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Foong YC, Merlo D, Gresle M, Buzzard K, Zhong M, Yeh WZ, Jokubaitis V, Monif M, Skibina O, Ozakbas S, Patti F, Grammond P, Amato MP, Kalincik T, Horakova D, Kubala Havrdova E, Weinstock-Guttman B, Lechner Scott J, Boz C, Sa MJ, Butzkueven H, van der Walt A, Zhu C. Comparing ocrelizumab to interferon/glatiramer acetate in people with multiple sclerosis over age 60. J Neurol Neurosurg Psychiatry 2024; 95:767-774. [PMID: 38453478 DOI: 10.1136/jnnp-2023-332883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/11/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Ongoing controversy exists regarding optimal management of disease modifying therapy (DMT) in older people with multiple sclerosis (pwMS). There is concern that the lower relapse rate, combined with a higher risk of DMT-related infections and side effects, may alter the risk-benefit balance in older pwMS. Given the lack of pwMS above age 60 in randomised controlled trials, the comparative efficacy of high-efficacy DMTs such as ocrelizumab has not been shown in older pwMS. We aimed to evaluate the comparative effectiveness of ocrelizumab, a high-efficacy DMT, versus interferon/glatiramer acetate (IFN/GA) in pwMS over the age of 60. METHODS Using data from MSBase registry, this multicentre cohort study included pwMS above 60 who switched to or started on ocrelizumab or IFN/GA. We analysed relapse and disability outcomes after balancing covariates using an inverse probability treatment weighting (IPTW) method. Propensity scores were obtained based on age, country, disease duration, sex, baseline Expanded Disability Status Scale, prior relapses (all-time, 12 months and 24 months) and prior DMT exposure (overall number and high-efficacy DMTs). After weighting, all covariates were balanced. Primary outcomes were time to first relapse and annualised relapse rate (ARR). Secondary outcomes were 6-month confirmed disability progression (CDP) and confirmed disability improvement (CDI). RESULTS A total of 248 participants received ocrelizumab, while 427 received IFN/GA. The IPTW-weighted ARR for ocrelizumab was 0.01 and 0.08 for IFN/GA. The IPTW-weighted ARR ratio was 0.15 (95% CI 0.06 to 0.33, p<0.001) for ocrelizumab compared with IFN/GA. On IPTW-weighted Cox regression models, HR for time to first relapse was 0.13 (95% CI 0.05 to 0.26, p<0.001). The hazard of first relapse was significantly reduced in ocrelizumab users after 5 months compared with IFN/GA users. However, the two groups did not differ in CDP or CDI over 3.57 years. CONCLUSION In older pwMS, ocrelizumab effectively reduced relapses compared with IFN/GA. Overall relapse activity was low. This study adds valuable real-world data for informed DMT decision making with older pwMS. Our study also confirms that there is a treatment benefit in older people with MS, given the existence of a clear differential treatment effect between ocrelizumab and IFN/GA in the over 60 age group.
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Affiliation(s)
- Yi Chao Foong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
| | - Melissa Gresle
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Melbourne Health, Melbourne, Victoria, Australia
| | - Katherine Buzzard
- Eastern Health, Box Hill, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael Zhong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Wei Zhen Yeh
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Olga Skibina
- Alfred Health, Melbourne, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
| | | | - Francesco Patti
- Neuroscience, University of Catania Department of Surgical and Medical Sciences and Advanced Technologies 'G.F. Ingrassia', Catania, Italy
- University of Catania, Catania, Italy
| | | | - Maria Pia Amato
- Department of Neurological Siences, University of Florence, Florence, Italy
| | - Tomas Kalincik
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | | | - Jeanette Lechner Scott
- Hunter New England Health, New Lambton, New South Wales, Australia
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Cavit Boz
- Karadeniz Technical University, Trabzon, Turkey
| | - Maria Jose Sa
- Neurology, Centro Hospitalar de São João, Porto, Portugal
- Faculty of Health Sciences University Fernando Pessoa, Porto, Portugal
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Xiong Q, Luo F, Chen Y, Duan Y, Huang J, Liu H, Jin P, Li R. Factors influencing fatigue, mental workload and burnout among Chinese health care workers during public emergencies: an online cross-sectional study. BMC Nurs 2024; 23:428. [PMID: 38918772 PMCID: PMC11197284 DOI: 10.1186/s12912-024-02070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES The purpose of this study was to investigate fatigue, mental workload, and burnout among health care workers (HCWs) and explore the possible underlying factors. MATERIALS AND METHODS An online cross-sectional survey design was used to collect data from HCWs in Chongqing, China. The online survey included the Fatigue Severity Scale, NASA Task Load Index, and Chinese version of the Maslach Burnout Inventory-General Survey to assess fatigue, mental workload, and burnout, respectively, and was conducted from February 1 to March 1, 2023. RESULTS In this study, the incidence of fatigue and burnout among HCWs was 76.40% and 89.14%, respectively, and the incidence of moderate to intolerable mental workloads was 90.26%. Work-family conflict, current symptoms, number of days of COVID-19 positivity, mental workload, burnout and reduced personal accomplishment were significantly associated with fatigue. Mental workload was affected by fatigue and reduced personal accomplishment. Furthermore, burnout was influenced by marital status and fatigue. Moreover, there was a correlation among mental workload, fatigue, and burnout. CONCLUSIONS Fatigue, mental workload and burnout had a high incidence and were influenced by multiple factors during COVID-19 public emergencies in China.
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Affiliation(s)
- Qian Xiong
- The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400042, China
| | - Feng Luo
- The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400042, China.
| | - Yue Chen
- The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400042, China.
| | - Yi Duan
- The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400042, China
| | - Jie Huang
- The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400042, China
| | - Hong Liu
- The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400042, China
| | - Pengjuan Jin
- The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400042, China
| | - Rong Li
- The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400042, China
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Navolokin N, Adushkina V, Zlatogorskaya D, Telnova V, Evsiukova A, Vodovozova E, Eroshova A, Dosadina E, Diduk S, Semyachkina-Glushkovskaya O. Promising Strategies to Reduce the SARS-CoV-2 Amyloid Deposition in the Brain and Prevent COVID-19-Exacerbated Dementia and Alzheimer's Disease. Pharmaceuticals (Basel) 2024; 17:788. [PMID: 38931455 PMCID: PMC11206883 DOI: 10.3390/ph17060788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/02/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
The COVID-19 pandemic, caused by infection with the SARS-CoV-2 virus, is associated with cognitive impairment and Alzheimer's disease (AD) progression. Once it enters the brain, the SARS-CoV-2 virus stimulates accumulation of amyloids in the brain that are highly toxic to neural cells. These amyloids may trigger neurological symptoms in COVID-19. The meningeal lymphatic vessels (MLVs) play an important role in removal of toxins and mediate viral drainage from the brain. MLVs are considered a promising target to prevent COVID-19-exacerbated dementia. However, there are limited methods for augmentation of MLV function. This review highlights new discoveries in the field of COVID-19-mediated amyloid accumulation in the brain associated with the neurological symptoms and the development of promising strategies to stimulate clearance of amyloids from the brain through lymphatic and other pathways. These strategies are based on innovative methods of treating brain dysfunction induced by COVID-19 infection, including the use of photobiomodulation, plasmalogens, and medicinal herbs, which offer hope for addressing the challenges posed by the SARS-CoV-2 virus.
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Affiliation(s)
- Nikita Navolokin
- Department of Pathological Anatomy, Saratov Medical State University, Bolshaya Kazachaya Str. 112, 410012 Saratov, Russia;
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia; (V.A.); (D.Z.); (V.T.); (A.E.)
| | - Viktoria Adushkina
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia; (V.A.); (D.Z.); (V.T.); (A.E.)
| | - Daria Zlatogorskaya
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia; (V.A.); (D.Z.); (V.T.); (A.E.)
| | - Valeria Telnova
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia; (V.A.); (D.Z.); (V.T.); (A.E.)
| | - Arina Evsiukova
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia; (V.A.); (D.Z.); (V.T.); (A.E.)
| | - Elena Vodovozova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia;
| | - Anna Eroshova
- Department of Biotechnology, Leeners LLC, Nagornyi Proezd 3a, 117105 Moscow, Russia; (A.E.); (E.D.); (S.D.)
| | - Elina Dosadina
- Department of Biotechnology, Leeners LLC, Nagornyi Proezd 3a, 117105 Moscow, Russia; (A.E.); (E.D.); (S.D.)
| | - Sergey Diduk
- Department of Biotechnology, Leeners LLC, Nagornyi Proezd 3a, 117105 Moscow, Russia; (A.E.); (E.D.); (S.D.)
- Research Institute of Carcinogenesis of the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, Kashirskoe Shosse 24, 115522 Moscow, Russia
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Lin F, Jiang DJ, Zhang S, Yang Z, Zeng HS, Liu ZP, Yang LY. Critically ill children with SARS-COV-2 Omicron infection at a national children medical center, Guangdong, China. BMC Pediatr 2024; 24:254. [PMID: 38622552 PMCID: PMC11017605 DOI: 10.1186/s12887-024-04735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND SARS-CoV-2 infection is described as asymptomatic, mild, or moderate disease in most children. SARS-CoV-2 infection related death in children and adolescents is rare according to the current reports. COVID-19 cases increased significantly in China during the omicron surge, clinical data regarding pediatric critical patients infected with the omicron variant is limited. In this study, we aim to provide an overview of the clinical characteristics and outcomes of critically ill children admitted to a national children's medical center in Guangdong Province, China, during the outbreak of the omicron variant infection. METHODS We conducted a retrospective study from November 25, 2022, to February 8, 2023, which included 63 critically ill children, under the age of 18, diagnosed with SARS-CoV-2 infection. The patients were referred from medical institutions of Guangdong province. The medical records of these patients were analyzed and summarized. RESULTS The median age of patients was 2 years (Interquartile Range, IQR: 1.0-8.0), sex-ratio (male/female) was 1.52. 12 (19%) patients (age ≥ 3 years) were vaccinated. The median length of hospital stay was 14 days (IQR: 6.5-23) in 63 cases, and duration of fever was 5 days (IQR: 3-8.5), pediatric intensive care unit (PICU) stay was 8 days (IQR 4.0-14.0) in 57 cases. 30 (48%) cases had clear contact history with family members who were infected with SARS-CoV-2. Three children who tested positive for SARS-CoV-2 infection did not show any abnormalities on chest imaging examination. Out of the total patients, 33 (52%) had a bacterial co-infection, with Staphylococcus aureus being the most commonly detected bacterial pathogen. Our cohort exhibited respiratory and nervous system involvement as the primary features. Furthermore, fifty (79%) patients required mechanical ventilation, with a median duration of 7 days (IQR 3.75-13.0). Among these patients, 35 (56%) developed respiratory failure, 16 (25%) patients experienced a deteriorating progression of symptoms and ultimately succumbed to the illness, septic shock was the most common condition among these patients (15 cases), followed by multiple organ failure in 12 cases, and encephalopathy identified in 7 cases. CONCLUSION We present a case series of critically ill children infected with the SARS-CoV-2 omicron variant. While there is evidence suggesting that Omicron may cause less severe symptoms, it is important to continue striving for measures that can minimize the pathogenic impact of SARS-CoV-2 infection in children.
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Affiliation(s)
- Fen Lin
- Precision Medical Lab Center, Chaozhou Central Hospital, Chaozhou, Guangdong Province, P. R. China
| | - Dao-Ju Jiang
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangdong Province, P. R. China
| | - Song Zhang
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangdong Province, P. R. China
| | - Zhe Yang
- Department of Pediatrics, Chaozhou Central Hospital, Chaozhou, Guangdong Province, P. R. China
| | - Hua-Song Zeng
- Department of Allergy, Immunology and Rheumatology, Guangzhou Women and Children's Medical Center, Guangdong Province, P. R. China
| | - Zhi-Ping Liu
- Precision Medical Lab Center, Chaozhou Central Hospital, Chaozhou, Guangdong Province, P. R. China
| | - Li-Ye Yang
- Precision Medical Lab Center, People's Hospital of Yangjiang, No.42 Dongshan Road, Jiangcheng District, Yangjiang, 529500, Guangdong Province, P. R. China.
