Neurological manifestations of patients with mild-to-moderate COVID-19 attending a public hospital in Lima, Peru

Meta-analysis of the serum/plasma proteome identifies significant associations between COVID-19 with Alzheimer's/Parkinson's diseases

In recent years, we have seen the widespread devastations and serious health complications manifested by COVID-19 globally. Although we have effectively controlled the pandemic, uncertainties persist regarding its potential long-term effects, including prolonged neurological issues. To gain comprehensive insights, we conducted a meta-analysis of mass spectrometry-based proteomics data retrieved from different studies with a total of 538 COVID-19 patients and 523 healthy controls. The meta-analysis revealed that top-enriched pathways were associated with neurological disorders, including Alzheimer's (AD) and Parkinson's disease (PD). Further analysis confirmed a direct correlation in the expression patterns of 24 proteins involved in Alzheimer's and 23 proteins in Parkinson's disease with COVID-19. Protein-protein interaction network and cluster analysis identified SNCA as a hub protein, a known biomarker for Parkinson's disease, in both AD and PD. To the best of our knowledge, this is the first meta-analysis study providing proteomic profiling evidence linking COVID-19 to neurological complications.

A review of neurological health disparities in Peru

Peru is a historically unique and culturally diverse Latin American country. As a low-to-middle-income country (LMIC), Peru faces health implications from the spread of communicable diseases as well as a growing rate of noncommunicable diseases, both of which have been worsened by the recent COVID-19 pandemic's impact on the national health system. Over the past two decades, the country has aimed to improve health access for its population through various efforts described in this review. Despite this, there are notable neurological health disparities that exist today. This narrative review investigates such disparities through the leading neurological contributors to the national burden of disease in the country, including migraine headaches, cerebrovascular disease, and dementia. Public health disparities that contribute to other major neurological diseases in the country, including epilepsy, neurocysticercosis, Chagas disease, multiple sclerosis, traumatic brain injury, traumatic and non-traumatic spinal cord injuries are also investigated. We also explore potential solutions for overcoming the various neurological health disparities covered in this review that may be applied through public policies, as well as in similar LMICs in Latin America. By overcoming such disparities, the country may be able to successfully address the major contributors of neurological disease burden and create a healthcare environment that can sustainably and equitably improve health outcomes for Peruvian people.

Taste loss as a distinct symptom of COVID-19: a systematic review and meta-analysis

Chemosensory scientists have been skeptical that reports of COVID-19 taste loss are genuine, in part because before COVID-19 taste loss was rare and often confused with smell loss. Therefore, to establish the predicted prevalence rate of taste loss in COVID-19 patients, we conducted a systematic review and meta-analysis of 376 papers published in 2020-2021, with 235 meeting all inclusion criteria. Drawing on previous studies and guided by early meta-analyses, we explored how methodological differences (direct vs. self-report measures) may affect these estimates. We hypothesized that direct measures of taste are at least as sensitive as those obtained by self-report and that the preponderance of evidence confirms taste loss is a symptom of COVID-19. The meta-analysis showed that, among 138,015 COVID-19-positive patients, 36.62% reported taste dysfunction (95% confidence interval: 33.02%-40.39%), and the prevalence estimates were slightly but not significantly higher from studies using direct (n = 15) versus self-report (n = 220) methodologies (Q = 1.73, df = 1, P = 0.1889). Generally, males reported lower rates of taste loss than did females, and taste loss was highest among middle-aged adults. Thus, taste loss is likely a bona fide symptom of COVID-19, meriting further research into the most appropriate direct methods to measure it and its underlying mechanisms.

