Martin Spanoghe

Objective: This study explored the epistemic barriers affecting the recognition and care of Long COVID. It sought to understand how uncertainty is produced, distributed, and navigated among clinicians, researchers, and patients, and how these dynamics shape care pathways and patient experiences. Methods: We conducted a qualitative analysis grounded in more than 400 accounts of clinical encounters, alongside more than 100 patient testimonies collected through the Long Covid Belgium organisation. Informed by interdisciplinary socio-medical scholarship, the analysis examined how Long COVID is narrated, negotiated, and recognised across healthcare and institutional pathways. Results: Clinical uncertainty was unevenly distributed among clinicians, researchers, and patients. From the patient perspective, these asymmetries frequently manifested as symptom minimisation, psychosocial reframing, delayed investigation, and fragmented care. Persistent gaps in recognition and care were linked to epistemic injustice and gender bias, alongside limitations associated with positivist medical training models. In response, patients increasingly drew on biomedical evidence and collective forms of lay knowledge, fostering the emergence of “expert patients”. Conclusion: Long COVID may be understood as a “total social fact,” revealing structural vulnerabilities within and beyond healthcare systems. More integrated, reflexive, and relational models of care are needed to improve recognition and management while reducing iatrogenic risk. The findings identify actionable pathways towards more epistemically responsible, coordinated, and patient-attuned care.

We read with attention the article by Ranque and Cogan (1) entitled "Internal medicine at the crossroads of Long COVID diagnosis and management." While the authors raise questions regarding the interplay between persistent symptoms, psychological factors, and illness perception in Long COVID (LC), key aspects of their interpretation overlook do not reflect substantial biomedical evidence, thereby affecting the conclusions drawn. In addition, insufficient little attention is paid to the epistemic and clinical implications of uncertainty, including the harm it has caused patients 1 . This commentary offers a constructive critique and proposes a more comprehensive perspective of LC with direct impact on patient care.The authors adopt a narrative review approach rather than a systematic evaluation of evidence strength.In the absence of meta-analytic synthesis, risk-of-bias assessment, or standardized quality appraisal, causal inferences remain limited and prone to extrapolations (2,3).The article relies on broad and heterogeneous definitions of LC, conflating self-reported prolonged symptoms with clinically confirmed cases, while not consistently applyingdiscounting standardized criteria proposed by WHO, NASEM, or ISARIC (4,5). Such criteria are essential for conceptual coherence, etiological interpretations, and the avoidance of overgeneralization (6). Similarly, their survey relies on a non-random, voluntary sample confined to a single national context, thereby limiting representativeness and introducing potential bias.The discussion emphasizes that psychological factors drive and perpetuate LC symptoms through the theoretical and clinically applied construct of "Functional Somatic Disorder (FSD)", promoted as a replacement for earlier notions such as somatoform disorders or medically unexplained symptoms (7,8). However, the existing literature is limited by selection bias and reliance on self-report screening tools, risking conflating primary pathology with psychological symptoms and obscuring causality. It has also not yielded mechanistic insight or objective outcomes and lacks longitudinal follow-up. Moreover, FSD lacks has been criticized for its lack of conceptual and clinical robustness, with including poor differentiation between overlapping patient groups, blurred diagnostic boundaries, and overly inclusive criteria, raising the risk of it functioning as an unstable diagnostic 'container' thereby functioning as a broad residual category rather than a coherent clearly delineated disease entity (9)(10)(11)(12). Without longitudinal or causal-modeling analyses, assigning primary etiological significance to psychological factors neglects likely overlooks reverse causality and overstates their role (13,14). MoreoverIn particular, citing a 'non-sequitur' is invoked when the failure of biomedical interventions in clinical trials is cited to support psychological explanations seems unwarranted, even thoughgiven that trial authors themselves acknowledged a lack of biomarkers as a key limitations (15). By contrast, the oppositeno analogous conclusion is not drawn from the poor-quality limited evidence base for "cognitive behavioral therapy" and "gradual physical activity" (16,17).Another limitation lies inOf further concern is the selective emphasis on functional or psychosomatic explanations at the expense of a substantial body of biomedical evidence supporting the multi-systemic nature of LC. , as reflected in three biomedical evidentiary gaps, constraining mechanistic interpretation and, in turn, the conclusions drawn: (i) Immunological uncertainty Claims that there is no consensus on immunological mechanisms are not well supported when grounded in a restricted in selective citation base rather than in a comprehensive appraisal of the literature ( 18), a standard seemingly not applied consistently to other post-viral acute infection syndromes (PAIS) like such as Guillain-Barré (19).The authors also faildo not to consider pre-pandemic evidence of linking human coronaviruses associated withto prolonged symptoms (20)(21)(22)(23)(24), as well asnor key post-pandemic research increasingly pointing to associations with consistently implicating viral persistence, immune dysregulation, neuroinflammation, endothelial/microvascular and skeletal muscle damage, mitochondrial dysfunction, blood-brain barrier disruption, autonomic impairment, post-exertional malaise and broader multisystem injury . Emerging evidence of causal mechanisms further supports biologically grounded hypotheses and motivates mechanistic and interventional research (51).Advanced neuroimaging reveals has reported neural and metabolic alterations, interpreted as consistent withlinked to diffuse gliosis, distinct from primary psychiatric disease, and consistent aligned with LC patients' symptoms (52)(53)(54)(55). In addition, candidate biomarkers provide converging evidence support for the hypothesis of viral persistence and biological dysfunction, which has been replicated in across different cohorts (56)(57)(58). These systematic omissions constrain mechanistic interpretation and the conclusions drawn.LC is a complex condition whose persistent uncertainty places patients in a position of heightened vulnerability and clinicians in an epistemic bind. Sociological research in healthcare shows that clinical uncertainty is not merely epistemic but also relational and emotional, with "not knowing" itself being burdensome (59,60). When clinicians fail to engage in reflexivity (ie.eg., acknowledging their own limitations, knowledge gaps, and the relational impact of uncertainty) and instead advance definitive judgments, or at least suggestive assertions, that frame illness primarily or disproportionately as psychosomatic/psychosocial, patients may further experience avoidable distress, self-doubt, diminished agency, isolation, and further psychological burden (60-64).Conversely, reflexive practice enables clinicians to...