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5
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Li S, Huang P, Lai F, Zhang T, Guan J, Wan H, He Y. Mechanisms of Ferritinophagy and Ferroptosis in Diseases. Mol Neurobiol 2024; 61:1605-1626. [PMID: 37736794 DOI: 10.1007/s12035-023-03640-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
The discovery of the role of autophagy, particularly the selective form like ferritinophagy, in promoting cells to undergo ferroptosis has inspired us to investigate functional connections between diseases and cell death. Ferroptosis is a novel model of procedural cell death characterized by the accumulation of iron-dependent reactive oxygen species (ROS), mitochondrial dysfunction, and neuroinflammatory response. Based on ferroptosis, the study of ferritinophagy is particularly important. In recent years, extensive research has elucidated the role of ferroptosis and ferritinophagy in neurological diseases and anemia, suggesting their potential as therapeutic targets. Besides, the global emergence and rapid transmission of COVID-19, which is caused by SARS-CoV-2, represents a considerable risk to public health worldwide. The potential involvement of ferroptosis in the pathophysiology of brain injury associated with COVID-19 is still unclear. This review summarizes the pathophysiological changes of ferroptosis and ferritinophagy in neurological diseases, anemia, and COVID-19, and hypothesizes that ferritinophagy may be a potential mechanism of ferroptosis. Advancements in these fields will enhance our comprehension of methods to prevent and address neurological disorders, anemia, and COVID-19.
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Affiliation(s)
- Siqi Li
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Ping Huang
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Feifan Lai
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Ting Zhang
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Jiaqi Guan
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Haitong Wan
- School of Basic Medicine Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Yu He
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
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Błażejewski G, Witkoś J, Hartman-Petrycka M. Changes in sensitivity and hedonic rating to transcutaneous electrical nerve stimulation following COVID-19. Sci Rep 2024; 14:1233. [PMID: 38216666 PMCID: PMC10786926 DOI: 10.1038/s41598-024-51596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
COVID-19 affects not only the respiratory system but also other biological systems such as the nervous system. Usually, these changes are reported based on the patient's subjective description. The aim of our study, therefore, was to objectively determine the effect that the SARS-CoV-2 virus and COVID-19 disease has on sensory threshold and the hedonic and subjective perception of an electrical stimulus. The sensory threshold was tested on the inner forearm by applying non-invasive transcutaneous electrical nerve stimulation (TENS) with 100 Hz and 100 µs parameters and a biphasic current waveform. The study involved 211 participants, aged 22-79 years, with a mean age of 56.9 ± 12.1 years. There were 131 subjects in the COVID group, while the NON-COVID group, the control group, was matched to the COVID group in terms of gender, age, body mass index and presence of chronic diseases. The research was carried out in 2022. Sensory sensitivity was highest in the group that had suffered with COVID-19. The median sensory sensitivity was 11 mA in the COVID group and 14 mA (p < 0.001) in the NON-COVID group, however, the current sensitivity threshold decreased over time (R = 0.52, p < 0.001). Post COVID-19, the electrical stimulus was more often perceived as unpleasant: COVID versus NON-COVID (23% vs. 3%, p < 0.001) and as a different sensation to tingling (27% vs. 2%, p < 0.001). Post-COVID-19 patients have a lower sensory threshold, the electrical stimulus is more often described as unpleasant and in subjective feelings it is more often described as pinching. The differences between COVID and NON-COVID decrease with time since the onset of COVID symptoms.
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Affiliation(s)
- Grzegorz Błażejewski
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.
| | - Joanna Witkoś
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Magdalena Hartman-Petrycka
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
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Benedetti GM, Guerriero RM, Press CA. Review of Noninvasive Neuromonitoring Modalities in Children II: EEG, qEEG. Neurocrit Care 2023; 39:618-638. [PMID: 36949358 PMCID: PMC10033183 DOI: 10.1007/s12028-023-01686-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 03/24/2023]
Abstract
Critically ill children with acute neurologic dysfunction are at risk for a variety of complications that can be detected by noninvasive bedside neuromonitoring. Continuous electroencephalography (cEEG) is the most widely available and utilized form of neuromonitoring in the pediatric intensive care unit. In this article, we review the role of cEEG and the emerging role of quantitative EEG (qEEG) in this patient population. cEEG has long been established as the gold standard for detecting seizures in critically ill children and assessing treatment response, and its role in background assessment and neuroprognostication after brain injury is also discussed. We explore the emerging utility of both cEEG and qEEG as biomarkers of degree of cerebral dysfunction after specific injuries and their ability to detect both neurologic deterioration and improvement.
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Affiliation(s)
- Giulia M Benedetti
- Division of Pediatric Neurology, Department of Neurology, Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, WA, USA.
- Division of Pediatric Neurology, Department of Pediatrics, C.S. Mott Children's Hospital and the University of Michigan, 1540 E Hospital Drive, Ann Arbor, MI, 48109-4279, USA.
| | - Rejéan M Guerriero
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Craig A Press
- Departments of Neurology and Pediatric, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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8
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Mo C, Li X, Wu Q, Fan Y, Liu D, Zhu Y, Yang Y, Liao X, Zhou Z, Zhou L, Li Q, Zhang Q, Liu W, Zhou R, Tian X. SARS-CoV-2 mRNA vaccine requires signal peptide to induce antibody responses. Vaccine 2023; 41:6863-6869. [PMID: 37821314 DOI: 10.1016/j.vaccine.2023.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/15/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
New SARS-CoV-2 variants continue to prevail worldwide, and effective vaccines are needed to prevent an epidemic. mRNA vaccines are gradually being applied to the prevention and control of infectious diseases with significant safety and effectiveness. The spike (S) protein of SARS-CoV-2 is the main target of mRNA vaccine design, but the impact of the signal peptide (SP), transmembrane region (TM), and cytoplasmic tail (CT) on mRNA vaccine remains unclear. In this study, we constructed three forms of mRNA vaccines related to the S protein: full-length, deletion of the TM and CT, and simultaneous deletion of the SP, TM and CT, and compared their immunogenicity. Our experimental data show that full-length S protein and deletion of the TM and CT could effectively induce neutralizing antibody production in mice, while S protein without the SP and TM could not. This indicates that the S protein SP is necessary for the design of mRNA vaccine.
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MESH Headings
- Animals
- Spike Glycoprotein, Coronavirus/immunology
- Spike Glycoprotein, Coronavirus/genetics
- SARS-CoV-2/immunology
- SARS-CoV-2/genetics
- Mice
- COVID-19 Vaccines/immunology
- Antibodies, Viral/immunology
- Antibodies, Viral/blood
- Protein Sorting Signals/genetics
- mRNA Vaccines/immunology
- Antibodies, Neutralizing/immunology
- Antibodies, Neutralizing/blood
- COVID-19/prevention & control
- COVID-19/immunology
- Mice, Inbred BALB C
- Female
- Vaccines, Synthetic/immunology
- Vaccines, Synthetic/administration & dosage
- Humans
- Immunogenicity, Vaccine
- Antibody Formation/immunology
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Affiliation(s)
- Chuncong Mo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China; Guangzhou Laboratory, No. 9 XingDaoHuanBei Road, Guangzhou International Bio Island, Guangzhou 510005, Guangdong Province, China
| | - Xiao Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Qianying Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Ye Fan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China; Guangzhou Laboratory, No. 9 XingDaoHuanBei Road, Guangzhou International Bio Island, Guangzhou 510005, Guangdong Province, China
| | - Donglan Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yuhui Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yujie Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xiaohong Liao
- Guangzhou Laboratory, No. 9 XingDaoHuanBei Road, Guangzhou International Bio Island, Guangzhou 510005, Guangdong Province, China
| | - Zhichao Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Liling Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Qiuru Li
- Guangzhou Laboratory, No. 9 XingDaoHuanBei Road, Guangzhou International Bio Island, Guangzhou 510005, Guangdong Province, China
| | - Qiong Zhang
- Guangzhou Laboratory, No. 9 XingDaoHuanBei Road, Guangzhou International Bio Island, Guangzhou 510005, Guangdong Province, China
| | - Wenkuan Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Rong Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China; Guangzhou Laboratory, No. 9 XingDaoHuanBei Road, Guangzhou International Bio Island, Guangzhou 510005, Guangdong Province, China.
| | - Xingui Tian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
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9
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Amput P, Tapanya W, Sangkarit N, Konsanit S, Wongphon S. Balance Ability and Quality of Life in Older Adult with Recovery from Mild COVID-19. Ann Geriatr Med Res 2023; 27:235-240. [PMID: 37592748 PMCID: PMC10556712 DOI: 10.4235/agmr.23.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/24/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND In this study, we aimed to assess the ability to balance and quality of life (QoL) among older adults without a history of coronavirus disease 2019 (COVID-19) and those who had recovered from mild COVID-19. METHODS We recruited 80 older adults and categorized them into the following two groups based on their history of COVID-19: those without COVID-19 (n=40) and those who had recovered from mild COVID-19 (n=40). We assessed the participants' ability to balance using the multi-directional reach test and timed up and go (TUG) test, and evaluated their QoL using the Short Form-36. RESULTS Compared with older adults without a history of COVID-19, those who had recovered from mild COVID-19 demonstrated no differences in the scores of the forward, backward, right, and left directions (p>0.05), but a significantly longer duration for the TUG test (p=0.02) and a reduced QoL. CONCLUSION Our study results demonstrated decreased ability to balance and poor QoL among older adults who had recovered from mild COVID-19.
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Affiliation(s)
- Patchareeya Amput
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence of Human Performance and Rehabilitations, University of Phayao, Phayao, Thailand
| | - Weerasak Tapanya
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence of Human Performance and Rehabilitations, University of Phayao, Phayao, Thailand
| | - Noppharath Sangkarit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence of Human Performance and Rehabilitations, University of Phayao, Phayao, Thailand
| | - Saisunee Konsanit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Sirima Wongphon
- Department of Traditional Chinese Medicine, School of Public Health, University of Phayao, Phayao, Thailand
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10
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Symeonidou E, Dimitriadou A, Morsi-Yeroyannis A, Sidiropoulou MS, Gkoutziotis I, Petras P, Mpallas K. COVID-19 related acute necrotizing encephalopathy presenting in the early postoperative period. Arch Clin Cases 2023; 10:78-85. [PMID: 37293685 PMCID: PMC10246599 DOI: 10.22551/2023.39.1002.10246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Besides respiratory and gastrointestinal symptoms, SARS-CoV-2 also has potential neurotropic effects. Acute hemorrhagic necrotizing encephalopathy is a rare complication of Covid-19. This article presents a case of an 81-year-old female, fully vaccinated, who underwent laparoscopic transhiatal esophagectomy due to gastroesophageal junction cancer. In the early postoperative period, the patient developed persistent fever accompanied by acute quadriplegia, impaired consciousness, and no signs of respiratory distress. Imaging with Computed Tomography and Magnetic Resonance revealed multiple bilateral lesions both in gray and white matter, as well as pulmonary embolism. Covid-19 infection was added to the differential diagnosis three weeks later, after other possible causes were excluded. The molecular test obtained at that time for coronavirus was negative. However, the high clinical suspicion index led to Covid-19 antibody testing (IgG and IgA), which confirmed the diagnosis. The patient was treated with corticosteroids with noticeable clinical improvement. She was discharged to a rehabilitation center. Six months later, the patient was in good general condition, although a neurological deficit was still present. This case indicates the significance of a high clinical suspicion index, based on a combination of clinical manifestations and neuroimaging, and the confirmation of the diagnosis with molecular and antibody testing. Constant awareness of a possible Covid-19 infection among hospitalized patients is mandatory.
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Affiliation(s)
- Elissavet Symeonidou
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | | | - Antonios Morsi-Yeroyannis
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | | | - Ioannis Gkoutziotis
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | - Panagiotis Petras
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | - Konstantinos Mpallas
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
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11
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Bîrluţiu V, Bîrluţiu RM, Feiereisz AI, Dobriţoiu ES. Facial palsy at the onset of SARS-CoV-2 infection. A case report. Germs 2023; 13:65-71. [PMID: 38023955 PMCID: PMC10659744 DOI: 10.18683/germs.2023.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/06/2023] [Accepted: 01/31/2023] [Indexed: 12/01/2023]
Abstract
Introduction SARS-CoV-2 infection has been associated with an increased number of deaths, due to severe respiratory damage, cardiovascular impairment, acute renal failure, and also neurological injury, including stroke, which is most commonly responsible for death. These are elements that determine patients to seek medical advice. Case report This is a case report of a female Caucasian patient, aged 65 years, with type 2 diabetes mellitus on metformin 1000 mg twice/day, and hypertension, who presented to the emergency department with one day history of left orbital hyperlacrimation and chewing and swallowing difficulty. On physical examination there was a decreased blink reflex, flattened nasolabial fold, and drooping left corner of the mouth, with left conjunctival hyperemia, and a present corneal reflex. Motion limited head CT and MRI revealed no pathological changes suggestive for the appearance of paresis. The patient was transferred to the Department of Infectious Diseases after laboratory confirmation of SARS-CoV-2 infection. Under treatment, improvement of paresis after three days was observed, with minimal asymmetry left five days after admission. A reassessment one month after discharge revealed complete recovery of the paresis, physical asthenia, and headache, in the context of long-COVID syndrome. Conclusions The appearance of paresis may be a consequence of the direct action of the virus on the nervous system, of hypercoagulability, or, later, of an immune mechanism. The case presented is judged as an early, direct action of the virus on the central nervous system, the respiratory symptoms were minimized by the patient at the time of presentation.
