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   <journal-id journal-id-type="nlm-ta">Ulutas Med J</journal-id>
   <journal-title-group>
    <journal-title>The Ulutas Medical Journal</journal-title>
    <abbrev-journal-title>Ulutas Med J</abbrev-journal-title>
   </journal-title-group>
   <issn pub-type="ppub">2149-0430</issn>
   <issn pub-type="epub">2149-388X</issn>
   <publisher>
    <publisher-name>Hayriye Zehra Ulutaş</publisher-name>
   </publisher>
  </journal-meta>
  <article-meta>
   <article-id pub-id-type="doi">10.5455/umj.20220427083613</article-id>
   <article-id pub-id-type="publisher-id">28293</article-id>
   <article-categories>
    <subj-group subj-group-type="heading">
     <subject>Letter to the Editor</subject>
    </subj-group>
    <subj-group subj-group-type="subject">
     <subject>Cognitive Behavioral Therapy</subject>
    </subj-group>
   </article-categories>
   <title-group>
    <article-title>Espousing Environmental Enrichment as Therapy for Post-Covid-19 Syndrome</article-title>
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      <given-names>Abayomi Oyeyemi</given-names>
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     <label>1</label>
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      <institution-id institution-id-type="ror">https://ror.org/05saqv884</institution-id>
      <institution>Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Science, Nile University of Nigeria</institution>
     </institution-wrap>
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      <institution-id institution-id-type="ror">https://ror.org/03k6gj822</institution-id>
      <institution>Developmental Neurobiology Unit Department of Physiology &amp; Anatomy Ajayi Crowther University, Oyo, Nigeria</institution>
     </institution-wrap>
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     <label>3</label>
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      <institution-id institution-id-type="ror">https://ror.org/05saqv884</institution-id>
      <institution>Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria</institution>
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   <pub-date publication-format="electronic" date-type="pub" iso-8601-date="2022-06-06">
    <day>06</day>
    <month>06</month>
    <year>2022</year>
   </pub-date>
   <pub-date publication-format="print" date-type="collection">
    <year>2022</year>
   </pub-date>
   <volume>8</volume>
   <issue>2</issue>
   <fpage>76</fpage>
   <lpage>78</lpage>
   <history>
    <date date-type="received" iso-8601-date="2022-04-02">
     <day>02</day>
     <month>04</month>
     <year>2022</year>
    </date>
    <date date-type="rev-recd" iso-8601-date="2022-05-06">
     <day>06</day>
     <month>05</month>
     <year>2022</year>
    </date>
    <date date-type="accepted" iso-8601-date="2022-05-20">
     <day>20</day>
     <month>05</month>
     <year>2022</year>
    </date>
   </history>
   <permissions>
    <copyright-statement>© 2022 The Author(s)</copyright-statement>
    <copyright-year>2022</copyright-year>
    <license>
     <ali:license_ref>https://creativecommons.org/licenses/by-nc/4.0/</ali:license_ref>
     <license-p>This is an open access article distributed under the CC BY-NC 4.0 licence.</license-p>
    </license>
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   <self-uri xlink:href="https://www.ulutasmedicaljournal.com/?mno=28293"/>
   <self-uri content-type="pdf" xlink:href="https://www.ulutasmedicaljournal.com/pdf/28293.pdf"/>
   <abstract>
    <p>Treatment for COVID-19 survivors is imperative since various symptoms have been discovered spanning from different levels of depression, sleep disorder and anxiety, in addition, Post-traumatic stress disorder (PTSD) as disclosed by approximately 97% of COVID-19 victims in seven hundred and fourteen (714) victims in China. Lengthened symptoms viz muscle pain, headaches, anosmia have been discovered in 112 hospitals and 2001 out of hospital COVID-19 positive patients with a greater number of asymptomatic or high mildly symptomatic victims in Belgium and Netherland This article recommends a non-invasive therapy called Environmental enrichment which entails enriching the abode of an individual, which its therapeutic effects have been established as its enhance neuroplasticity, neurogenesis, memory, mood, passion, alleviate lethargy. This article listed food, music therapy and yoga as enrichment components to ameliorate post-COVID-19 syndrome.</p>
   </abstract>
   <kwd-group kwd-group-type="author">
    <kwd>Post Covid-19 syndrome</kwd>
    <kwd>environmental enrichment</kwd>
    <kwd>therapy</kwd>
    <kwd>music therapy</kwd>
    <kwd>neuroplasticity</kwd>
   </kwd-group>
   <funding-group>
    <funding-statement>Funding information was not reported in the published version of this article.</funding-statement>
   </funding-group>
  </article-meta>
 </front>
 <body>
  <p id="b-1">
   <bold>Dear Editor, </bold>
Coronavirus disease-19(COVID-19) is primarily a disease of the respiratory system which started in December 2019, swiftly spread and its causative agent is Severe Acute Respiratory Syndrome Corona virus-2 (SARS-CoV-2) (   <xref ref-type="bibr" rid="ref1">1</xref>
,   <xref ref-type="bibr" rid="ref2">2</xref>
). High number of mortalities have been recorded till now due to the disease and its victims having various symptoms such as fever, dry cough, fatigue and failure of the respiratory system (   <xref ref-type="bibr" rid="ref3">3</xref>
). Presentations from COVID-19 range from mild cases with manageable symptoms which require treatment at home in the absence of oxygen therapy and chronic cases which were transferred to the intensive care unit (ICU) (   <xref ref-type="bibr" rid="ref3">3</xref>
