1
|
Poloni S, Hamani A, Kassis V, Escoffier P, Hagenkotter B, Gendrin V, Zayet S, Klopfenstein T. Acute Cerebellitis Following COVID-19: Alarming Clinical Presentation Challenged by Normal Paraclinical Findings. Infect Dis Ther 2024:10.1007/s40121-024-01048-4. [PMID: 39316326 DOI: 10.1007/s40121-024-01048-4] [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: 07/05/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024] Open
Abstract
We report the case of an acute cerebellitis following COVID-19 in 32-year-old man who presented with a life-threatening critical cerebellar syndrome contrasting with normal paraclinical findings. Despite this fulminant critical presentation, the patient fully recovered in 37 days after early treatment with high-dose steroids and intravenous immunoglobulins. This case highlights the need for clinicians to be aware of acute cerebellitis following COVID-19, despite normal laboratory, imaging and electroencephalography findings and the importance to start appropriate treatment as soon as possible.
Collapse
Affiliation(s)
- Samantha Poloni
- Department of Infectious and Tropical Diseases, Nord Franche-Comté Hospital, 90400, Trévenans, France
| | - Abdoulaye Hamani
- Department of Infectious and Tropical Diseases, Nord Franche-Comté Hospital, 90400, Trévenans, France
| | - Valentine Kassis
- Department of Infectious and Tropical Diseases, Nord Franche-Comté Hospital, 90400, Trévenans, France
| | - Pauline Escoffier
- Department of Infectious and Tropical Diseases, Nord Franche-Comté Hospital, 90400, Trévenans, France
| | - Beate Hagenkotter
- Department of Neurology, Nord Franche-Comté Hospital, 90400, Trévenans, France
| | - Vincent Gendrin
- Department of Infectious and Tropical Diseases, Nord Franche-Comté Hospital, 90400, Trévenans, France
| | - Souheil Zayet
- Department of Infectious and Tropical Diseases, Nord Franche-Comté Hospital, 90400, Trévenans, France
| | - Timothée Klopfenstein
- Department of Infectious and Tropical Diseases, Nord Franche-Comté Hospital, 90400, Trévenans, France.
| |
Collapse
|
2
|
Valades MT, Montero-Torres M, Lara-Abelenda FJ, Carabot F, Ortega MA, Álvarez-Mon M, Alvarez-Mon MA. Understanding public perceptions and discussions on diseases involving chronic pain through social media: cross-sectional infodemiology study. BMC Musculoskelet Disord 2024; 25:569. [PMID: 39034398 PMCID: PMC11265081 DOI: 10.1186/s12891-024-07687-5] [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: 02/26/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent medical condition that negatively impacts quality of life and is associated with considerable functional disability. Certain diseases, such as fibromyalgia, headache, paraplegia, neuropathy, and multiple sclerosis, manifest with chronic pain. OBJECTIVE The aim of this study is to examine the number and type of tweets (original or retweet) related to chronic pain, as well as to analyze the emotions and compare the societal impact of the diseases under study. METHODS We investigated tweets posted between January 1, 2018, and December 31, 2022, by Twitter users in English and Spanish, as well as the generated retweets. Additionally, emotions were extracted from these tweets and their diffusion was analyzed. Furthermore, the topics most frequently discussed by users were collected. RESULTS A total of 72,874 tweets were analyzed, including 44,467 in English and 28,407 in Spanish. Paraplegia represented 23.3% with 16,461 of the classified tweets, followed by headache and fibromyalgia with 15,337 (21.7%) and 15,179 (21.5%) tweets, respectively. Multiple sclerosis generated 14,781 tweets (21%), and the fewest tweets were related to neuropathy with 8,830 tweets (12.5%). The results showed that the primary emotions extracted were "fear" and "sadness." Additionally, the reach and impact of these tweets were investigated through the generated retweets, with those related to headaches showing the highest interest and interaction among users. CONCLUSION Our results underscore the potential of leveraging social media for a better understanding of patients suffering from chronic pain and its impact on society. Among the most frequently encountered topics are those related to treatment, symptoms, or causes of the disease. Therefore, it is relevant to inform the patient to prevent misconceptions regarding their illness.
Collapse
Affiliation(s)
- M T Valades
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain.