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Affiliation(s)
- Victoria Bîrluţiu
- Prof. habil., MD, PhD, Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Romania and County Clinical Emergency Hospital, 2A Lucian Blaga street, 550169, Sibiu, Romania
| | - Rareş Mircea Bîrluţiu
- MD, PhD, FOIŞOR Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB, 35-37 Ferdinand boulevard, District 2, 021382, Bucharest, Romania
| | - Alin Iulian Feiereisz
- MD, PhD student, Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Romania and County Clinical Emergency Hospital, 2A Lucian Blaga street, 550169, Sibiu, Romania
| | - Elena Simona Dobriţoiu
- MD, PhD student, Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Romania and County Clinical Emergency Hospital, 2A Lucian Blaga street, 550169, Sibiu, Romania
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12
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Peeters G, Van Remoortel A, Nagels G, Van Schependom J, D'haeseleer M. Occurrence and Severity of Coronavirus Disease 2019 Are Associated With Clinical Disability Worsening in Patients With Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200089. [PMID: 36807080 PMCID: PMC9942531 DOI: 10.1212/nxi.0000000000200089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/09/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Large-scale observational studies have shown that, in patients with multiple sclerosis (MS), the risk of becoming more severely ill from coronavirus disease 2019 (COVID-19) is determined by older age, male sex, cardiovascular comorbidities, African American ethnicity, progressive disease, recent use of corticosteroids, and B cell-depleting disease-modifying treatment. In contrast, the effect of COVID-19 on the disease course of MS has been studied much less extensively. Our main goal was to explore whether COVID-19 is associated with accelerated clinical disability worsening in patients with MS. METHODS Since March 2020, demographics and infectious outcome (categorized as ambulatory, hospitalized, and/or death) of patients with MS who developed COVID-19 have been collected at the Belgian National MS Center in Melsbroek. On February 28, 2022, this database was locked and complemented with clinical disability measures-Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FWT), 9-Hole Peg Test (9HPT), and Symbol Digit Modalities Test (SDMT)-that were available from a larger local database, obtained during routine medical follow-up. For each parameter, the first 2 assessments before COVID-19 diagnosis (T0 and T1; T1 is the closest to COVID-19 diagnosis), and the first thereafter (T2), were retrieved. RESULTS We identified 234 unique cases of COVID-19. Thirty-one patients were hospitalized (13.2%), and 5 died (2.1%) as a result of their infection. Among survivors with complete EDSS results (N = 138), mean annualized T1-to-T2 EDSS worsening was more pronounced, compared with the respective change between T0 and T1 (0.3 ± 0.9 vs 0.1 ± 0.9, p = 0.012). No such differences were found for the T25FWT, 9HPT, and SDMT scores. Severe COVID-19 (hospitalization) was associated with clinically relevant T1-to-T2 EDSS worsening (OR 2.65, p = 0.042). Vaccination coverage in the total cohort was 53.8%. Being unprotected by vaccination at the time of infection was associated with a worse COVID-19 outcome (hospitalization and/or death; OR 3.52, p = 0.002) but not with clinically relevant T1-to-T2 EDSS worsening. DISCUSSION The occurrence and severity of COVID-19 are both associated with clinical disability worsening in patients with MS. Vaccination protects against a more severe course of COVID-19 in this specific population. TRIAL REGISTRATION INFORMATION The study has been registered at ClinicalTrials.gov (study registration number: NCT05403463).
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Affiliation(s)
| | | | | | | | - Miguel D'haeseleer
- From the Universitair Ziekenhuis Brussel (UZ Brussel) (G.P., G.N., M.D.), Department of Neurology, Belgium; Nationaal Multiple Sclerose Centrum (NMSC) (G.P., A.V.R., M.D.), Melsbroek, Belgium; Vrije Universiteit Brussel (VUB) (G.N., J.V.S., M.D.), Center for Neurosciences (C4N), NEUR and AIMS, Brussels, Belgium; Icometrix (G.N.), Leuven, Belgium; and Vrije Universiteit Brussel (VUB) (J.V.S.), Department of Electronics and Informatics (ETRO), Belgium.
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13
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Korchut A, Rejdak K. Late neurological consequences of SARS-CoV-2 infection: New challenges for the neurologist. Front Neurosci 2023; 17:1004957. [PMID: 36845421 PMCID: PMC9947479 DOI: 10.3389/fnins.2023.1004957] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Objective In this study, a systematic review of the literature was performed to study the frequency of neurological symptoms and diseases in adult patients with COVID-19 that may be late consequences of SARS-CoV-2 infection. Methods Relevant studies were identified through electronic explorations of Scopus, PubMed, and Google Scholar. We followed PRISMA guidelines. Data were collected from studies where the diagnosis of COVID-19 was confirmed and its late neurological consequences occurred at least 4 weeks after initial SARS-CoV-2 infection. Review articles were excluded from the study. Neurological manifestations were stratified based on frequency (above 5, 10, and 20%), where the number of studies and sample size were significant. Results A total of 497 articles were identified for eligible content. This article provides relevant information from 45 studies involving 9,746 patients. Fatigue, cognitive problems, and smell and taste dysfunctions were the most frequently reported long-term neurological symptoms in patients with COVID-19. Other common neurological issues were paresthesia, headache, and dizziness. Conclusion On a global scale of patients affected with COVID-19, prolonged neurological problems have become increasingly recognized and concerning. Our review might be an additional source of knowledge about potential long-term neurological impacts.
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Affiliation(s)
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
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14
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Merza MA, Almufty HB, Younis HA, Rasool SO, Mohammed SA. Memory impairment among recovered COVID-19 patients: The prevalence and risk factors, a retrospective cohort study. J Med Virol 2023; 95:e28459. [PMID: 36602051 DOI: 10.1002/jmv.28459] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
The aim of this study is to demonstrate the prevalence of the long-term side effects of COVID-19, namely memory impairment among recovered patients, and obtaining the associated factors that link with memory impairment. It is a cross-sectional retrospective cohort study, that has been conducted from September to November 2022 in Iraq. People who were previously infected with COVID-19 were included. The study was performed by asking people to complete a questionnaire platform by either online or face-to-face interview. The Memory Assessment Clinic-Q (MAC-Q) test was utilized, scores that are equal or higher than 25 are indicative of memory decline. Thousand two hundred and eighty-seven participated in this study. However, only 1157 were included in the final analysis. Three hundred ninety-nine (34.49%) have memory impairment after COVID-19 recovery. Female gender, older age group, repeated exposure to COVID-19 infections, severe diseases, and exposure to multiple SARS-CoV-2 variants were independent risk factors of memory deficit in post-COVID-19 survivors with a p-value of 0.0001, 0.02, 0.0001, 0.001, 0.0001 respectively. It is crucial to pay particular attention to psychosocial rehabilitation of such risky groups. COVID-19 vaccine administrations with booster shots are necessary steps to decrease the disease incidence and avoid subsequent post-COVID-19 symptoms.
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Affiliation(s)
- Muayad A Merza
- Department of Internal Medicine, Azadi Teaching Hospital, College of Pharmacy, University of Duhok, Duhok, Iraq
| | - Hind B Almufty
- Department of Clinical Pharmacy, College of Pharmacy, University of Duhok, Duhok, Iraq
| | - Heewa A Younis
- Department of Medicine, College of Medicine, University of Duhok, Duhok, Iraq
| | - Suzan O Rasool
- Department of Clinical Pharmacy, College of Pharmacy, University of Duhok, Duhok, Iraq
| | - Shinah A Mohammed
- Department of Pharmaceutics, College of Pharmacy, University of Duhok, Duhok, Iraq
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15
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Takao M, Ohira M. Neurological post-acute sequelae of SARS-CoV-2 infection. Psychiatry Clin Neurosci 2023; 77:72-83. [PMID: 36148558 PMCID: PMC9538807 DOI: 10.1111/pcn.13481] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
The novel coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can have two phases: acute (generally 4 weeks after onset) and chronic (>4 weeks after onset). Both phases include a wide variety of signs and symptoms including neurological and psychiatric symptoms. The signs and symptoms that are considered sequelae of COVID-19 are termed post-COVID condition, long COVID-19, and post-acute sequelae of SARS-CoV-2 infection (PASC). PASC symptoms include fatigue, dyspnea, palpitation, dysosmia, subfever, hypertension, alopecia, sleep problems, loss of concentration, amnesia, numbness, pain, gastrointestinal symptoms, depression, and anxiety. Because the specific pathophysiology of PASC has not yet been clarified, there are no definite criteria of the condition, hence the World Health Organization's definition is quite broad. Consequently, it is difficult to correctly diagnose PASC. Approximately 50% of patients may show at least one PASC symptom up to 12 months after COVID-19 infection; however, the exact prevalence of PASC has not been determined. Despite extensive research in progress worldwide, there are currently no clear diagnostic methodologies or treatments for PASC. In this review, we discuss the currently available information on PASC and highlight the neurological sequelae of COVID-19 infection. Furthermore, we provide clinical suggestions for diagnosing and caring for patients with PASC based on our outpatient clinic experience.
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Affiliation(s)
- Masaki Takao
- Department of Clinical Laboratory and Internal Medicine, National Center of Neurology and Psychiatry (NCNP), National Center Hospital, Tokyo, Japan
| | - Masayuki Ohira
- Department of Clinical Laboratory and Internal Medicine, National Center of Neurology and Psychiatry (NCNP), National Center Hospital, Tokyo, Japan
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16
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Khalimova KM, Rashidova NS, Salimjonov JJ. [Neurological complications after covid-19 vaccination]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:13-19. [PMID: 38147377 DOI: 10.17116/jnevro202312312113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
The aim of our work was to study the relevance and incidence of neurological post-vaccination complications during the COVID-19 pandemic. Based on the results of a systematic literature search of several databases, the current review describes the diagnosed complications, including neurological, that occurred after the administration of the COVID-19 vaccine during the pandemic period. To fully establish the pathophysiological mechanisms of the development of a causal relationship of neurological complications with vaccines against COVID-19, it becomes necessary to continue long-term studies. This will make it possible to carry out a pharmacological correction of the quality of vaccine safety.
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17
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Yang Z, Ma Y, Bi W, Tang J. Exploring the research landscape of COVID-19-induced olfactory dysfunction: A bibliometric study. Front Neurosci 2023; 17:1164901. [PMID: 37034158 PMCID: PMC10079987 DOI: 10.3389/fnins.2023.1164901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Since the outbreak of COVID-19, olfactory dysfunction (OD) has become an important and persistent legacy problem that seriously affects the quality of life. The purpose of this paper is to quantitatively analyze and visualize the current research status and development trend of COVID-19 related OD by using VOSviewer software. Based on the Web of Science database, a total of 1,592 relevant documents were retrieved in January 2023, with publication time spanning from 2020 to 2023. The bibliometric analysis revealed that the most influential research results in the field of COVID-19 related OD were concentrated in journals of related disciplines such as otorhinolaryngology, medicine, general and internal, virology, neurosciences, etc. The knowledge base of the research is mainly formed in two fields: COVID-19 clinical research and OD specialized research. The research hotspots are mainly concentrated in six directions: COVID-19, long COVID, smell, anosmia, OD, and recovery. Based on the results of the bibliometric analysis, the temporal trends of COVID-19 related OD studies were visually revealed, and relevant suggestions for future research were proposed.