“Vision Loss” and COVID-19 Infection: A Systematic Review and Meta-Analysis

Background: Visual impairment in terms of reduced visual acuity and “visual loss” has been reported as an atypical symptom in patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. This systematic review and meta-analysis aims to assess the cumulative incidence of “visual loss” during coronavirus disease 2019 (COVID-19) and review the current evidence regarding “visual loss” caused by SARS-CoV-2 infection. Methods: We performed a systematic review and meta-analysis of studies following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched the PubMed, Embase, and Scopus databases for relevant studies published that clearly described “vision loss” and SARS-CoV-2 infection. All studies reporting concomitant “vision loss” and laboratory-confirmed SARS-CoV-2 infection were included. Meta-analyses were conducted using the measurement of risk and a 95% confidence interval for each study. Results: Our search identified 1143 manuscripts published in the English language. After study screening, twenty-nine articles were selected: two cross-sectional studies, twenty-four case reports, and three case series. A random-effect meta-analysis demonstrated that the pooled “visual loss” cumulative incidence in COVID-19 patients was 0.16 (95% CI 0.12–0.21). The quality rating of the cross-sectional studies averaged four out of the maximum score on the Newcastle–Ottawa scale. Conclusions: COVID-19 infection might cause “visual loss”. Even if the current evidence is limited, ophthalmological assessment should be promptly provided to all patients experiencing visual impairment symptoms during SARS-CoV-2 infection.

The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection

COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.

Taste loss as a distinct symptom of COVID-19: a systematic review and meta-analysis

Chemosensory scientists have been skeptical that reports of COVID-19 taste loss are genuine, in part because before COVID-19 taste loss was rare and often confused with smell loss. Therefore, to establish the predicted prevalence rate of taste loss in COVID-19 patients, we conducted a systematic review and meta-analysis of 376 papers published in 2020-2021, with 241 meeting all inclusion criteria. Drawing on previous studies and guided by early meta-analyses, we explored how methodological differences (direct vs. self-report measures) may affect these estimates. We hypothesized that direct measures of taste are at least as sensitive as those obtained by self-report and that the preponderance of evidence confirms taste loss is a symptom of COVID-19. The meta-analysis showed that, among 138,897 COVID-19-positive patients, 39.2% reported taste dysfunction (95% confidence interval: 35.34%-43.12%), and the prevalence estimates were slightly but not significantly higher from studies using direct (n = 18) versus self-report (n = 223) methodologies (Q = 0.57, df = 1, P = 0.45). Generally, males reported lower rates of taste loss than did females, and taste loss was highest among middle-aged adults. Thus, taste loss is likely a bona fide symptom of COVID-19, meriting further research into the most appropriate direct methods to measure it and its underlying mechanisms.

COVID-19 neurological manifestations: correlation of cerebral MRI imaging and lung imaging—Observational study

Background

During the current pandemic, there is an increased incidence of neurologic/neuropsychiatric manifestations in patients with the novel coronavirus (COVID-19). Neurologic manifestations may be coincident or result of disease and its therapy. In the emergency department, orientation of the clinician with this issue is crucial for accurate decision making to limit the spread of infection during neurologic treatment. This study aimed to be familiar with MRI findings in patients with Neuro-COVID. Seventy patients presented with neurologic/neuropsychiatric manifestation either post COVID or during hospitalization underwent cerebral MRI from April 2020 to June 2021 (39 men and 31women; mean age 43.27, age range from 16 to 69 years).

Results

Headache (80%), is the most prevalent neurological manifestations followed by smell and taste impairment (62.9%) and stroke symptoms (45.7%). Low mood and anxiety (17.1%), prolonged fatigue (14.3%) and depression (7.1%) are the most common psychiatric symptoms. Infarctions, hematoma and demyelinating disease are the most prevalent findings. There is a week positive correlation between MRI findings and CT chest finding but without statistical significance (P-value 0.2).

Conclusions

Cerebrovascular disease and demyelinating lesions are common manifestations of COVID 19. Familiarity of neurologists and radiologist in the emergency department and in-patient with this issue is crucial to avoid misdiagnosis and the spread of infection.

The myocardial and neuronal infectivity of SARS-CoV-2 and detrimental outcomes

The epidemiological outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), alias COVID-19, began in Wuhan, Hubei, China, in late December and eventually turned into a pandemic that has led to over 3.71 million deaths and over 173 million infected cases worldwide. In addition to respiratory manifestations, COVID-19 patients with neurological and myocardial dysfunctions exhibit a higher risk of in-hospital mortality. The immune function tends to be affected by cardiovascular risk factors and is thus indirectly related to the prognosis of COVID-19 patients. Many neurological symptoms and manifestations have been reported in COVID-19 patients; however, detailed descriptions on the prevalence and characteristic features of these symptoms are restricted due to insufficient data. It is thus advisable for clinicians to be vigilant for both cardiovascular and neurological manifestations to detect them at an early stage to avoid inappropriate management of COVID-19 and to address the manifestations adequately. Patients with severe COVID-19 are notably more susceptible to developing cardiovascular and neurological complications than non-severe COVID-19 patients. This review focuses on the consequential outcomes of COVID-19 on cardiovascular and neuronal functions, including other influencing factors.