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain.
| | - M Montero-Torres
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
| | - F J Lara-Abelenda
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Madrid, Spain
| | - F Carabot
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain
| | - M A Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain
| | - M Álvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, Center for Biomedical Research in Hepatic and Digestive Diseases Network, University Hospital Principe de Asturias, Alcala de Henares, Madrid, Spain
| | - M A Alvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Alcala de Henares, Madrid, Spain
- Ramon y Cajal Institute of Sanitary Research (IRYCIS), Ramon y Cajal Hospital, Madrid, Spain
- Department of Psychiatry and Mental Health, University Hospital Infanta Leonor, Madrid, Spain
- CIBERSAM-ISCIII, Biomedical Research Networking Centre in Mental Health, Madrid, Spain
| |
Collapse
|
3
|
Poutoglidis A, Tsetsos N, Karamitsou P, Forozidou E, Garefis K, Keramari S, Vlachtsis K. Bilateral vocal fold palsy following COVID-19 infection. EAR, NOSE & THROAT JOURNAL 2024; 103:162S-163S. [PMID: 35225022 PMCID: PMC8883131 DOI: 10.1177/01455613221080987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Paraskevi Karamitsou
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Evropi Forozidou
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Konstantinos Garefis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Stergiani Keramari
- 2nd Department of Paediatrics, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Konstantinos Vlachtsis
- Department of Otorhinolaryngology-Head and Neck Surgery, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| |
Collapse
|
4
|
Kakaletsis N, Alevroudis I, Kotoulas SC, Dourliou V, Stougianni M, Massa E, Mouloudi E. COVID-19 Presenting as Encephalitis and Myopericarditis: A Report of a Rare Case. Cureus 2024; 16:e62056. [PMID: 38989350 PMCID: PMC11235390 DOI: 10.7759/cureus.62056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
COVID-19 might present with a wide range of clinical manifestations, from mild respiratory distress to severe multi-organ dysfunction. We present a unique case of complex COVID-19 presentation in a 45-year-old female who initially developed general symptoms such as fever, cough, headache, and weakness, which escalated to coma, requiring intubation and ICU admission. A brain MRI revealed lesions compatible with encephalitis, the cause of which remained unexplained after an in-depth clinical, laboratory, and imaging investigation. While in the ICU, the patient also developed cardiac tamponade, requiring pericardiocentesis, and atypical electrocardiographic changes. After treatment with steroids, her condition improved, and the patient was extubated and transferred to the ward. Upon checkup, cardiac MRI revealed fibrous tissue in the inferior cardiac wall and the adjacent intraventricular septum. In the absence of an alternative diagnosis, it might be important to consider the central nervous system and cardiac involvement in patients with COVID-19.
Collapse
Affiliation(s)
- Nikolaos Kakaletsis
- Internal Medicine Unit, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Alevroudis
- Cardiology Unit, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | - Vasiliki Dourliou
- Adult Intensive Care Unit, Ippokrateio General Hospital, Thessaloniki, GRC
| | - Maria Stougianni
- Adult Intensive Care Unit, Ippokrateio General Hospital, Thessaloniki, GRC
| | - Eleni Massa
- Adult Intensive Care Unit, Ippokrateio General Hospital, Thessaloniki, GRC
| | - Eleni Mouloudi
- Adult Intensive Care Unit, Ippokrateio General Hospital, Thessaloniki, GRC
| |
Collapse
|
5
|
Pauna HF, Silva VAR, Lavinsky J, Hyppolito MA, Vianna MF, Gouveia MDCL, Monsanto RDC, Polanski JF, Silva MNLD, Soares VYR, Sampaio ALL, Zanini RVR, Abrahão NM, Guimarães GC, Chone CT, Castilho AM. Task force of the Brazilian Society of Otology - evaluation and management of peripheral facial palsy. Braz J Otorhinolaryngol 2024; 90:101374. [PMID: 38377729 PMCID: PMC10884764 DOI: 10.1016/j.bjorl.2023.101374] [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: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.
