ArticleFrontiers in medicine2023
A review of cytokine-based pathophysiology of Long COVID symptoms.
Article in Frontiers in medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06294756 (Effects of Sulfurous Thermal Waters Inhalations on Long-COVID Syndrome), which is not on this map. Cited by 89 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effects of Sulfurous Thermal Waters Inhalations on Long-COVID Syndrome: a Double-blinded, Interventional, Randomized Case-control, Pilot Study on a Spa Centered Rehab Program
Who cites it
89 citing papers in PubMed, 2 syntheses or guidelines pooled it, 158 citations in OpenAlex.
- Long COVID and health-related quality of life: a systematic review of immune, inflammatory, and metabolic markers.Frontiers in public health · 2026Pooled it
- Effectiveness of inspiratory muscle training and multicomponent physical training in patients with post-COVID conditions: a systematic review and meta-analysis.Systematic reviews · 2025Pooled it
- Vitamins K2 and D3 Improve Long COVID, Fungal Translocation, and Inflammation: Randomized Controlled Trial.Nutrients · 2025Trial
- Herbal medicine (Kyungok-go) for fatigue in Long COVID patients: A prospective multicenter pilot study.Integrative medicine research · 2026Article
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- Article
- Review
- The effect of pre-existing sleep disturbance on T cell responses to SARS-CoV-2 variants, pro-inflammatory and pro-resolving mediators, and glucocorticoid sensitivity in Long COVID.Scientific reports · 2026Article
- Review
- Taming the Cytokine Storm: Therapeutic Strategies for Post-Acute Sequelae of SARS-CoV-2 Infection.Health science reports · 2026Article
- NET Biomarkers in COVID-19 and Post-COVID Syndrome: a Comprehensive Analysis.Journal of clinical immunology · 2026Article
- Hybrid immunity from bivalent vaccination and prior infection enhances humoral and innate protection against Omicron XBB.1.16 and EG.5.1.1 variants in Japan.Frontiers in immunology · 2026Article
- Proteomic landscapes of post-COVID condition: biomarkers and translational pathways.Frontiers in immunology · 2026Review
- Mechanisms and impact of long COVID: pathophysiology, neuropsychiatric effects and vaccination.Frontiers in immunology · 2026Review
- Longitudinal trajectories of hematological indices and serum metalloproteinases-2 and 9 over 1 year after moderate and severe COVID-19.Frontiers in medicine · 2026Article
- Principal component analysis of cytokine signature in COVID-19 and Long COVID.Frontiers in immunology · 2026Article
- CD169Frontiers in cellular and infection microbiology · 2026Article
- P-Selectin and Platelet-Monocyte Interaction in Inflammation: Mechanisms, Hypothesis, and Open Questions.Journal of inflammation research · 2026Review
- SGLT2 inhibitors prevent long-COVID-associated cognitive and pain symptoms in type 2 diabetes patients.Virology journal · 2025Article
- Persistent Low-Grade Inflammation and Post-COVID Condition: Evidence from the ORCHESTRA Cohort.Biomedicines · 2025Article
29 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The Long COVID/Post Acute Sequelae of COVID-19 (PASC) group includes patients with initial mild-to-moderate symptoms during the acute phase of the illness, in whom recovery is prolonged, or new symptoms are developed over months. Here, we propose a description of the pathophysiology of the Long COVID presentation based on inflammatory cytokine cascades and the p38 MAP kinase signaling pathways that regulate cytokine production. In this model, the SARS-CoV-2 viral infection is hypothesized to trigger a dysregulated peripheral immune system activation with subsequent cytokine release. Chronic low-grade inflammation leads to dysregulated brain microglia with an exaggerated release of central cytokines, producing neuroinflammation. Immunothrombosis linked to chronic inflammation with microclot formation leads to decreased tissue perfusion and ischemia. Intermittent fatigue, Post Exertional Malaise (PEM), CNS symptoms with "brain fog," arthralgias, paresthesias, dysautonomia, and GI and ophthalmic problems can consequently arise as result of the elevated peripheral and central cytokines. There are abundant similarities between symptoms in Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). DNA polymorphisms and viral-induced epigenetic changes to cytokine gene expression may lead to chronic inflammation in Long COVID patients, predisposing some to develop autoimmunity, which may be the gateway to ME/CFS.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.