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Affiliation(s)
- Zhirong Yang
- Library of Zhuhai Campus, Jinan University, Zhuhai, China
| | - Yukun Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wei Bi
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Wei Bi
| | - Jingqian Tang
- Department of Subject Service and Consultation, Jinan University Library, Guangzhou, China
- Intellectual Property Information Service Center, Jinan University, Guangzhou, China
- Jingqian Tang
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18
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Vakili K, Fathi M, Yaghoobpoor S, Sayehmiri F, Nazerian Y, Nazerian A, Mohamadkhani A, Khodabakhsh P, Réus GZ, Hajibeygi R, Rezaei-Tavirani M. The contribution of gut-brain axis to development of neurological symptoms in COVID-19 recovered patients: A hypothesis and review of literature. Front Cell Infect Microbiol 2022; 12:983089. [PMID: 36619768 PMCID: PMC9815719 DOI: 10.3389/fcimb.2022.983089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
The gut microbiota undergoes significant alterations in response to viral infections, particularly the novel SARS-CoV-2. As impaired gut microbiota can trigger numerous neurological disorders, we suggest that the long-term neurological symptoms of COVID-19 may be related to intestinal microbiota disorders in these patients. Thus, we have gathered available information on how the virus can affect the microbiota of gastrointestinal systems, both in the acute and the recovery phase of the disease, and described several mechanisms through which this gut dysbiosis can lead to long-term neurological disorders, such as Guillain-Barre syndrome, chronic fatigue, psychiatric disorders such as depression and anxiety, and even neurodegenerative diseases such as Alzheimer's and Parkinson's disease. These mechanisms may be mediated by inflammatory cytokines, as well as certain chemicals such as gastrointestinal hormones (e.g., CCK), neurotransmitters (e.g., 5-HT), etc. (e.g., short-chain fatty acids), and the autonomic nervous system. In addition to the direct influences of the virus, repurposed medications used for COVID-19 patients can also play a role in gut dysbiosis. In conclusion, although there are many dark spots in our current knowledge of the mechanism of COVID-19-related gut-brain axis disturbance, based on available evidence, we can hypothesize that these two phenomena are more than just a coincidence and highly recommend large-scale epidemiologic studies in the future.
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Affiliation(s)
- Kimia Vakili
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Fathi
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Yaghoobpoor
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sayehmiri
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Nazerian
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ashraf Mohamadkhani
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pariya Khodabakhsh
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gislaine Z. Réus
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Ramtin Hajibeygi
- Department of Cardiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Mostafa Rezaei-Tavirani,
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19
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Maranduca MA, Vamesu CG, Tanase DM, Clim A, Drochioi IC, Pinzariu AC, Filip N, Dima N, Tudorancea I, Serban DN, Serban IL. The RAAS Axis and SARS-CoV-2: From Oral to Systemic Manifestations. Medicina (B Aires) 2022; 58:medicina58121717. [PMID: 36556919 PMCID: PMC9784172 DOI: 10.3390/medicina58121717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
One of the essential regulators of arterial blood pressure, the renin-angiotensin-aldosterone system (RAAS) seems to be one of the most complex mechanisms in the human body. Since the discovery of its key components and their actions, new substances and functions are still being unraveled. The main pathway begins with the secretion of renin in the kidney and culminates with the synthesis of angiotensin II (Ang II)-a strong vasoconstrictor-thanks to the angiotensin-converting enzyme (ACE). Research conducted in 2000 identified another enzyme, named ACE2, that converts Ang II into Ang-(1-7), a heptapeptide with opposing effects to those of Ang II: vasodilation and anti-inflammatory properties. This particular enzyme became of paramount importance during the last two decades, as a result of the confrontation of the human race with life-threatening epidemics. Multiple studies have been performed in order to uncover the link between ACE2 and human coronaviruses, the results of which we systemized in order to create an overview of the pathogenic mechanism. Human coronaviruses, such as SARS-CoV and SARS-CoV-2, attach to ACE2 via their spike proteins (S), causing the destruction of the enzyme. Because ACE2 limits the production of Ang II (by converting it into Ang-(1-7)), its destruction leads to a dysregulated inflammatory response. The purpose of this review is to decipher the complex pathophysiological mechanisms underlying the multiorgan complications (oral, cardiac, pulmonary, systemic) that appear as a result of the interaction of the SARS CoV-2 virus with the angiotensin-converting enzyme type 2.
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Affiliation(s)
- Minela Aida Maranduca
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
| | - Calin George Vamesu
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Daniela Maria Tanase
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Clim
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ilie Cristian Drochioi
- Department of Oral and Maxillofacial Surgery and Reconstructive, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania
- Correspondence: (I.C.D.); (A.C.P.)
| | - Alin Constantin Pinzariu
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (I.C.D.); (A.C.P.)
| | - Nina Filip
- Department of Morpho-Functional Sciences II, Discipline of Biochemistry, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Nicoleta Dima
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iasi, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ionut Tudorancea
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Dragomir Nicolae Serban
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ionela Lacramioara Serban
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Griggs E, Trageser K, Naughton S, Yang EJ, Mathew B, Van Hyfte G, Hellmers L, Jette N, Estill M, Shen L, Fischer T, Pasinetti GM. Molecular and cellular similarities in the brain of SARS-CoV-2 and Alzheimer's disease individuals. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2022:2022.11.23.517706. [PMID: 36451886 PMCID: PMC9709800 DOI: 10.1101/2022.11.23.517706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
UNLABELLED Infection with the etiological agent of COVID-19, SARS-CoV-2, appears capable of impacting cognition, which some patients with Post-acute Sequelae of SARS-CoV-2 (PASC). To evaluate neuro-pathophysiological consequences of SARS-CoV-2 infection, we examine transcriptional and cellular signatures in the Broadman area 9 (BA9) of the frontal cortex and the hippocampal formation (HF) in SARS-CoV-2, Alzheimer's disease (AD) and SARS-CoV-2 infected AD individuals, compared to age- and gender-matched neurological cases. Here we show similar alterations of neuroinflammation and blood-brain barrier integrity in SARS-CoV-2, AD, and SARS-CoV-2 infected AD individuals. Distribution of microglial changes reflected by the increase of Iba-1 reveal nodular morphological alterations in SARS-CoV-2 infected AD individuals. Similarly, HIF-1α is significantly upregulated in the context of SARS-CoV-2 infection in the same brain regions regardless of AD status. The finding may help to inform decision-making regarding therapeutic treatments in patients with neuro-PASC, especially those at increased risk of developing AD. TEASER SARS-CoV-2 and Alzheimer's disease share similar neuroinflammatory processes, which may help explain neuro-PASC.
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21
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Abdelmissih S. A Bitter Experience That Enlightens the Future: COVID-19 Neurological Affection and Perspectives on the Orexigenic System. Cureus 2022; 14:e30788. [DOI: 10.7759/cureus.30788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
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22
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Shahbaz MA, De Bernardi F, Alatalo A, Sachana M, Clerbaux LA, Muñoz A, Parvatam S, Landesmann B, Kanninen KM, Coecke S. Mechanistic Understanding of the Olfactory Neuroepithelium Involvement Leading to Short-Term Anosmia in COVID-19 Using the Adverse Outcome Pathway Framework. Cells 2022; 11:3027. [PMID: 36230989 PMCID: PMC9563945 DOI: 10.3390/cells11193027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022] Open
Abstract
Loss of the sense of smell (anosmia) has been included as a COVID-19 symptom by the World Health Organization. The majority of patients recover the sense of smell within a few weeks postinfection (short-term anosmia), while others report persistent anosmia. Several studies have investigated the mechanisms leading to anosmia in COVID-19; however, the evidence is scattered, and the mechanisms remain poorly understood. Based on a comprehensive review of the literature, we aim here to evaluate the current knowledge and uncertainties regarding the mechanisms leading to short-term anosmia following SARS-CoV-2 infection. We applied an adverse outcome pathway (AOP) framework, well established in toxicology, to propose a sequence of measurable key events (KEs) leading to short-term anosmia in COVID-19. Those KEs are (1) SARS-CoV-2 Spike proteins binding to ACE-2 expressed by the sustentacular (SUS) cells in the olfactory epithelium (OE); (2) viral entry into SUS cells; (3) viral replication in the SUS cells; (4) SUS cell death; (5) damage to the olfactory sensory neurons and the olfactory epithelium (OE). This AOP-aligned approach allows for the identification of gaps where more research should be conducted and where therapeutic intervention could act. Finally, this AOP gives a frame to explain several disease features and can be linked to specific factors that lead to interindividual differences in response to SARS-CoV-2 infection.
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Affiliation(s)
- Muhammad Ali Shahbaz
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70211 Kuopio, Finland
| | - Francesca De Bernardi
- Division of Otorhinolaryngology, Department of Biotechnologies and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy
| | - Arto Alatalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70211 Kuopio, Finland
| | - Magdalini Sachana
- Environment Health and Safety Division, Environment Directorate, Organisation for Economic Cooperation and Development (OECD), 75775 Paris, France
| | | | - Amalia Muñoz
- European Commission, Joint Research Centre (JRC), 2440 Geel, Belgium
| | - Surat Parvatam
- Centre for Predictive Human Model Systems, Atal Incubation Centre-Centre for Cellular and Molecular Biology (AIC-CCMB), Habsiguda, Hyderabad 500039, India
| | | | - Katja M. Kanninen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70211 Kuopio, Finland
| | - Sandra Coecke
- European Commission, Joint Research Centre (JRC), 21027 Ispra, Italy
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23
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da Silva Júnior RT, Santos Apolonio J, Cuzzuol BR, da Costa BT, Silva CS, Araújo GRL, Silva Luz M, Marques HS, Santos LKDS, Pinheiro SLR, Lima de Souza Gonçalves V, Calmon MS, Freire de Melo F. COVID-19 neuropsychiatric repercussions: Current evidence on the subject. World J Methodol 2022; 12:365-380. [PMID: 36186752 PMCID: PMC9516547 DOI: 10.5662/wjm.v12.i5.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected the entire world, causing the coronavirus disease 2019 (COVID-19) pandemic since it was first discovered in Wuhan, China in December 2019. Among the clinical presentation of the disease, in addition to fever, fatigue, cough, dyspnea, diarrhea, nausea, vomiting, and abdominal pain, infected patients may also experience neurological and psychiatric repercussions during the course of the disease and as a post-COVID-19 sequelae. Thus, headache, dizziness, olfactory and gustatory dysfunction, cerebrovascular disorders, neuromuscular abnormalities, anxiety, depression, and post-traumatic stress disorder can occur both from the infection itself and from social distancing and quarantine. According to current evidence about this infection, the virus has the ability to infect the central nervous system (CNS) via angiotensin-converting enzyme 2 (ACE2) receptors on host cells. Several studies have shown the presence of ACE2 in nerve cells and nasal mucosa, as well as transmembrane serine protease 2, key points for interaction with the viral Spike glycoprotein and entry into the CNS, being olfactory tract and blood-brain barrier, through hematogenous dissemination, potential pathways. Thus, the presence of SARS-CoV-2 in the CNS supports the development of neuropsychiatric symptoms. The management of these manifestations seems more complex, given that the dense parenchyma and impermeability of brain tissue, despite protecting the brain from the infectious process, may hinder virus elimination. Still, some alternatives used in non-COVID-19 situations may lead to worse prognosis of acute respiratory syndrome, requiring caution. Therefore, the aim of this review is to bring more current points related to this infection in the CNS, as well as the repercussions of the isolation involved by the pandemic and to present perspectives on interventions in this scenario.
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Affiliation(s)
| | - Jonathan Santos Apolonio
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Beatriz Rocha Cuzzuol
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Bruna Teixeira da Costa
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Camilo Santana Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Glauber Rocha Lima Araújo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Marcel Silva Luz
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Hanna Santos Marques
- Universidade Estadual do Sudoeste da Bahia, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083900, Brazil
| | - Luana Kauany de Sá Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Samuel Luca Rocha Pinheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | | | - Mariana Santos Calmon
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029094, Brazil
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Neuroinflammatory Disease following Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children. J Pediatr 2022; 247:22-28.e2. [PMID: 35577119 PMCID: PMC9106400 DOI: 10.1016/j.jpeds.2022.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe neurologic, radiologic and laboratory features in children with central nervous system (CNS) inflammatory disease complicating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. STUDY DESIGN We focused on CNS inflammatory diseases in children referred from 12 hospitals in the Paris area to Necker-Sick Children Reference Centre. RESULTS We identified 19 children who had a history of SARS-CoV-2 infection and manifest a variety of CNS inflammatory diseases: encephalopathy, cerebellar ataxia, acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, or optic neuritis. All patients had a history of SARS-CoV-2 exposure, and all tested positive for circulating antibodies against SARS-CoV-2. At the onset of the neurologic disease, SARS-CoV-2 PCR results (nasopharyngeal swabs) were positive in 8 children. Cerebrospinal fluid was abnormal in 58% (11/19) and magnetic resonance imaging was abnormal in 74% (14/19). We identified an autoantibody co-trigger in 4 children (myelin-oligodendrocyte and aquaporin 4 antibodies), representing 21% of the cases. No autoantibody was found in the 6 children whose CNS inflammation was accompanied by a multisystem inflammatory syndrome in children. Overall, 89% of patients (17/19) received anti-inflammatory treatment, primarily high-pulse methylprednisolone. All patients had a complete long-term recovery and, to date, no patient with autoantibodies presented with a relapse. CONCLUSIONS SARS2-CoV-2 represents a new trigger of postinfectious CNS inflammatory diseases in children.