Collapse
Affiliation(s)
- Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | | | | | - José Fernando Polanski
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Maurício Noschang Lopes da Silva
- Hospital de Clínicas de Porto Alegre (UFRGS), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil
| | - Vítor Yamashiro Rocha Soares
- Hospital Flávio Santos and Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Raul Vitor Rossi Zanini
- Hospital Israelita Albert Einstein, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nicolau M Abrahão
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Guilherme Correa Guimarães
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| |
Collapse
|
6
|
Chavhan R, Wanjari A, Kumar S, Acharya S, Rathod N, Reddy H, Gemnani R. A Comprehensive Review on Navigating the Neurological Landscape of COVID-19: Insights Into Etiopathogenesis and Clinical Management. Cureus 2024; 16:e60079. [PMID: 38860093 PMCID: PMC11163389 DOI: 10.7759/cureus.60079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global health crisis with significant neurological implications. While initially characterized by respiratory symptoms, COVID-19 has been increasingly recognized for its diverse neurological manifestations, including encephalopathy, stroke, peripheral neuropathies, and neuropsychiatric disorders. Understanding the neurological landscape of COVID-19 is essential for elucidating its pathophysiology, optimizing clinical management, and improving patient outcomes. This comprehensive review provides insights into the etiopathogenesis, clinical manifestations, diagnostic approaches, management strategies, and prognostic implications of neurological involvement in COVID-19. Mechanistic insights highlight the multifactorial nature of neurological complications involving direct viral invasion, immune-mediated mechanisms, and thrombotic events. Diagnostic challenges underscore the importance of a multidisciplinary approach to patient care, while management strategies emphasize early recognition and appropriate intervention. Long-term neurological sequelae and prognostic factors are also examined, emphasizing the need for comprehensive follow-up and rehabilitation services. Finally, recommendations for future research prioritize efforts to elucidate underlying mechanisms, identify biomarkers, and evaluate rehabilitative interventions. By addressing these challenges, we can better understand and mitigate the neurological consequences of the ongoing COVID-19 pandemic.
Collapse
Affiliation(s)
- Roma Chavhan
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institiute of Higher Education and Research, Wardha, IND
| | - Anil Wanjari
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institiute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institiute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institiute of Higher Education and Research, Wardha, IND
| | - Nishant Rathod
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institiute of Higher Education and Research, Wardha, IND
| | - Harshitha Reddy
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institiute of Higher Education and Research, Wardha, IND
| | - Rinkle Gemnani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institiute of Higher Education and Research, Wardha, IND
| |
Collapse
|
7
|
Bastos CIM, Dani C, Cechinel LR, da Silva Neves AH, Rasia FB, Bianchi SE, da Silveira Loss E, Lamers ML, Meirelles G, Bassani VL, Siqueira IR. Achyrocline satureioides as an adjuvant therapy for the management of mild viral respiratory infections in the context of COVID-19: Preliminary results of a randomized, placebo-controlled, and open-label clinical trial. Phytother Res 2023; 37:5354-5365. [PMID: 37583121 DOI: 10.1002/ptr.7976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/02/2023] [Accepted: 07/23/2023] [Indexed: 08/17/2023]
Abstract
We evaluated the impact of an Achyrocline satureioides inflorescence infusion on the clinical outcomes of viral respiratory infections, including those caused by SARS-CoV-2, in a monocentric, randomized, open-label, placebo-controlled clinical trial. Patients with symptoms of viral respiratory infection, including suspected cases of COVID-19, were included and assigned to receive either A. satureioides (n = 57) or Malus domestica (n = 67) infusions twice a day for 14 days. All participants were included before the RT-PCR results, performed using a nasopharyngeal swab. The patients were further divided into subgroups according to real-time polymerase chain reaction results: SARS-CoV-2-positive and SARS-CoV-2-negative subgroups for statistical analyses. We assessed clinical outcomes, such as the latency to resolution of cough, dyspnea, fever, sore throat, chest pain, smell and taste dysfunctions, diarrhea, nausea, abdominal pain, and loss of appetite; hospitalization; and mortality with questionnaires and medical records. The subjects that received early A. satureioides infusion showed a significant reduction in the average number of days with respiratory and neurological symptoms compared with the control group (M. domestica infusion). We conclude that A. satureioides is a safe agent and, in combination with standard care, improves viral respiratory infection symptoms, especially those related to COVID-19.
