Neurological problems in the context of COVID-19 infection in Egypt. A multicenter retrospective analysis

Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion : A Systematic Literature Review

PURPOSE

This systematic review is aimed at synthesising the literature base to date on the frequency and topographical distribution of neuroanatomical changes seen on imaging following COVID-19 invasion with a focus on both the acute and chronic phases of the disease.

METHODS

In this study, 8 databases were systematically searched to identify relevant articles published from December 2019 to March 2022 and supplemented with a manual reference search. Data were extracted from the included studies and narrative synthesis was employed to integrate the findings.

RESULTS

A total of 110 studies met the inclusion criteria and comprised 119,307 participants (including 31,073 acute and 143 long COVID-19 patients manifesting neurological alterations) and controls. Considerable variability in both the localisation and nature of neuroanatomical abnormalities are noted along the continuum with a wide range of neuropathologies relating to the cerebrovascular/neurovascular system, (sub)cortical structures (including deep grey and white matter structures), brainstem, and predominant regional and/or global alterations in the cerebellum with varying degrees of spinal involvement.

CONCLUSION

Structural regional alterations on neuroimaging are frequently demonstrated in both the acute and chronic phases of SARS-CoV‑2 infection, particularly prevalent across subcortical, prefrontal/frontal and cortico-limbic brain areas as well as the cerebrovascular/neurovascular system. These findings contribute to our understanding of the acute and chronic effects of the virus on the nervous system and has the potential to provide information on acute and long-term treatment and neurorehabilitation decisions.

Prevalence and risk factors for long COVID and post-COVID-19 condition in Africa: a systematic review

BACKGROUND

An improved estimation of the clinical sequelae of SARS-CoV-2 infection is crucial in African countries, where the subject has received little attention despite more than 12 million reported cases and evidence that many more people were infected. We reviewed the evidence on prevalence, associated risk factors for long COVID, and systemic or sociocultural determinants of reporting long COVID.

METHODS

We conducted a systematic review, searching PubMed, the Living OVerview of Evidence platform, and grey literature sources for publications from Dec 1, 2019, to Nov 23, 2022. We included articles published in English, French, Spanish, or Portuguese that reported on any study type in Africa with participants of any age who had symptoms for 4 weeks or more after an acute SARS-CoV-2 infection. We excluded secondary research, comments, and correspondence. Screening and data extraction were performed by two reviewers. Summary estimates were extracted, including sociodemographic factors, medical history, prevalence of persistent symptoms, and symptoms and associated factors. Results were analysed descriptively. The study was registered on the Open Science Framework platform.

FINDINGS

Our search yielded 294 articles, of which 24 peer-reviewed manuscripts were included, reporting on 9712 patients from eight African countries. Only one study exclusively recruited children, and one other study included children as part of their study population. Studies indicated moderate to low risk of bias. Prevalence of long COVID varied widely, from 2% in Ghana to 86% in Egypt. Long COVID was positively associated with female sex, older age, non-Black ethnicity, low level of education, and the severity of acute infection and underlying comorbidity. HIV and tuberculosis were not identified as risk factors. Factors influencing reporting included absence of awareness, inadequate clinical data and diagnostics, and little access to health-care services.

INTERPRETATION

In Africa, research on long COVID is scarce, particularly among children, who represent the majority of the population. However, existing studies show a substantial prevalence across settings, emphasising the importance of vaccination and other prevention strategies to avert the effects of long COVID on individual wellbeing, the increased strain on health systems, and the potential negative effects on economically vulnerable populations. At a global level, including African countries, tools for research on long COVID need to be harmonised to maximise the usefulness of the data collected.

FUNDING

None.

Clinical characteristics of Guillain–Barre syndrome in COVID-19: a systematic review and meta-analysis of observational studies

Background

Guillain–Barre syndrome (GBS) is a complication that occurs in patients with Coronavirus Disease (COVID-19) infection. The spectrum of symptoms varies from mild to severe symptoms, even death. The study aimed to compare the clinical manifestations in GBS patients with and without COVID-19 comorbidity.

Results

A systematic review and meta-analysis of cohort and cross-sectional studies was conducted comparing the characteristics and course of GBS disease in the COVID-19 positive and COVID-19 negative groups. Four articles were selected with a total sample of 61 COVID-19 positive and 110 COVID-19 negative GBS patients. Based on clinical manifestations, COVID-19 infection increased the likelihood of tetraparesis (OR: 2.54; 95% CI 1.12–5.74; p = 0.03) and the presence of facial nerve involvement (OR: 2.34; 95% CI 1.00–5.47; p = 0.05). Demyelinating type GBS or AIDP was more common in the COVID-19 positive group (OR: 2.32; 95% CI 1.16–4.61; p = 0.02). COVID-19 in GBS significantly increased the need for intensive care (OR: 3.32; 95% CI 1.48–7.46; p = 0.004) and the use of mechanical ventilation (OR: 2.42; 95% CI 1.00–5.86; p = 0.05).

Conclusions

GBS following COVID-19 infection showed more severe variations in clinical characteristics compared to the group of GBS patients without COVID-19. Early detection of GBS, especially the typical manifestations post COVID-19 infection, is very important to carry out intensive monitoring and early management before the patient's condition worsens.