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Key Words
- adem, acute disseminated encephalomyelitis
- aqp4, aquaporin 4
- cns, central nervous system
- covid-19, coronavirus disease 2019
- csf, cerebrospinal fluid
- il, interleukin
- mis-c, multisystem inflammatory syndrome in children
- mri, magnetic resonance imaging
- mogad, mog-associated disorder
- mog, myelin-oligodendrocyte glycoprotein
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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25
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Targeting autophagy regulation in NLRP3 inflammasome-mediated lung inflammation in COVID-19. Clin Immunol 2022; 244:109093. [PMID: 35944881 PMCID: PMC9356669 DOI: 10.1016/j.clim.2022.109093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Emerging evidence indicates that the NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome is activated, which results in a cytokine storm at the late stage of COVID-19. Autophagy regulation is involved in the infection and replication of SARS-CoV-2 at the early stage and the inhibition of NLRP3 inflammasome-mediated lung inflammation at the late stage of COVID-19. Here, we discuss the autophagy regulation at different stages of COVID-19. Specifically, we highlight the therapeutic potential of autophagy activators in COVID-19 by inhibiting the NLRP3 inflammasome, thereby avoiding the cytokine storm. We hope this review provides enlightenment for the use of autophagy activators targeting the inhibition of the NLRP3 inflammasome, specifically the combinational therapy of autophagy modulators with the inhibitors of the NLRP3 inflammasome, antiviral drugs, or anti-inflammatory drugs in the fight against COVID-19.
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26
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Neurological manifestations by sex and age group in COVID-19 inhospital patients. eNeurologicalSci 2022; 28:100419. [PMID: 35935176 PMCID: PMC9338167 DOI: 10.1016/j.ensci.2022.100419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/15/2022] [Accepted: 07/24/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Neurological manifestations have been associated with a poorer prognosis in COVID-19. However, data regarding their incidence according to sex and age groups is still lacking. Methods This retrospective multicentric cohort collected data from 39 Brazilian hospitals from 17 cities, from adult COVID-19 admitted from March 2020 to January 2022. Neurological manifestations presented at hospital admission were assessed according to incidence by sex and age group. Results From 13,603 COVID-19 patients, median age was 60 years old and 53.0% were men. Women were more likely to present with headaches (22.4% vs. 17.7%, p < 0.001; OR 1.36, 95% confidence interval [CI] 1.22–1.52) than men and also presented a lower risk of having seizures (OR 0.43, 95% CI 0.20–0.94). Although delirium was more frequent in women (6.6% vs. 5.7%, p = 0.020), sex was not associated with delirium in the multivariable logistc regresssion analysis. Delirium, syncope and coma increased with age (1.5% [18–39 years] vs. 22.4% [80 years or over], p < 0.001, OR 1.07, 95% CI 1.06–1.07; 0.7% vs. 1.7%, p = 0.002, OR 1.01, 95% CI 1.00–1.02; 0.2% vs. 1.3% p < 0.001, OR 1.04, 95% CI 1.02–1.06), while, headache (26.5% vs. 7.1%, OR 0.98, 95% CI 0.98–0.99), anosmia (11.4% vs. 3.3%, OR 0.99, 95% CI] 0.98–0.99 and ageusia (13.1% vs. 3.5%, OR 0.99, CI 0.98–0.99) decreased (p < 0.001 for all). Conclusion Older COVID-19 patients were more likely to present delirium, syncope and coma, while the incidence of anosmia, ageusia and headaches decreased with age. Women were more likely to present headache, and less likely to present seizures. Older COVID-19 patients were more likely to present delirium and coma. Younger COVID-19 patients were more likely to report anosmia, ageusia and headache. Women with COVID-19 are more likely to present headache.
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27
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Nia AM, Srinivasan VM, Lall RR, Kan P. COVID-19 and Stroke Recurrence by Subtypes: A Propensity-Score Matched Analyses of Stroke Subtypes in 44,994 Patients. J Stroke Cerebrovasc Dis 2022; 31:106591. [PMID: 35779365 PMCID: PMC9162984 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Anna M Nia
- Department of Neurosurgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, 350 W Thomas Rd, Phoenix, AZ 85013, USA
| | - Rishi R Lall
- Department of Neurosurgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
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28
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Conway SE, Healy BC, Zurawski J, Severson C, Kaplan T, Stazzone L, Galetta K, Chitnis T, Houtchens MK. COVID-19 severity is associated with worsened neurological outcomes in Multiple Sclerosis and Related Disorders. Mult Scler Relat Disord 2022; 63:103946. [PMID: 35709663 PMCID: PMC9556032 DOI: 10.1016/j.msard.2022.103946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/20/2022] [Accepted: 06/04/2022] [Indexed: 11/15/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Sarah E Conway
- Brigham Multiple Sclerosis Center, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian C Healy
- Biostatistics Center, Brigham Multiple Sclerosis Center, Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Jonathan Zurawski
- Brigham Multiple Sclerosis Center, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher Severson
- Brigham Multiple Sclerosis Center, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tamara Kaplan
- Brigham Multiple Sclerosis Center, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Lynn Stazzone
- Brigham Multiple Sclerosis Center, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristin Galetta
- Brigham Multiple Sclerosis Center, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Maria K Houtchens
- Brigham Multiple Sclerosis Center, Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
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Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) is a well established respiratory tract illness. Recent studies in adults and children have shown an increasing number of patients reporting polymorphic cutaneous manifestations during COVID-19, including different types of rashes, from maculopapular, vascular, vesicular to atypical forms. RECENT FINDINGS Although pathogenesis of skin manifestations is still not fully understood, it has been proposed that cutaneous involvement during COVID-19 may be the results of the activation of the immune response against severe acute respiratory syndrome coronavirus-2, the reactivation or co-infection of herpesviruses or drug hypersensitivity. SUMMARY According to available literature, skin manifestations in patients with COVID-19 may be categorized on the basis of their clinical presentations as follows: erythematous rashes, lesions of vascular origin, vesicular rash, urticarial rash and acute generalized exanthematous pustulosis (AGEP), erythema multiforme and other polymorphic erythema/atypical reactions. Prompt recognition of these cutaneous manifestations represents a crucial point to facilitate diagnosis and management of COVID-19 patients.
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30
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Zhang R, Sun C, Chen X, Han Y, Zang W, Jiang C, Wang J, Wang J. COVID-19-Related Brain Injury: The Potential Role of Ferroptosis. J Inflamm Res 2022; 15:2181-2198. [PMID: 35411172 PMCID: PMC8994634 DOI: 10.2147/jir.s353467] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has caused devastating loss of life and a healthcare crisis worldwide. SARS-CoV-2 is the causative pathogen of COVID-19 and is transmitted mainly through the respiratory tract, where the virus infects host cells by binding to the ACE2 receptor. SARS-CoV-2 infection is associated with acute pneumonia, but neuropsychiatric symptoms and different brain injuries are also present. The possible routes by which SARS-CoV-2 invades the brain are unclear, as are the mechanisms underlying brain injuries with the resultant neuropsychiatric symptoms in patients with COVID-19. Ferroptosis is a unique iron-dependent form of non-apoptotic cell death, characterized by lipid peroxidation with high levels of glutathione consumption. Ferroptosis plays a primary role in various acute and chronic brain diseases, but to date, ferroptosis in COVID-19-related brain injuries has not been explored. This review discusses the mechanisms of ferroptosis and recent evidence suggesting a potential pathogenic role for ferroptosis in COVID-19-related brain injury. Furthermore, the possible routes through which SARS-CoV-2 could invade the brain are also discussed. Discoveries in these areas will open possibilities for treatment strategies to prevent or reduce brain-related complications of COVID-19.
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Affiliation(s)
- Ruoyu Zhang
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People’s Republic of China
| | - Chen Sun
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People’s Republic of China
| | - Xuemei Chen
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People’s Republic of China
| | - Yunze Han
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People’s Republic of China
| | - Weidong Zang
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People’s Republic of China
| | - Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052, People’s Republic of China
| | - Junmin Wang
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People’s Republic of China
| | - Jian Wang
- Department of Human Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, 450001, People’s Republic of China
- Correspondence: Jian Wang; Junmin Wang, Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China, Email ;
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31
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Hingorani KS, Bhadola S, Cervantes-Arslanian AM. COVID-19 and the Brain. Trends Cardiovasc Med 2022; 32:323-330. [PMID: 35461991 PMCID: PMC9022395 DOI: 10.1016/j.tcm.2022.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/11/2022]
Abstract
Entering the third year into the pandemic, overwhelming evidence demonstrates that Coronavirus disease 2019 (COVID-19) infection is a systemic illness, often with involvement of the central nervous system. Multiple mechanisms may underlie the development of neurologic manifestations of illness, including hypoxia, systemic illness, hypercoagulability, endothelial dysfunction, general critical illness, inflammatory response, and neurotropism of the severe acute respiratory syndrome coronavirus 2 (SARS-Co-V2) virus. COVID-19 infection is associated with neurologic involvement in all stages; acute infection, subacute/post-infection, and growing evidence also suggests during a chronic phase, the post-acute sequalae of COVID-19 (PASC). With over 20,000 published articles on COVID and the brain at the time of writing, it is virtually impossible to present an unbiased comprehensive review of how SARS-Co-V2 impacts the nervous system. In this review, we will present an overview of common neurologic manifestations, in particular focusing on the cerebrovascular complications, and proposed pathophysiology.
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32
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Kakovan M, Shirkouhi SG, Zarei M, Andalib S. Stroke Associated with COVID-19 Vaccines. J Stroke Cerebrovasc Dis 2022; 31:106440. [PMID: 35339857 PMCID: PMC8894799 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106440] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/28/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives Development of safe and effective vaccines against coronavirus disease 2019 (COVID-19) remains the cornerstone of controlling this pandemic. However, there are increasing reports of various types of stroke including ischemic stroke, and hemorrhagic stroke, as well as cerebral venous sinus thrombosis (CVST) after COVID-19 vaccination. This paper aims to review reports of stroke associated with COVID-19 vaccines and provide a coherent clinical picture of this condition. Materials and methods A literature review was performed with a focus on data from recent studies. Results Most of such patients are women under 60 years of age and who had received ChAdOx1 nCoV-19 vaccine. Most studies reported CVST with or without secondary ischemic or hemorrhagic stroke, and some with Vaccine-induced Thrombotic Thrombocytopenia (VITT). The most common clinical symptom of CVST seen after COVID-19 vaccination was headache. The clinical course of CVST after COVID-19 vaccination may be more severe than CVST not associated with COVID vaccination. Management of CVST following COVID-19 vaccination is challenging and may differ from the standard treatment of CVST. Low molecular weight heparin is commonly used in the treatment of CVST; however, it may worsen outcomes in CVST associated with VITT. Furthermore, administration of intravenous immunoglobulin and high-dose glucocorticoids have been recommended with various success rates. Conclusion These contradictory observations are a source of confusion in clinical decision-making and warrant further study and development of clinical guidelines. Clinicians should be aware of clinical presentation, diagnosis, and management of stroke associated with COVID-19 vaccination.
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33
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Wang S, Jawed Y, Perkins A, Gao S, Seyffert S, Khan S, Boustani M, Khan B. Healthy Aging Brain Care Monitor, Caregiver Version: Screening for Post-Intensive Care Syndrome. Am J Crit Care 2022; 31:137-144. [PMID: 35229151 PMCID: PMC9112132 DOI: 10.4037/ajcc2022451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cognitive impairment is common in intensive care unit survivors, pointing to the potential utility of a caregiver-based tool to screen for post-intensive care syndrome. OBJECTIVE To validate the Healthy Aging Brain Care Monitor, Caregiver Version (HABC-M CG), as a caregiver-based tool to screen for post-intensive care syndrome. METHODS A total of 116 patients who survived a stay in the intensive care unit completed standardized assessments of cognition, psychological symptoms, and physical functioning, and their caregivers completed the HABC-M CG. The Cronbach α was used to measure the internal consistency of the scale items. Validity of the HABC-M CG versus comparison tests was measured using the Spearman rank correlation. Generalized linear models were used to adjust for age, sex, and education level. RESULTS The total scale and all subscales of the HABC-M CG showed excellent internal consistency (Cronbach α = 0.88-0.93). Scores on the psychological subscale correlated with standardized measures of depressive symptoms (Spearman ρ = 0.58). Scores on the cognitive subscale correlated with the Mini-Mental State Examination score (Spearman ρ = -0.33). Scores on the functional subscale correlated with scores on the Physical Self-Maintenance Scale (Spearman ρ = -0.36). CONCLUSION The HABC-M CG is a valid informant-based clinical tool for the assessment of symptoms of post- intensive care syndrome.