Collapse
Affiliation(s)
- Catherina Isdra Moszkowicz Bastos
- Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Caroline Dani
- Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Reck Cechinel
- Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Arthur Hipolito da Silva Neves
- Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fabiana Briato Rasia
- Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sara Elis Bianchi
- Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eloisa da Silveira Loss
- Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcelo Lazzaron Lamers
- Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Meirelles
- Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Valquiria Linck Bassani
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ionara Rodrigues Siqueira
- Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
8
|
Montes-Grajales D, Garcia-Serna R, Mestres J. Impact of the COVID-19 pandemic on the spontaneous reporting and signal detection of adverse drug events. Sci Rep 2023; 13:18817. [PMID: 37914862 PMCID: PMC10620227 DOI: 10.1038/s41598-023-46275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
External factors severely affecting in a short period of time the spontaneous reporting of adverse events (AEs) can significantly impact drug safety signal detection. Coronavirus disease 2019 (COVID-19) represented an enormous challenge for health systems, with over 767 million cases and massive vaccination campaigns involving over 70% of the worldwide population. This study investigates the potential masking effect on certain AEs caused by the substantial increase in reports solely related to COVID-19 vaccines within various spontaneous reporting systems (SRSs). Three SRSs were used to monitor AEs reporting before and during the pandemic, namely, the World Health Organisation (WHO) global individual case safety reports database (VigiBase®), the United States Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report database (JADER). Findings revealed a sudden over-reporting of 35 AEs (≥ 200%) during the pandemic, with an increment of the RRF value in 2021 of at least double the RRF reported in 2020. This translates into a substantial reduction in signals of disproportionate reporting (SDR) due to the massive inclusion of COVID-19 vaccine reports. To mitigate the masking effect of COVID-19 vaccines in post-marketing SRS analyses, we recommend utilizing COVID-19-corrected versions for a more accurate assessment.
Collapse
Affiliation(s)
- Diana Montes-Grajales
- Chemotargets SL, Parc Científic de Barcelona, Baldiri Reixac 4 (TR-03), 08028, Barcelona, Catalonia, Spain
| | - Ricard Garcia-Serna
- Chemotargets SL, Parc Científic de Barcelona, Baldiri Reixac 4 (TR-03), 08028, Barcelona, Catalonia, Spain
| | - Jordi Mestres
- Chemotargets SL, Parc Científic de Barcelona, Baldiri Reixac 4 (TR-03), 08028, Barcelona, Catalonia, Spain.
- Institut de Quimica Computacional i Catalisi, Facultat de Ciencies, Universitat de Girona, Maria Aurelia Capmany 69, 17003, Girona, Catalonia, Spain.
| |
Collapse
|
9
|
Karami S, Khalaj F, Sotoudeh H, Tajabadi Z, Shahidi R, Habibi MA, Sattari MS, Azimi A, Forouzannia SA, Rafiei R, Reihani H, Nemati R, Teimori S, Khalaji A, Sarmadi V, Dadjou A. Acute Necrotizing Encephalopathy in Adult Patients With COVID-19: A Systematic Review of Case Reports and Case Series. J Clin Neurol 2023; 19:597-611. [PMID: 37455513 PMCID: PMC10622717 DOI: 10.3988/jcn.2022.0431] [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: 11/10/2022] [Revised: 12/22/2022] [Accepted: 02/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Acute necrotizing encephalopathy (ANE) is a rare neurological disorder that is often associated with viral infections. Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a few COVID-19-associated ANE cases have been reported. Since very little is known about ANE, the present study aimed to determine the clinical, biochemical, and radiological characteristics of affected patients. METHODS A search was conducted on PubMed, Scopus, Embase, and Web of Science databases for articles published up to August 30, 2022 using relevant keywords. Case reports and series in the English language that reported ANE in adult patients with COVID-19 confirmed by reverse transcription polymerase chain reaction were included in this study. Data on the demographic, clinical, laboratory, and radiological characteristics of patients were extracted and analyzed using the SPSS software (version 26). RESULTS The study included 30 patients (18 males) with COVID-19 and ANE who were aged 49.87±18.68 years (mean±standard deviation). Fever was the most-prevalent symptom at presentation (66.7%). Elevated C-reactive protein was observed in the laboratory assessments of 13 patients. Computed tomography and magnetic resonance imaging were the most-common radiological modalities used for brain assessments. The most commonly prescribed medications were methylprednisolone (30%) and remdesivir (26.7%). Sixteen patients died prior to discharge. CONCLUSIONS The diagnosis of COVID-19-associated ANE requires a thorough knowledge of the disease. Since the clinical presentations of ANE are neither sensitive nor specific, further laboratory and brain radiological evaluations will be needed to confirm the diagnosis. The suspicion of ANE should be raised among patients with COVID-19 who present with progressive neurological symptoms.
