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Abstract The term ”post-COVID-19 condition” is used to describe the state experienced by individuals who have recovered from the acute phase of COVID-19 but still exhibit lingering effects or an extended manifestation of symptoms beyond the expected duration (more than three weeks) or even new symptoms. This condition appears to manifest as a multisystem disease, persisting even after a relatively mild initial illness. Vitamin D plays a crucial role in enhancing the immune system and regulating immune-modulatory mechanisms. Maintaining an optimal serum level of vitamin D is associated with reduced viral infections, complications, and the occurrence and progression of various chronic conditions. The current study aims to assess the prevalence of post-COVID-19 symptoms and serum vitamin D levels among participants. Additionally, it investigates the impact of vitamin D supplementation on alleviating post-COVID-19 symptoms. The study aimed to address its objectives through a comprehensive approach, involving patients recruited from a post-COVID-19 outpatient clinic at Menoufia University Hospital. The study spanned from June 1, 2021, to April 1, 2023. It adopted a two-phase design, beginning with a cross-sectional study for case recruitment, followed by a double-blinded, placebo-controlled randomized clinical trial involving 111 participants with abnormal vitamin D level. The primary objective of this interventional trial was to assess the impact of vitamin D supplementation on post-COVID-19 symptoms. The cross-sectional study conducted prior to the intervention facilitated the identification and recruitment of cases. The eligible participants were assessed using: Summary 127 Interviewing questionnaire: Participants underwent face-to-face interviews at the post-COVID-19 outpatient clinic, utilizing a self-designed, structured, and validated Arabic questionnaire with seven sections. The first section covered sociodemographic data (age, gender, education, occupation, etc.). The second section delved into risk factors for post-COVID-19 symptoms, including medications, previous hospitalization, and long-term health conditions (diabetes mellitus, bronchial asthma, hypertension, obesity, etc.). The third section focused on risk factors for vitamin D deficiency, encompassing nutritional history, sun exposure, sunscreen use, and gastrointestinal diseases. The fourth to seventh sections comprised questions about COVID-19 infection, post-COVID-19 symptoms, functional status, mental health, fatigue, and COVID-19 vaccination status. Post-COVID-19 symptoms were categorized by the CDC into general, cardio-respiratory, neuropsychiatric, gastrointestinal, and cutaneous symptoms. Severity assessment utilized the ESAS scale, ranging from 1 to 10, with one indicating very mild and ten signifying very severe symptoms. Physical examination: A comprehensive examination was conducted on all patients, encompassing anthropometric measurements, vital signs, signs associated with vitamin D deficiency, and possible signs related to post-COVID-19 conditions. Laboratory investigations to assess serum vitamin D levels: Blood samples (2 ml) were withdrawn from all participants via venipuncture to assess the 25-hydroxy vitamin D level in the serum. Vitamin Summary 128 D levels were categorized as normal if (> 30 ng/dl), and abnormal below this level. Subsequently, patients with abnormal vitamin D level (111 participants) were categorized into two groups for the randomized control phase. The case group (56 patients) received oral vitamin D tablets for two months, while the control group (55 patients) received a visually similar placebo for the same duration. Both groups underwent clinical follow-up after two months, during which participants completed the post-COVID-19 symptoms questionnaire based on the ESAS scale to assess changes in symptom severity. The control group received vitamin D supplementation after the follow-up stage for ethical considerations. The study findings reveal the following key results: 1- The prevalence of post-COVID-19 conditions was 50.32% in the subacute period (between 4 to 12 weeks from COVID-19 infection) and 49.68% in the chronic period (after 12 weeks from COVID-19 infection). 2- Various comorbidities among post-COVID-19 participants were examined including smoking, bronchial asthma, obesity, hypertension, and psychiatric disease. 3- Approximately 75.48% of participants experienced three or more persistent post-COVID-19 symptoms. 4- Different post-COVID-19 symptoms were identified, including fatigue, sleep disturbance, poor memory, lack of concentration, headache, myalgia, arthralgia, cough, palpitation, dyspnea, skin rash, and hair loss. Summary 129 5- Cardio-respiratory, neuropsychiatric, and musculoskeletal symptoms exhibited greater severity during the ongoing post-COVID-19 period compared to the chronic period (p-value <0.001). 6- A significant relationship was observed between post-COVID-19 condition types and fatigue. 7- Regarding the functional state, the chronic post-COVID-19 group demonstrated more severe functional limitations than the ongoing group. 8- Fatigue and headache were the most prevalent symptoms after receiving the COVID-19 vaccine. 9- The frequency of vitamin D deficiency among the participants was 71.6%. 10- The severity of post-COVID-19 symptoms displayed a negative correlation with vitamin D levels. 11- Concerning risk factors for vitamin D deficiency, a significant relation excited between vitamin D deficiencies, sun exposure, and daily milk intake. 12- Cardio-respiratory and neuropsychiatric symptoms were more frequent among participants with vitamin D level deficiency than those with a normal level. 13- Vitamin D supplements in the form of 2000 IU once tablet daily for two months demonstrated an improvement in various post-COVID-19 symptoms. The present study concluded that: Post-COVID-19 conditions were prevalent among attendees of Menoufia University Hospital, affecting nearly half of individuals during the Summary 130 chronic period. Notably, vitamin D deficiency was widespread among post- COVID-19 patients, with an observed association with symptom frequency. While vitamin D supplementation showed partial effectiveness in alleviating symptoms, it holds promise as a potential preventive strategy for mitigating COVID-19 sequelae. These findings underscore the importance of further investigation into the role of vitamin D in post-COVID-19 recovery and the potential benefits of supplementation in reducing the burden of long-term sequelae. Based on the findings of the current study, the following recommendations are proposed: 1- Educate patients about the criteria and possibility of post-COVID-19 conditions. 2- Evaluate serum vitamin D levels during both COVID-19 and post- COVID-19 periods. 3- Administer vitamin D supplementation to post-COVID-19 patients for alleviating symptoms. 4- Consider fortifying commonly consumed foods such as milk, cheese, margarine, rice, flour, orange juice, and cereals to effectively enhance vitamin D intake and status among adult populations. 5- Develop a public health policy to enhance the population’s understanding of vitamin D sources and benefits. This can be achieved through TV advertisements, written brochures in clinics, and ensuring the availability of different forms of vitamin D, such as drops or tablets, in primary health care unit. |