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Affiliation(s)
- Sophia Wang
- Sophia Wang is an assistant professor, Department of Psychiatry, and the outreach, recruitment, and engagement core leader, Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis
| | - Yameena Jawed
- Yameena Jawed is a fellow, Division of Sleep Medicine, Department of Neurology, University of California San Francisco
| | - Anthony Perkins
- Anthony Perkins is a biostatistician, Department of Biostatistics, Indiana University School of Medicine
| | - Sujuan Gao
- Sujuan Gao is a professor, Department of Biostatistics, Indiana University School of Medicine
| | - Sarah Seyffert
- Sarah Seyffert is a resident physician, Department of Internal Medicine, Indiana University School of Medicine
| | - Sikandar Khan
- Sikandar Khan is an assistant professor, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, and a research scientist, Center for Health Innovation and Implementation Science, Indiana University School of Medicine and IU Center for Aging Research, Regenstrief Institute, Indianapolis
| | - Malaz Boustani
- Malaz Boustani is a professor, Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, and the chief innovation and implementation officer, Center for Health Innovation and Implementation Science
| | - Babar Khan
- Babar Khan is a professor, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, a researcher, Center for Health Innovation and Implementation Science, Indiana University School of Medicine; and a research scientist and codirector, IU Center for Aging Research, Regenstrief Institute
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Gambella A, Barreca A, Biancone L, Roccatello D, Peruzzi L, Besso L, Licata C, Attanasio A, Papotti M, Cassoni P. Spectrum of Kidney Injury Following COVID-19 Disease: Renal Biopsy Findings in a Single Italian Pathology Service. Biomolecules 2022; 12:biom12020298. [PMID: 35204798 PMCID: PMC8961620 DOI: 10.3390/biom12020298] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
The onset of coronavirus disease (COVID-19) as a pandemic infection, has led to increasing insights on its pathophysiology and clinical features being revealed, such as a noticeable kidney involvement. In this study, we describe the histopathological, immunofluorescence, and ultrastructural features of biopsy-proven kidney injury observed in a series of SARS-CoV-2 positive cases in our institution from April 2020 to November 2021. We retrieved and retrospectively reviewed nine cases (two pediatric and seven adults) that experienced nephrotic syndrome (six cases), acute kidney injury (two cases), and a clinically silent microhematuria and leukocyturia. Kidney biopsies were investigated by means of light microscopy, direct immunofluorescence, and electron microscopy. The primary diagnoses were minimal change disease (four cases), acute tubular necrosis (two cases), collapsing glomerulopathy (two cases), and C3 glomerulopathy (one case). None of the cases showed viral or viral-like particles on ultrastructural analysis. Novel and specific histologic features on kidney biopsy related to SARS-CoV-2 infection have been gradually disclosed and reported, harboring relevant clinical and therapeutic implications. Recognizing and properly diagnosing renal involvement in patients experiencing COVID-19 could be challenging (due to the lack of direct proof of viral infection, e.g., viral particles) and requires a proper integration of clinical and pathological data.
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Affiliation(s)
- Alessandro Gambella
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy; (A.G.); (A.A.)
| | - Antonella Barreca
- Pathology Unit, “Città della Salute e della Scienza di Torino” University Hospital, Via Santena 7, 10126 Turin, Italy;
| | - Luigi Biancone
- Division of Nephrology Dialysis and Transplantation, AOU Città della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, 10126 Turin, Italy;
| | - Dario Roccatello
- CMID, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Nephrology and Dialysis Unit (ERK-Net Member), San Giovanni Bosco Hub Hospital, University of Turin, 10144 Turin, Italy;
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Luca Besso
- Division of Nephrology and Dialysis, AO S. Croce e Carle di Cuneo, 12100 Cuneo, Italy;
| | - Carolina Licata
- Division of Nephrology and Dialysis, ASL TO4, 10073 Ciriè, Italy;
| | - Angelo Attanasio
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy; (A.G.); (A.A.)
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin, Via Santena 7, 10126 Turin, Italy;
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy; (A.G.); (A.A.)
- Correspondence:
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Ojha P, Dixit A. Olfactory training for Olfactory dysfunction in COVID-19: A promising mitigation amidst looming neurocognitive sequelae of the pandemic. Clin Exp Pharmacol Physiol 2022; 49:462-473. [PMID: 35090056 DOI: 10.1111/1440-1681.13626] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/15/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
Olfactory dysfunction (OD) is a recognized symptom of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is independently associated with neurodegenerative disorders. Moreover, the central nervous system manifestations in patients infected with the coronavirus -2019 (COVID-19) have demonstrated cognitive decline and neuropsychiatric manifestations. Hence, OD in COVID -19 necessitates perusal of its' mechanism and available treatment options to avert possible development of neurocognitive sequelae of the pandemic. The article presents a literature review organized from the published information about olfactory training (OT) for OD during COVID-19. The methodology comprised retrieval of available literature from database searches and subsequent scrutinization of relevant information. Inferentially, Injury to the sustentacular cells, possessing angiotensin-converting enzyme 2 (ACE-2) receptors, is an important mechanism causing OD in COVID-19. OD may be prolonged in severe cases of anosmia predisposing to neurodegenerative and cognitive impairment in COVID-19 infection. OT demonstrates an effective treatment for OD based on human and animal-derived evidence through recent studies. It curtails the progression of OD, besides inducing neural rearrangement and changes in functional connectivity in patients receiving OT. Additionally, contemporary reports support that the administration of OT for COVID-induced anosmia is effective and encompasses no significant adverse effects. The present review highlights the prominence of olfactory training as a recommended intervention for OD in COVID-19. This review can guide the clinicians in curbing neurological repercussions of COVID besides enhancing cognitive rehabilitation through olfactory training.
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Affiliation(s)
- Pooja Ojha
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Abhinav Dixit
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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36
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COVID-19 Pandemic and Periodontal Practice: The Immunological, Clinical, and Economic Points of View. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3918980. [PMID: 35047633 PMCID: PMC8763038 DOI: 10.1155/2022/3918980] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022]
Abstract
The recent global health problem, COVID-19, has had far-reaching impacts on lifestyles. Although many effective WHO-approved vaccines have been produced that have reduced the spread and severity of the disease, it appears to persist in humans for a long time and possibly forever as everyday it turns out to have new mutations. COVID-19 involves the lungs and other organs primarily through cytokine storms, which have been implicated in many other inflammatory disorders, including periodontal diseases. COVID-19 is in a close association with dental and periodontal practice from two respects: first, repeated mandatory lockdowns have reduced patient referrals to dentists and limited the dental and periodontal procedures to emergency treatments, whereas it is important to recognize the oral manifestations of COVID-19 as well as the influence of oral and periodontal disease on the severity of COVID-19. Second, dentistry is one of the high-risk professions in terms of close contact with unmasked individuals, necessitating redefining the principles of infection control. The pressures of the economic recession on patients as well as dentists add to the difficulty of resuming elective dental services. Therefore, this study is divided into two parts corresponding to what mentioned above: the first part examines the clinical and immunological associations between COVID-19 and periodontal and oral diseases, and the second part delineates the measures needed to control the disease transmission in dental clinics as well as the economic impact of the pandemic era on dental services.
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Joaquim L, Della Giustina A, Machado RS, Metzker KLL, Bonfante S, Danielski LG, Goldim MPDS, Petronilho F. The Infected Lungs and Brain Interface in COVID-19: The Impact on Cognitive Function. Neuroimmunomodulation 2022; 29:269-281. [PMID: 36323239 PMCID: PMC9747745 DOI: 10.1159/000526653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
Many coronavirus disease 2019 (COVID-19)-recovered patients report signs and symptoms and are experiencing neurological, psychiatric, and cognitive problems. However, the exact prevalence and outcome of cognitive sequelae is unclear. Even though the severe acute respiratory syndrome coronavirus 2 has target brain cells through binding to angiotensin-converting enzyme 2 (ACE2) receptor in acute infection, several studies indicate the absence of the virus in the brain of many COVID-19 patients who developed neurological disorders. Thus, the COVID-19 mechanisms for stimulating cognitive dysfunction may include neuroinflammation, which is mediated by a sustained systemic inflammation, a disrupted brain barrier, and severe glial reactiveness, especially within the limbic system. This review explores the interplay of infected lungs and brain in COVID-19 and its impact on the cognitive function.
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Affiliation(s)
- Larissa Joaquim
- Health Sciences Unit, Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, University of South Santa Catarina, Tubarao, Brazil
| | - Amanda Della Giustina
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Simon Machado
- Health Sciences Unit, Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, University of South Santa Catarina, Tubarao, Brazil
| | - Kiuanne Lino Lobo Metzker
- Health Sciences Unit, Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, University of South Santa Catarina, Tubarao, Brazil
| | - Sandra Bonfante
- Health Sciences Unit, Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, University of South Santa Catarina, Tubarao, Brazil
| | - Lucineia Gainski Danielski
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, University of Southern Santa Catarina, Criciuma, Brazil
| | - Mariana Pereira de Souza Goldim
- Health Sciences Unit, Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, University of South Santa Catarina, Tubarao, Brazil
| | - Fabricia Petronilho
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, University of Southern Santa Catarina, Criciuma, Brazil
- *Fabricia Petronilho,
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Cartin-Ceba R, Smith R, Lachner C, Singh V. Intensive care unit delirium in patients with severe COVID-19: A prospective observational cohort study. Int J Crit Illn Inj Sci 2022; 12:61-69. [PMID: 35845128 PMCID: PMC9285129 DOI: 10.4103/ijciis.ijciis_93_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Delirium is common in patients with severe coronavirus disease-19 (COVID-19). The purpose of our study was to determine whether severe COVID-19 is an independent risk factor for the development of delirium in patients treated in the intensive care unit (ICU). Methods: This prospective observational cohort study involved 162 critically ill patients admitted to a multidisciplinary ICU during 2019 and 2020. A validated screening tool was used to diagnose delirium. Multiple delirium risk factors were collected daily including clinical characteristics, hospital course, lab values, vital signs, surgical exposure, drug exposure, and COVID-19 characteristics. After univariate analysis, a multivariate logistic regression analysis was performed to determine independent risk factors associated with the development of delirium. Results: In our study population, 50 (31%) patients developed delirium. A total of 39 (24.1%) tested positive for COVID-19. Initial analysis showed COVID-19 to be more prevalent in those patients that developed delirium (40% vs. 17%; P = 0.003). Multivariate analysis showed opioid use (odds ratio [OR]: 24 [95% confidence intervals (CI): 16–27]; P ≤ 0.001), benzodiazepine use (OR: 23 [95% CI: 16–63] P = 0.001), and estimated mortality based on acute physiology and chronic health evaluation IV score (OR: 1.04 [95% CI: 1.01–1.07] P = 0.002) to be independently associated with delirium development. COVID-19 (OR: 1.44 [95% CI: 0.13–10.6]; P = 0.7) was not found to be associated with delirium. Conclusion: Delirium is prevalent in critically ill patients admitted to the ICU, including those with COVID-19. However, after adjustment for important covariates, we found in this cohort that COVID-19 was not an independent risk factor for delirium.
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39
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Le Gentil S, Prampart S, Karakachoff M, Bureau ML, Chapelet G, De Decker L, Rouaud A, Boureau AS. Functional Decline in COVID-19 Older Survivors Compared to Other Pneumonia Patients, a Case Control Study. J Nutr Health Aging 2022; 26:896-903. [PMID: 36156682 PMCID: PMC9470507 DOI: 10.1007/s12603-022-1845-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/15/2022] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Among patients over 75 years, little is known about functional decline due to COVID-19. The aim of this study was to explore this functional decline, compare to other infectious pneumonia. DESIGN AND SETTING This case-control study included all COVID-19 patients hospitalized from March to December 2020 in Acute Geriatric Ward in Nantes University Hospital matched 1/1 with patients with pneumonia hospitalized in geriatric department between March 2017 and March 2019 (controls) on sex, age. Functional decline was assessed at 3 month follow up as it is routinely done after hospitalization in geriatric ward. We performed multivariable analyses to compare clinical outcomes between patients with COVID-19 vs controls. RESULTS 132 pairs were matched on age (mean: 87 y-o), and sex (61% of women). In multivariable logistic regression analysis, there were no statistical significant association between COVID-19 infection and functional decline (OR=0.89 p=0.72). A statistical significant association was found between functional decline and Charlson comorbidity index (OR=1.17, p=0.039); prior fall (OR=2.08, p=0.012); malnutrition (OR=1.97, p=0.018); length of hospital stay (OR=1.05, p=0.002) and preadmission ADL(OR=1.25, p=0.049). CONCLUSION COVID-19 does not seem to be responsible for a more frequent or severe functional decline than other infectious pneumonia in older and comorbid population after 3 month follow up. In this population, pneumonia is associated with functional decline in almost 1 in 2 cases. The individual preadmission frailty seems to be a more important predictor of functional decline, encouraging multidimensional care management for this population.