Collapse
Affiliation(s)
- Shaghayegh Karami
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fattaneh Khalaj
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Houman Sotoudeh
- Department of Radiology and Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Zohreh Tajabadi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Shahidi
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Mohammad Amin Habibi
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Amir Azimi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Forouzannia
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Romina Rafiei
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reihani
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Nemati
- Department of Neurology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Soraya Teimori
- Young Researchers and Elites Club, Faculty of Medicine, Islamic Azad University, Yazd Branch, Iran
| | | | - Vida Sarmadi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Dadjou
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| |
Collapse
|
10
|
Safan AS, Imam Y, Khatib MY, Al Wraidat M, Altermanini MM, Al-Mughalles SA, Al-Assaf A, Olish M, Elshafei MS, Nashwan AJ. COVID-19-associated neurological sequelae: A case series on cerebral microbleeds and encephalopathy. Qatar Med J 2023; 2023:29. [PMID: 37920783 PMCID: PMC10618109 DOI: 10.5339/qmj.2023.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/10/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Critical illness-associated cerebral microbleeds and leukoencephalopathy connected to coronavirus disease 2019 (COVID-19) infection are emerging areas of concern in current medical literature. METHODS We reviewed cases of patients with COVID-19-associated neurological manifestations to study the prevalence and outcome of such conditions. Case Series Findings: Our review yielded seven distinct patients. Six exhibited cerebral microbleeds, primarily localized in the juxtacortical white matter and the corpus callosum. In contrast, one individual presented with leukoencephalopathy. Tragically, of these patients, five succumbed to their ailments. One was discharged with mild cognitive impairments, while another underwent a tracheostomy and was subsequently moved to a long-term care establishment. CONCLUSION Our findings underscore the significance of neuro-radiological observations in those grappling with severe manifestations of COVID-19, drawing attention to the possible neurological repercussions of the virus.
Collapse
Affiliation(s)
| | - Yahia Imam
- Neurology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohamad Y Khatib
- Critical Care Department, Hamad Medical Corporation (HMC), Doha, Qatar ORCID ID: 0000-0002-0557-6071
| | - Mohammad Al Wraidat
- Critical Care Department, Hamad Medical Corporation (HMC), Doha, Qatar ORCID ID: 0000-0002-0557-6071
| | | | | | - Anood Al-Assaf
- Critical Care Department, Hamad Medical Corporation (HMC), Doha, Qatar ORCID ID: 0000-0002-0557-6071
| | - Mariam Olish
- Critical Care Department, Hamad Medical Corporation (HMC), Doha, Qatar ORCID ID: 0000-0002-0557-6071
| | - Moustafa S Elshafei
- Critical Care Department, Hamad Medical Corporation (HMC), Doha, Qatar ORCID ID: 0000-0002-0557-6071
| | - Abdulqadir J Nashwan
- Critical Care Department, Hamad Medical Corporation (HMC), Doha, Qatar ORCID ID: 0000-0002-0557-6071
| |
Collapse
|
11
|
Tsilioni I, Theoharides TC. Recombinant SARS-CoV-2 Spike Protein and Its Receptor Binding Domain Stimulate Release of Different Pro-Inflammatory Mediators via Activation of Distinct Receptors on Human Microglia Cells. Mol Neurobiol 2023; 60:6704-6714. [PMID: 37477768 DOI: 10.1007/s12035-023-03493-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
SARS-CoV-2 infects cells via its spike (S) protein binding to its surface receptor angiotensin converting enzyme 2 (ACE2) on target cells and results in acute symptoms involving especially the lungs known as COVID-19. However, increasing evidence indicates that SARS-CoV-2 infection produces neuroinflammation associated with neurological, neuropsychiatric, and cognitive symptoms persists well past the resolution of the infection, known as post-COVID-19 sequalae or long-COVID. The neuroimmune mechanism(s) involved in long-COVID have not been adequately characterized. In this study, we show that recombinant SARS-CoV-2 full-length S protein stimulates release of pro-inflammatory IL-1b, CXCL8, IL-6, and MMP-9 from cultured human microglia via TLR4 receptor activation. Instead, recombinant receptor-binding domain (RBD) stimulates release of TNF-α, IL-18, and S100B via ACE2 signaling. These results provide evidence that SARS-CoV-2 spike protein contributes to neuroinflammation through different mechanisms that may be involved in CNS pathologies associated with long-COVID.