Taste loss as a distinct symptom of COVID-19: A systematic review and meta-analysis

Chemosensory scientists have been skeptical that reports of COVID-19 taste loss are genuine, in part because before COVID-19, taste loss was rare and often confused with smell loss. Therefore, to establish the predicted prevalence rate of taste loss in COVID-19 patients, we conducted a systematic review and meta-analysis of 376 papers published in 2020-2021, with 241 meeting all inclusion criteria. Additionally, we explored how methodological differences (direct vs. self-report measures) may affect these estimates. We hypothesized that direct prevalence measures of taste loss would be the most valid because they avoid the taste/smell confusion of self-report. The meta-analysis showed that, among 138,897 COVID-19-positive patients, 39.2% reported taste dysfunction (95% CI: 35.34-43.12%), and the prevalence estimates were slightly but not significantly higher from studies using direct (n = 18) versus self-report (n = 223) methodologies (Q = 0.57, df = 1, p = 0.45). Generally, males reported lower rates of taste loss than did females and taste loss was highest in middle-aged groups. Thus, taste loss is a bona fide symptom COVID-19, meriting further research into the most appropriate direct methods to measure it and its underlying mechanisms.

What can the neurological manifestations of COVID-19 tell us: a meta-analysis

Background

Covid-19 became a global pandemic in 2019. Studies have shown that coronavirus can cause neurological symptoms, but clinical studies on its neurological symptoms are limited. In this meta-analysis, we aimed to summarize the various neurological manifestations that occurred in COVID-19 patients and calculate the incidence of various neurological manifestations. At the same time, we further explored the mechanism of nervous system injury and prognosis in COVID-19 patients in combination with their nervous system manifestations. This study provides a reference for early clinical identification of COVID-19 nervous system injury in the future, so as to achieve early treatment and reduce neurological sequelae.

Methods

We systematically searched all published English literature related to the neurological manifestations of COVID-19 from January 1, 2020, to April 30, 2021, in Pubmed, Embase, and Cochrane Library. The keywords used were COVID-19 and terminology related to the nervous system performance. All included studies were selected by two independent reviewers using EndNote and NoteExpress software, any disagreement was resolved by consensus or by a third reviewer, and the selected data were then collected for meta-analysis using a random-effects model.

Results

A total of 168 articles (n = 292,693) were included in the study, and the meta-analysis showed that the most common neurological manifestations of COVID-19 were myalgia(33%; 95%CI 0.30–0.37; I² = 99.17%), smell impairment(33%; 95%CI 0.28–0.38; I² = 99.40%), taste dysfunction(33%; 95%CI 0.27–0.39; I² = 99.09%), altered mental status(32%; 95%CI 0.22–0.43; I² = 99.06%), headache(29%; 95%CI 0.25–0.33; I² = 99.42%), encephalopathy(26%; 95%CI 0.16–0.38; I² = 99.31%), alteration of consciousness(13%; 95%CI 0.08–0.19; I² = 98.10%), stroke(12%; 95%CI 0.08–0.16; I² = 98.95%), dizziness(10%; 95%CI 0.08–0.13; I² = 96.45%), vision impairment(6%; 95%CI 0.03–0.09; I² = 86.82%), intracerebral haemorrhage(5%; 95%CI 0.03–0.09; I² = 95.60%), seizure(4%; 95%CI 0.02 -0.05; I² = 98.15%), encephalitis(2%; 95%CI 0.01–0.03; I² = 90.36%), Guillan-Barré Syndrome (GBS) (1%; 95%CI 0.00–0.03; I² = 89.48%).

Conclusions

Neurological symptoms are common and varied in Covid-19 infections, and a growing number of reports suggest that the prevalence of neurological symptoms may be increasing. In the future, the role of COVID-19 neurological symptoms in the progression of COVID-19 should be further studied, and its pathogenesis and assessment methods should be explored, to detect and treat early neurological complications of COVID-19 and reduce mortality.