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Affiliation(s)
- S Le Gentil
- Anne-Sophie Boureau, Department of Geriatrics, University Hospital, 44093 Nantes, France; phone: +33 2-40-16-50-46;
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Xiao M, You Z, Zeng C, Huang Z, Dong L. Update on neurological symptoms in patients infected with severe acute respiratory syndrome coronavirus-2. IBRAIN 2021; 7:351-361. [PMID: 37786557 PMCID: PMC10528815 DOI: 10.1002/ibra.12008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 10/04/2023]
Abstract
Novel coronavirus 19 (COVID-19) is the latest and most intense epidemic, which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In addition to causing respiratory symptoms, SARS-CoV-2 can have severe effects on the nervous system. Clinically, COVID-19 patients have been reported ranging from mild hypogeusia and hyposmia to severe neurological disorders, such as encephalopathy, encephalitis, strokes, and seizures syndrome. However, the pathological mechanisms of this SARS-CoV-2 neuro aggressiveness remain unclear, so it is of great significance to explore the neurological effects of SARS-CoV-2 infection. To facilitate clinicians to timely recognize the manifestations of COVID-19 patients with neurological injury and timely treatment, the author hereby reviews the latest research progress in the possible pathways, clinical manifestations, and pathogenesis of COVID-19 patients with nerve injury.
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Affiliation(s)
- Mei‐Fang Xiao
- Health Management Center, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina
| | - Zhi‐Jian You
- Department of AnesthesiologyLiuzhou People's Hospital Affiliated to Guangxi Medical UniversityLiuzhouGuangxiChina
| | - Chang Zeng
- Health Management Center, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina
| | - Ze‐Bing Huang
- Department of Infectious Diseases, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Key Laboratory of Viral HepatitisChangshaHunanChina
| | - Liang Dong
- Department of AnesthesiologyLiuzhou People's Hospital Affiliated to Guangxi Medical UniversityLiuzhouGuangxiChina
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Akhmedzhanova LT, Voskresenskaia ON, Isaikin AI, Ermilova EV, Nasonova TI, Chernousov PA, Rusin VV. Acute disseminated encephalomyelitis and myelitis associated with new coronavirus infection COVID-19. Case report. TERAPEVT ARKH 2021; 93:1375-1380. [DOI: 10.26442/00403660.2021.11.201168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
Abstract
Acute disseminated encephalomyelitis (AEM) and acute transverse myelitis (OPM) are autoimmune demyelinating diseases of the central nervous system. Two clinical observations of AEM and OPM developed after suffering acute coronavirus infection (SARS-CoV-2) are presented. Differential diagnosis was carried out with multiple sclerosis, encephalitis of an infectious nature, compressive myelopathy, and opticomyelitis. Both observations show an almost complete recovery of lost functions. The pathogenetic mechanisms of the development of AEM and OPM in patients with coronavirus infection are discussed. The onset of central nervous system dysimmune lesion in the context of coronavirus infection makes it necessary to monitor the clinical situation with the involvement of a neurologist for timely diagnosis and determination of therapeutic tactics that can reduce the degree of disability of patients.
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Klein R, Soung A, Sissoko C, Nordvig A, Canoll P, Mariani M, Jiang X, Bricker T, Goldman J, Rosoklija G, Arango V, Underwood M, Mann JJ, Boon A, Dowrk A, Boldrini M. COVID-19 induces neuroinflammation and loss of hippocampal neurogenesis. RESEARCH SQUARE 2021:rs.3.rs-1031824. [PMID: 34729556 PMCID: PMC8562542 DOI: 10.21203/rs.3.rs-1031824/v1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infection with the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is associated with onset of neurological and psychiatric symptoms during and after the acute phase of illness 1-4 . Acute SARS-CoV-2 disease (COVID-19) presents with deficits of memory, attention, movement coordination, and mood. The mechanisms of these central nervous system symptoms remain largely unknown.In an established hamster model of intranasal infection with SARS-CoV-2 5 , and patients deceased from COVID-19, we report a lack of viral neuroinvasion despite aberrant BBB permeability, microglial activation, and brain expression of interleukin (IL)-1β and IL-6, especially within the hippocampus and the inferior olivary nucleus of the medulla, when compared with non-COVID control hamsters and humans who died from other infections, cardiovascular disease, uremia or trauma. In the hippocampus dentate gyrus of both COVID-19 hamsters and humans, fewer cells expressed doublecortin, a marker of neuroblasts and immature neurons.Despite absence of viral neurotropism, we find SARS-CoV-2-induced inflammation, and hypoxia in humans, affect brain regions essential for fine motor function, learning, memory, and emotional responses, and result in loss of adult hippocampal neurogenesis. Neuroinflammation could affect cognition and behaviour via disruption of brain vasculature integrity, neurotransmission, and neurogenesis, acute effects that may persist in COVID-19 survivors with long-COVID symptoms.
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Sasanejad P, Afshar Hezarkhani L, Arsang-Jang S, Tsivgoulis G, Ghoreishi A, Kristian B, Rahmig J, Farhoudi M, Sadeghi Hokmabadi E, Borhani-Haghighi A, Sariaslani P, Sharifi-Razavi A, Ghandehari K, Khosravi A, Smith C, Nilanont Y, Akbari Y, Nguyen TN, Bersano A, Yassi N, Yoshimoto T, Lattanzi S, Gupta A, Zand R, Rafie S, Pourandokht Mousavian S, Reza Shahsavaripour M, Amini S, Kamenova SU, Kondybayeva A, Zhanuzakov M, Macri EM, Nobleza COS, Ruland S, Cervantes-Arslanian AM, Desai MJ, Ranta A, Moghadam Ahmadi A, Rostamihosseinkhani M, Foroughi R, Hooshmandi E, Akhoundi FH, Shuaib A, Liebeskind DS, Siegler J, Romano JG, Mayer SA, Bavarsad Shahripour R, Zamani B, Woolsey A, Fazli Y, Mojtaba K, Isaac CF, Biller J, Di Napoli M, Azarpazhooh MR. Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative. J Stroke Cerebrovasc Dis 2021; 30:106121. [PMID: 34601242 PMCID: PMC8450304 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19. METHODS This multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes. RESULTS A total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054). CONCLUSION IV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.
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Affiliation(s)
- Payam Sasanejad
- Department of Neurology Mashhad Fellowship of interventional radiology Mashhad University of Medical Sciences.
| | - Leila Afshar Hezarkhani
- Department of Neurology School of Medicine Farabi Hospital Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahram Arsang-Jang
- Department of Biostatistics and Epidemiology School of Medicine Zanjan University of Medical Sciences, Zanjan, Iran
| | - Georgios Tsivgoulis
- Second Department of Neurology National & Kapodistrian University of Athens,Professor of Neurology, Athens, Greece
| | - Abdoreza Ghoreishi
- Department of Neurology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences
| | - Barlinn Kristian
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - Jan Rahmig
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mehdi Farhoudi
- Neurosciences Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elyar Sadeghi Hokmabadi
- Neurosciences Research Center, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz
| | | | - Payam Sariaslani
- Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Athena Sharifi-Razavi
- Clinical Research Development Unit of Bou-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kavian Ghandehari
- Department of Neurology Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Khosravi
- Clinical Immunology Research Center, Department of Neurology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Craig Smith
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK; Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Yongchai Nilanont
- Siriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yama Akbari
- Departments of Neurology, Neurological Surgery, and Anatomy & Neurobiology, and Beckman Laser Institute & Medical Clinic, School of Medicine, University of California, Irvine, CA, USA
| | - Thanh N Nguyen
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico carlo Besta, Milano, Italy
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca, Ancona, Italy
| | - Animesh Gupta
- Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Ramin Zand
- Department of Neurology, Neuroscience Institute, Geisinger Medical Center, Danville, PA, USA
| | - Shahram Rafie
- Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Shahram Amini
- Department of Anesthesia, Intensive care Unit, Lung Research Center, Mashhad, Mashhad University of Medical Sciences
| | - Saltanat U Kamenova
- Department of Medicine, Al-Farabi Kazakh National University, Doctor of Medical Science, Professor. Almaty, Kazakhstan
| | - Aida Kondybayeva
- Doctor of Medical Science, Professor Doctor of Medical Science, Professor, Department of Medicine, Al-Farabi Kazakh National University. Almaty, Kazakhstan
| | - Murat Zhanuzakov
- Doctor of Medical Science Professor, Department of Internal Medicine, Kazakh-Russian Medical University. Almaty, Kazakhstan
| | | | | | - Sean Ruland
- Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Chicago, IL
| | - Anna M Cervantes-Arslanian
- Departments of Neurology, Neurosurgery, and Medicine (Infectious Disease), Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Masoom J Desai
- Assistant Professor of Neurology, University of New Mexico, Albuquerque
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington and Department of Neurology, Wellington Regional Hospital, New Zealand
| | - Amir Moghadam Ahmadi
- Associate Professor of Neurology, School of Medicine, Non-communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Razieh Foroughi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Etrat Hooshmandi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh H Akhoundi
- Department of Neurology, Iran University of medical Sciences, Tehran, Iran
| | - Ashfaq Shuaib
- Professor of Neurology and Director Stroke Program University of Alberta, Alberta, Canada
| | | | - James Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ
| | - Jose G Romano
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephan A Mayer
- Professor of Neurology and Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, NY
| | - Reza Bavarsad Shahripour
- University of California San Diego Neurosciences center, Comprehensive Stroke center, San Diego, CA
| | - Babak Zamani
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Amadene Woolsey
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada. Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Yasaman Fazli
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khazaei Mojtaba
- Assistant Professor of Neurology, Assistant Professor of Neurology, Hamadan Medical University of Medical Sciences, Fellowship of neurovascular intervention
| | | | - Jose Biller
- Department of Neurology, Loyola University Health System, Stritch School of Medicine, Chicago, IL, USA
| | - Mario Di Napoli
- Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy
| | - M Reza Azarpazhooh
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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44
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Affiliation(s)
- Carol S North
- From Metrocare Services and the Department of Psychiatry, University of Texas Southwestern Medical Center - both in Dallas (C.S.N.); and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Massachusetts General Hospital, and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Harvard Medical School - both in Boston
| | - Emily M Sorg
- From Metrocare Services and the Department of Psychiatry, University of Texas Southwestern Medical Center - both in Dallas (C.S.N.); and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Massachusetts General Hospital, and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Harvard Medical School - both in Boston
| | - SooJeong Youn
- From Metrocare Services and the Department of Psychiatry, University of Texas Southwestern Medical Center - both in Dallas (C.S.N.); and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Massachusetts General Hospital, and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Harvard Medical School - both in Boston
| | - Jacqueline T Chu
- From Metrocare Services and the Department of Psychiatry, University of Texas Southwestern Medical Center - both in Dallas (C.S.N.); and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Massachusetts General Hospital, and the Departments of Psychiatry (E.M.S., S.Y.) and Medicine (J.T.C.), Harvard Medical School - both in Boston
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Finsterer J, Scorza FA, Scorza CA, Fiorini AC. Extrapulmonary onset manifestations of COVID-19. Clinics (Sao Paulo) 2021; 76:e2900. [PMID: 34231709 PMCID: PMC8240766 DOI: 10.6061/clinics/2021/e2900] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease (COVID-19) usually starts with pulmonary signs and symptoms. However, in some cases, the initial clinical presentations are extrapulmonary. This literature review aimed at summarizing and discussing the extrapulmonary onset manifestations of COVID-19. The most frequent initial extrapulmonary manifestations include hypogeusia, hyposmia, non-specific abdominal symptoms, corneal congestion, and deep venous thrombosis. Several rarer extrapulmonary manifestations in locations such as the brain, peripheral nerves, muscles, eyes, ears, myocardium, intestines, skin, or vessels have been additionally reported as onset presentations of COVID-19. In conclusion, it is crucial for clinicians and health care providers to consider extrapulmonary presentations at the onset of COVID-19 to avoid overlooking the infection and contributing to the spread of the disease.