Background. Simple sequence repeat (SSR) markers are widely used for genetic analysis in plant breeding, allowing for the investigation of genetic divergence and similarity of genotypes, identification of unique alleles and determination of levels of genetic diversity. Materials and Methods. Analysis of 42 wheat cultivars and lines from the bree­ding program of Poltava State Agrarian University was carried out using 11 SSR mar­kers located on different chromosomes. A set of 11 microsatellite single locus primer pairs was used in this study (Xgwm 11, Xgwm 44, Xgwm 46, Xgwm 135, Xgwm 174, Xgwm 186, Xgwm 194, Xgwm 219, Xgwm 312, Xgwm 372, Xgwm 389). Amplification of 11 loci was performed using the Kapa2G FastHotStart PCR Kit (Kapa Biosystems, Boston, USA). The mixture for PCR amplification contained 1.5 x Kapa2G buffer, 0.5 mM dNTP mix, 0.5 μM of each primer (Sigma-Aldrich), 1 unit of Kapa2G FastHotStart DNA Polymerase and 11.8 ng of template DNA in a volume of 25 μl. Fragment lengths were determined using GeneMapper 4.0 software (Applied Biosystems). Dendrogram was constructed using UPGMA (unweighted pair-group method with arithmetic average) in DarWin 6.0 software (Perrier and Jacquemoud-Collet 2006) for clustering analysis. Results and Discussion. The number of alleles detected per locus varied from 5 (Xgwm 11, Xgwm 135, Xgwm 219) to 12 (Xgwm 174). A total of 80 alleles were identified for the 11 loci studied. Among these, 25 unique alleles were found, each of which was present in only one genotype. The polimorphism information content (PIC) values ranged from 0.48 to 0.87. The markers Xgwm 174 (PIC = 0.87), Xgwm 389 (PIC = 0.84) and Xgwm 372 (PIC = 0.83) were the most polymorphic in our study. We obtained a distribution of cultivars and lines by genetic similarity into five clusters. Conclusion. The use of SSR markers made it possible to identify rare alleles within the varieties presented. The study of the genetic similarity of the presented geno­types showed their relationship according to their origin. It was shown that unique alleles tended to occur in certain local breeding genotypes. This study has shown that genotypes representing the local Ukrainian breeding program often have the same allelic variants and at the same time some genotypes have unique allelic variants. The results obtained from the study of 42 winter wheat genotypes based on 11 SSR markers showed that molecular markers can be very useful in assessing genetic similarity and identifying genotypes in the local breeding program.

