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The absence of clear distinctions in the quantity of nucleocapsid protein and the equal presence of B- and T-cells following exercise suggests that factors other than viral persistence are associated with the pathophysiology of post-exertional malaise in patients with long COVID

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In animal studies, L-carnitine has been shown to support testosterone synthesis pathways and spermatogenesis under metabolic stress

In the subgroup analysis on route of L-carnitnine supplementation, three studies supplementing L-carnitine orally (47 participants) demonstrated a significant lower odds of dialysis-related hypotension comparing L-carnitine to placebo (pooled OR = 0.03, 95% CI [0.0010.96], p = 0.04, I 2 = 88.3%) while 5 studies supplementing L-carnitine intravenously (177 participants) failed to reveal a difference in incidence of dialysis-related hypotension between these two groups (pooled OR = 0.51, 95% CI [0.251.06], p = 0.07, I 2 = 42.7%) (Table 3)