). However, there is a link between co-morbidities and age with the intensity of COVID-19 (   <xref ref-type="bibr" rid="ref3">3</xref>
). After succeeding severe acute respiratory syndromes (SARS) outbreak in 2003, post recuperation expressions on victims revealed different symptoms of clinical relevance namely depression, muscle pain, psychiatric disorders and severe tiredness which were severe and prolonged, coupled with the aforementioned symptoms was a mild low stimulation of the hypothalamic-pituitary-adrenal axis as recorded by Leow et al. in 2005 (   <xref ref-type="bibr" rid="ref3">3</xref>
). Studies have been disclosing chronic neuropsychological effects of COVID-19 spanning from different levels of depression, sleep disorder and anxiety, in addition, post-traumatic stress disorder (PTSD) as disclosed from approximately 97% of COVID-19 victims in 714 victims in China (   <xref ref-type="bibr" rid="ref1">1</xref>
). Lengthened symptoms viz muscle pain, headaches, anosmia have been discovered in 112 hospitals and 2001 out of hospital COVID- 19 positive patients with a greater number of asymptomatic or high mildly symptomatic victims in Belgium and Netherland (   <xref ref-type="bibr" rid="ref1">1</xref>
).</p>
  <p id="b-2">Post COVID-19 expressions disclosed various symptoms in a greater number of victims spanning from lethargy (72.8%), anxiety (38%), the pain of the joints (28.6%), shortness of breath (28.2%) while 10.8% of patients express no symptoms as recorded from a study conducted on 287 recuperated COVID-19 (   <xref ref-type="bibr" rid="ref3">3</xref>
). However, a great percent (67.6%) recuperated from post-COVID-19 expressions while 32.4% of patients have prolonged manifestations which are remarkable figures, notwithstanding multivitamins(natural/pharmaceutical products) were administered to 90.6% of all sufferers at the period of the disease. However, age and comorbidities cannot be ignored regarding the gravity of post-COVID-19 manifestation (   <xref ref-type="bibr" rid="ref3">3</xref>
). Regulating the human environment is feasible and it has been reported in the literature concerning the potency of the environment in enhancing the evolution of good habits in most species which can be done via enriching the environment and environmental enrichment involves the integration of novelty to stimulate cognitive, behavioral and social functions (   <xref ref-type="bibr" rid="ref4">4</xref>
). The purpose of environmental enrichment is to upsurge composite and interaction in the abode, enhancing newness and stimulating better all-inclusive life-permitting modulation of the environment and mitigating tendency of anomalous behaviors which were corroborated in health and behaviors (   <xref ref-type="bibr" rid="ref4">4</xref>
). Environmental enrichment effectively integrates changes in the structure and function of the brain which has a positive effect on cognition and emotion via neurogenesis (formation of new nerve cells) and brain neuroplasticity (   <xref ref-type="bibr" rid="ref4">4</xref>
).</p>
  <p id="b-3">Some elements of environment enrichment vitalize healthier brain function viz food, routine physical exercise in addition actions that invigorate the brain and are a catalyst for the evolution of neuroplasticity (   <xref ref-type="bibr" rid="ref4">4</xref>
). It has been discovered from studies that foods abundant in progenitors and cofactors of neurotransmitters namely acetylcholine, serotonin and dopamine are imperative in enhancing brain function and general functions such as memory, mood, and passion (   <xref ref-type="bibr" rid="ref4">4</xref>
). Tryptophan is the progenitor amino acid of serotonin which affect happiness and well-being and is located abundantly in foods of the main source of cocoa namely chocolates, almond, oats and bananas. In addition, another better origin of tryptophan is established in kiwi, a fruit from China (   <xref ref-type="bibr" rid="ref4">4</xref>
).</p>
  <p id="b-4">The therapeutic effect of music integrated into depression and anxiety which is part of post- COVID-19 syndrome conditions has been disclosed to be potent from a neurochemistry viewpoint via its stimulating action which has been established on limbic and paralimbic units namely the amygdala, the hippocampus, and the nucleus accumbens in victims of depression. From a rehabilitation perspective, music therapy regulates the function of the motor areas which can be linked to happiness and in the long run have an impact on disposition (   <xref ref-type="bibr" rid="ref5">5</xref>
). Great biochemical changes concerning oxidative stress management have been earmarked in individual who executes Yoga namely, high manufacturing of antioxidant enzymes, upsurge metabolism of glutathione, and effective elimination of per-oxidation outcomes (   <xref ref-type="bibr" rid="ref6">6</xref>
). Motor function namely flexibility of the shoulder, spinal pliability, and torsion of the upper and lower limb enhancements has been highlighted as the effects of Yoga which will ameliorate fatigue recorded as a post- COVID-19 syndrome (   <xref ref-type="bibr" rid="ref6">6</xref>
).</p>
  <p id="b-5">The negative Polymerase chain reaction (PCR) test result does not stop keeping under surveillance recuperated patients from COVID- 19 as the post-COVID-19 syndrome is in existence and prompt intervention is imperative to ameliorate the silent killer. This article recommends Environmental enrichment as therapy for all COVID-19 survivors for a long duration via food, music therapy, and yoga.</p>
 </body>
 <back>
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</article>