We investigated the changes in genetic diversity over time and space of the cultivated potato (Solanum tuberosum L.) for the period pre-1800 to 2021. A substantial panel of 1219 potato varieties, belonging to different spatiotemporal groups, was examined using a set of 35 microsatellite markers (SSR). Genotypic data covering a total of 407 alleles was analyzed using both self-organizing map (SOM) and discriminant analysis of principal components (DAPC) de novo and a priori clustering methods, respectively. Data analysis based on different models of genetic structuring provided evidence of (1) at least two early lineages that have been maintained since their initial introduction from the Andes into Europe in the 16th century, followed by later ones coming from reintroduction events from the US in the mid-1800s; (2) a level of diversity that has gradually evolved throughout the studied time periods and areas, with the most modern variety groups encompassing most of the diversity found in earlier decades; (3) the emergence of new genetic groups within the current population due to increases in the use of germplasm enhancement practices using exotic germplasms. In addition, analysis revealed significant genetic differentiation both among and within the spatiotemporal groups of germplasm studied. Our results therefore highlight that no major genetic narrowing events have occurred within the cultivated potato over the past three centuries. On the contrary, the genetic base shows promising signs of improvement, thanks to extensive breeding work that is gaining momentum. This overview could be drawn on not only to understand better how past decisions have impacted the current genetic cultivated potato resources, but also to develop appropriate new strategies for breeding programs consistent with the socio-economic and sustainability challenges faced by agrifood systems.

Knowledge of both the genetic diversity and geographical distribution of animal genetic resources is a prerequisite for their sustainable utilization, improvement and conservation. The present study was undertaken to explore the current morphological variability within the sheep population in Benin as a prelude for their molecular characterization. From November 2018 to February 2020, 25 quantitative linear body measurements and 5 qualitative physical traits were recorded on 1240 adult ewes from the 10 phytogeographic zones that comprise the three vegetation zones of Benin. Fourteen morphological indices were calculated based on the linear body measurements. The collected data were first analyzed using multiple comparisons of least-square means (LSmeans), followed by generalized linear model (GLM) procedures, to explore the relationships among the measured morphometric traits and the 10 phytogeographic zones. Next, the presence of any genetic sub-populations was examined using multivariate analytical methods, including canonical discriminant analysis (CDA) and ascending hierarchical clustering (AHC). Univariate analyses indicated that all quantitative linear body measurements varied significantly (P<0.05) across the phytogeographic zones. The highest values (LSmean± standard error) of withers height (68.3±0.47 cm), sternum height (46.0±0.35 cm), and rump height (68.8±0.47 cm) were recorded in the Mekrou-Pendjari zone, the drier phytogeographic zone in the North, whereas the lowest values, 49.2±0.34, 25.9±0.26, and 52.0±0.35 cm, respectively, were recorded in the Pobe zone in the South. Multivariate analyses revealed the prevalence of four distinct sheep sub-populations in Benin. The sub-population from the South could be assimilated to the short-legged and that from the North to the West African long-legged sheep. The two other sub-populations were intermediate and closer to the crossbreeds or another short-legged sub-breed. The proportion of individuals correctly classified in their group of origin was approximately 74%. These results uncovered a spatial morphological variation in the Beninese sheep population along a South-North phytogeographic gradient.