting from prerequisites savor atherosclerosis (the buildup of fats, ldl cholesterol, and other substances in and on the artery walls) and mini-strokes, play in the pattern of vascular dementia, as seen in my mother’s case?
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Vascular dementia is a manufacture of Alzheimer’s or Alzheimer’s kind of dementia. It is related to the vasculature now not functioning effectively in your brain. Vascular dementia can begin developing many years earlier than a formal diagnosis is got. So the question is, whether perhaps the Covid match fair correct fast-tracked it, that is perhaps a possibility, we stare that a lot.
Diabetes, hypertension, ldl cholesterol, cardiovascular risk, all of these varieties of comorbidities in individuals… Nonetheless it certainly is in these individuals that we now know that acute Covid is way more severe. If we search at the Long Covid population, many of the of us suffering from Long Covid will have had these varieties of comorbidities earlier than their acute phase.
Now, we can also say that it is perhaps fair correct be that you develop into sicker faster. So that may well have been the case with your mother. I am now not a clinician, so I can’t say anything about her specifically. Nonetheless that’s what we stare when we search at the patient teams.
Interestingly, many Long Covid patients also have by no means had comorbidities, they had been relatively healthy earlier than they had been in the acute phase. Some of us also had been completely healthy, and now battle with things savor Long Covid. That is perhaps resulting from the genetics of your complete composition, perhaps they’d have developed diabetes 10 years from now, earlier than Covid. We merely assemble now not know what the contrivance off is, and why some who are completely healthy, earn Long Covid.
May well you clarify if the clinicians you talked about earlier are specifically targeted on treating Long Covid as a distinct situation?
I think it be now effectively exhibited, there are a complete bunch of thousands of papers showing pathology (see of the situation).
Unfortunately, there are restful individuals and clinicians who may well think that it be all in the patient’s head. They say they are fair correct overthinking it, they (are) psychologizing it and they are gaslighting patients by saying: ‘You already know what, fair correct perambulate and have a walk in the park, you are going to internet over it.’
It is now not that, it is now not a thing in your head, you are ailing.
Unfortunately, many of us including clinicians may well restful be suggesting to some patients that there is nothing to fear about. That it be a psychological kind of disease, because unfortunately, at the moment, the reason for it is that there are no real diagnoses for it.