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Affiliation(s)
| | - Fulvio A. Scorza
- Disciplina de Neurociencia, Escola Paulista de Medicina/Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP, BR
| | - Carla A. Scorza
- Disciplina de Neurociencia, Escola Paulista de Medicina/Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP, BR
| | - Ana C. Fiorini
- Programa de Estudos Pos-Graduados em Fonoaudiologia, Pontificia Universidade Catolica de Sao Paulo (PUC-SP), Sao Paulo, SP, BR, Departamento de Fonoaudiologia, Escola Paulista de Medicina/Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP, BR
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46
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Moghimi N, Di Napoli M, Biller J, Siegler JE, Shekhar R, McCullough LD, Harkins MS, Hong E, Alaouieh DA, Mansueto G, Divani AA. The Neurological Manifestations of Post-Acute Sequelae of SARS-CoV-2 infection. Curr Neurol Neurosci Rep 2021; 21:44. [PMID: 34181102 PMCID: PMC8237541 DOI: 10.1007/s11910-021-01130-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 02/06/2023]
Abstract
Purpose of Review Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global health challenge. This review aims to summarize the incidence, risk factors, possible pathophysiology, and proposed management of neurological manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC) or neuro-PASC based on the published literature. Recent Findings The National Institutes of Health has noted that PASC is a multi-organ disorder ranging from mild symptoms to an incapacitating state that can last for weeks or longer following recovery from initial infection with SARS-CoV-2. Various pathophysiological mechanisms have been proposed as the culprit for the development of PASC. These include, but are not limited to, direct or indirect invasion of the virus into the brain, immune dysregulation, hormonal disturbances, elevated cytokine levels due to immune reaction leading to chronic inflammation, direct tissue damage to other organs, and persistent low-grade infection. A multidisciplinary approach for the treatment of neuro-PASC will be required to diagnose and address these symptoms. Tailored rehabilitation and novel cognitive therapy protocols are as important as pharmacological treatments to treat neuro-PASC effectively. Summary With recognizing the growing numbers of COVID-19 patients suffering from neuro-PASC, there is an urgent need to identify affected individuals early to provide the most appropriate and efficient treatments. Awareness among the general population and health care professionals about PASC is rising, and more efforts are needed to understand and treat this new emerging challenge. In this review, we summarize the relevant scientific literature about neuro-PASC.
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Affiliation(s)
- Narges Moghimi
- Department of Neurology, School of Medicine, 1 University of New Mexico, MSC10-5620, Albuquerque, NM 87131 USA
| | - Mario Di Napoli
- Neurological Service, SS Annunziata Hospital, Sulmona, L’Aquila, Italy
| | - José Biller
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL USA
| | - James E. Siegler
- Cooper Neurological Institute, Cooper University Health Care, Camden, NJ 08103 USA
| | - Rahul Shekhar
- Department of Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Louise D. McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas USA
| | - Michelle S. Harkins
- Department of Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Emily Hong
- Department of Neurology, School of Medicine, 1 University of New Mexico, MSC10-5620, Albuquerque, NM 87131 USA
| | - Danielle A. Alaouieh
- Department of Neurology, School of Medicine, 1 University of New Mexico, MSC10-5620, Albuquerque, NM 87131 USA
| | - Gelsomina Mansueto
- Department of Advanced Medical and Surgical Sciences, University of Campania, Naples, Italy
| | - Afshin A. Divani
- Department of Neurology, School of Medicine, 1 University of New Mexico, MSC10-5620, Albuquerque, NM 87131 USA
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Arjmand B, Alavi-Moghadam S, Parhizkar Roudsari P, Rezaei-Tavirani M, Rahim F, Gilany K, Mohamadi-Jahani F, Adibi H, Larijani B. COVID-19 Pathology on Various Organs and Regenerative Medicine and Stem Cell-Based Interventions. Front Cell Dev Biol 2021; 9:675310. [PMID: 34195193 PMCID: PMC8238122 DOI: 10.3389/fcell.2021.675310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022] Open
Abstract
Severe acute respiratory syndrome-coronavirus 2, a novel betacoronavirus, has caused the global outbreak of a contagious infection named coronavirus disease-2019. Severely ill subjects have shown higher levels of pro-inflammatory cytokines. Cytokine storm is the term that can be used for a systemic inflammation leading to the production of inflammatory cytokines and activation of immune cells. In coronavirus disease-2019 infection, a cytokine storm contributes to the mortality rate of the disease and can lead to multiple-organ dysfunction syndrome through auto-destructive responses of systemic inflammation. Direct effects of the severe acute respiratory syndrome associated with infection as well as hyperinflammatory reactions are in association with disease complications. Besides acute respiratory distress syndrome, functional impairments of the cardiovascular system, central nervous system, kidneys, liver, and several others can be mentioned as the possible consequences. In addition to the current therapeutic approaches for coronavirus disease-2019, which are mostly supportive, stem cell-based therapies have shown the capacity for controlling the inflammation and attenuating the cytokine storm. Therefore, after a brief review of novel coronavirus characteristics, this review aims to explain the effects of coronavirus disease-2019 cytokine storm on different organs of the human body. The roles of stem cell-based therapies on attenuating cytokine release syndrome are also stated.
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Affiliation(s)
- Babak Arjmand
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Alavi-Moghadam
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyvand Parhizkar Roudsari
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fakher Rahim
- Health Research Institute, Thalassemia and Hemoglobinopathies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Gilany
- Reproductive Immunology Research Center, Avicenna Research Institute, The Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Department of Integrative Oncology, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Fereshteh Mohamadi-Jahani
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Adibi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Martinez-Perez R, Kortz MW, Carroll BW, Duran D, Neill JS, Luzardo GD, Zachariah MA. Coronavirus Disease 2019 and Pituitary Apoplexy: A Single-Center Case Series and Review of the Literature. World Neurosurg 2021; 152:e678-e687. [PMID: 34129968 PMCID: PMC8196470 DOI: 10.1016/j.wneu.2021.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022]
Abstract
Background Pituitary apoplexy (PA) is a rare, but life-threatening, condition characterized by pituitary infarction and hemorrhage, most often in the setting of a preexisting adenoma. The risk factors and mechanisms associated with PA are poorly understood. Although neurovascular manifestations of coronavirus disease 2019 (COVID-19) infection have been documented, its association with PA has not yet been determined. Methods From a prospectively collected database of patients treated at a tertiary care center for pituitary adenoma, we conducted a retrospective medical record review of PA cases during the COVID-19 pandemic from March 2020 to December 2020. We also conducted a literature review to identify other reported cases. Results We identified 3 consecutive cases of PA and concomitant COVID-19 infection. The most common symptoms at presentation were headache and vision changes. The included patients were successfully treated with surgical decompression and medical management of the associated endocrinopathy, ultimately experiencing improvement in their visual symptoms at the latest follow-up examination. COVID-19 infection in the perioperative period was corroborated by polymerase chain reaction test results in all the patients. Conclusions With the addition of our series to the literature, 10 cases of PA in the setting of COVID-19 infection have been confirmed. The present series was limited in its ability to draw conclusions about the relationship between these 2 entities. However, COVID-19 infection might represent a risk factor for the development of PA. Further studies are required.
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Affiliation(s)
| | - Michael W Kortz
- Department of Neurological Surgery, University of Colorado, Aurora, Colorado, USA
| | - Benjamin W Carroll
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Daniel Duran
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - James S Neill
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gustavo D Luzardo
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Marcus A Zachariah
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Iovino L, Thur LA, Gnjatic S, Chapuis A, Milano F, Hill JA. Shared inflammatory pathways and therapeutic strategies in COVID-19 and cancer immunotherapy. J Immunother Cancer 2021; 9:e002392. [PMID: 33986127 PMCID: PMC8126446 DOI: 10.1136/jitc-2021-002392] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 01/28/2023] Open
Abstract
COVID-19, the syndrome caused by the infection with SARS-CoV-2 coronavirus, is characterized, in its severe form, by interstitial diffuse pneumonitis and acute respiratory distress syndrome (ARDS). ARDS and systemic manifestations of COVID-19 are mainly due to an exaggerated immune response triggered by the viral infection. Cytokine release syndrome (CRS), an inflammatory syndrome characterized by elevated levels of circulating cytokines, and endothelial dysfunction are systemic manifestations of COVID-19. CRS is also an adverse event of immunotherapy (IMTX), the treatment of diseases using drugs, cells, and antibodies to stimulate or suppress the immune system. Graft-versus-host disease complications after an allogeneic stem cell transplant, toxicity after the infusion of chimeric antigen receptor-T cell therapy and monoclonal antibodies can all lead to CRS. It is hypothesized that anti-inflammatory drugs used for treatment of CRS in IMTX may be useful in reducing the mortality in COVID-19, whereas IMTX itself may help in ameliorating effects of SARS-CoV-2 infection. In this paper, we focused on the potential shared mechanisms and differences between COVID-19 and IMTX-related toxicities. We performed a systematic review of the clinical trials testing anti-inflammatory therapies and of the data published from prospective trials. Preliminary evidence suggests there might be a benefit in targeting the cytokines involved in the pathogenesis of COVID-19, especially by inhibiting the interleukin-6 pathway. Many other approaches based on novel drugs and cell therapies are currently under investigation and may lead to a reduction in hospitalization and mortality due to COVID-19.
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Affiliation(s)
- Lorenzo Iovino
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laurel A Thur
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sacha Gnjatic
- Medicine-Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aude Chapuis
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joshua A Hill
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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50
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Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol 2021; 12:653786. [PMID: 33981305 PMCID: PMC8107358 DOI: 10.3389/fimmu.2021.653786] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/08/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Although acute transverse myelitis (ATM) is a rare neurological condition (1.34-4.6 cases per million/year) COVID-19-associated ATM cases have occurred during the pandemic. Case-finding methods We report a patient from Panama with SARS-CoV-2 infection complicated by ATM and present a comprehensive clinical review of 43 patients with COVID-19-associated ATM from 21 countries published from March 2020 to January 2021. In addition, 3 cases of ATM were reported as serious adverse events during the clinical trials of the COVID-19 vaccine ChAdOx1 nCoV-19 (AZD1222). Results All patients had typical features of ATM with acute onset of paralysis, sensory level and sphincter deficits due to spinal cord lesions demonstrated by imaging. There were 23 males (53%) and 20 females (47%) ranging from ages 21- to 73- years-old (mean age, 49 years), with two peaks at 29 and 58 years, excluding 3 pediatric cases. The main clinical manifestations were quadriplegia (58%) and paraplegia (42%). MRI reports were available in 40 patients; localized ATM lesions affected ≤3 cord segments (12 cases, 30%) at cervical (5 cases) and thoracic cord levels (7 cases); 28 cases (70%) had longitudinally-extensive ATM (LEATM) involving ≥4 spinal cord segments (cervicothoracic in 18 cases and thoracolumbar-sacral in 10 patients). Acute disseminated encephalomyelitis (ADEM) occurred in 8 patients, mainly women (67%) ranging from 27- to 64-years-old. Three ATM patients also had blindness from myeloneuritis optica (MNO) and two more also had acute motor axonal neuropathy (AMAN). Conclusions We found ATM to be an unexpectedly frequent neurological complication of COVID-19. Most cases (68%) had a latency of 10 days to 6 weeks that may indicate post-infectious neurological complications mediated by the host’s response to the virus. In 32% a brief latency (15 hours to 5 days) suggested a direct neurotropic effect of SARS-CoV-2. The occurrence of 3 reported ATM adverse effects among 11,636 participants in the AZD1222 vaccine trials is extremely high considering a worldwide incidence of 0.5/million COVID-19-associated ATM cases found in this report. The pathogenesis of ATM remains unknown, but it is conceivable that SARS-CoV-2 antigens –perhaps also present in the AZD1222 COVID-19 vaccine or its chimpanzee adenovirus adjuvant– may induce immune mechanisms leading to the myelitis.
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Affiliation(s)
- Gustavo C Román
- Department of Neurology, Neurological Institute, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell College of Medicine, Cornell University, New York, NY, United States.,Department of Neurology, Texas A&M University College of Medicine, Bryan, TX, United States
| | - Fernando Gracia
- Neurology Service, Hospital Paitilla, Panama City, Panama.,Faculty of Health Sciences, Interamerican University of Panama, Panama City, Panama.,Neurology Service, Hospital Santo Tomás, Panama City, Panama
| | - Antonio Torres
- Infectious Disease Service, Hospital Santo Tomás, Panama City, Panama
| | - Alexis Palacios
- Neuroradiology Service, Complejo Hospitalario Metropolitano, CSS (Caja de Seguro Social), Panama City, Panama
| | - Karla Gracia
- Interamerican University of Panama, Panama City, Panama
| | - Diógenes Harris
- Neurosurgery Service, Complejo Hospitalario Metropolitano, CSS, Panama City, Panama
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