Collapse
Affiliation(s)
- Irene Tsilioni
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology, Tufts University School of Medicine, 136 Harrison Avenue, Suite 304, Boston, MA, 02111, USA.
| | - Theoharis C Theoharides
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology, Tufts University School of Medicine, 136 Harrison Avenue, Suite 304, Boston, MA, 02111, USA
- Institute of Neuro-Immune Medicine, Nova Southeastern University, Clearwater, FL, 33759, USA
| |
Collapse
|
12
|
Vahabizad F, Togha M, Ariyanfar S, Fattahi MR, Haghighi S, Ebadi Z, Ahmadi Karvigh S, Heidari S, Shafaei M, Ashraf H, Haddadi A, Talebpour M, Safaei A, Asefi H. Clinical characteristics of 365 hospitalized COVID-19 patients with neurological symptoms: an observational study. Acta Neurol Belg 2023; 123:1805-1811. [PMID: 36008590 PMCID: PMC9409615 DOI: 10.1007/s13760-022-02027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Since the beginning of the COVID-19 pandemic, a number of COVID-related neurological manifestations have been reported. We aimed to categorize the features of hospitalized COVID-19 patients who experienced neurological symptoms. METHODS In this descriptive, cross-sectional study, we enrolled all patients hospitalized with COVID-19 who experienced neurological symptoms in two hospitals in Tehran. Diagnosis of COVID-19 was established by PCR tests or computed tomography of the chest combined with COVID-19 clinical findings. The clinical characteristics, laboratory data, and imaging findings from 365 patients were analyzed. RESULTS The average patient age was 59.2 ± 16.7 years and included 213 males and 152 females. The most prevalent neurological symptoms were headache (56.2%), impaired consciousness (55%), and dizziness (20.5%). During hospitalization, most of the patients did not require mechanical ventilation (81.9%). The percentage of patients with end-organ damage was 9% and mortality was 15%. Regression analysis on the neurological symptoms indicated that the mortality rate of patients with headaches was 84% lower than for the other neurological symptoms. Hyperglycemia was significantly related with end-organ damage and mortality (p = 0.029, p = 0.08, respectively). New vascular lesions were evident on brain MRIs of 9 patients and brain CTs of 16 patients. CONCLUSION Among the neurological symptoms of patients with COVID-19, headache appeared to indicate a protective factor against development of end-organ damage as well as mortality.
Collapse
Affiliation(s)
- Fahimeh Vahabizad
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
| | - Mansoureh Togha
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Imam Street, Tehran, Iran.
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shadi Ariyanfar
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Fattahi
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Haghighi
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
| | - Zahra Ebadi
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
| | - Sanaz Ahmadi Karvigh
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Heidari
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
| | - Maryam Shafaei
- Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
| | - Hale Ashraf
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Haddadi
- Department of Infectious Disease, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Safaei
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Asefi
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Tabatabaee S, Akhoundi FH, Khobeydeh A, Tabatabaei SM, Haghi Ashtiani B. Acute cerebellitis following COVID-19 vaccination: A case report. Clin Case Rep 2023; 11:e8050. [PMID: 37850056 PMCID: PMC10577163 DOI: 10.1002/ccr3.8050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
A plethora of neurological symptoms have been reported as the side effects of COVID-19 vaccines. Vaccine-associated acute cerebellitis is quite rare. Here, we report a 45-year-old female with acute onset cerebellitis, beginning 10 days after administration of Sinopharm vaccine. The patient's CSF COVID-19 PCR was found to be positive, with no pulmonary symptoms.
Collapse
Affiliation(s)
- Seyedehnarges Tabatabaee
- Department of Neurology, Firoozgar hospital, School of MedicineIran University of Medical SciencesTehranIran
| | - Fahimeh H. Akhoundi
- Department of Neurology, Firoozgar hospital, School of MedicineIran University of Medical SciencesTehranIran
| | - Afsaneh Khobeydeh
- Department of Neurology, Firoozgar hospital, School of MedicineIran University of Medical SciencesTehranIran
| | | | - Bahram Haghi Ashtiani
- Department of Neurology, Firoozgar hospital, School of MedicineIran University of Medical SciencesTehranIran
| |
Collapse
|
14
|
Sarkar M, Roy A, Bhakta S, Chowdhoury SR, Mandal RK. Retrospective analysis of clinico-laboratory parameters, outcome and predictors of scrub typhus co- infection in covid-19 affected children. Trop Doct 2023; 53:448-454. [PMID: 37587858 DOI: 10.1177/00494755221076904] [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: 08/18/2023]
Abstract
The objective of this study was to describe clinico-laboratory parameters, outcome and predictors of scrub typhus co- infection in COVID-19 affected children. Ours was a retrospective analysis done in a tertiary care pediatric COVID facility. COVID-19 positive children in the age group of 1 month to 12 years who were tested for scrub typhus co-infection between May to August 2020 were included in the study. In all positive cases, clinical, laboratory, treatment and outcome data were analyzed. Relevant data were compared between scrub typhus confirmed, and suspected but negative patients. All six patients with co-infection had fever for >5 days and four had features of cerebral involvement. These had lymphocytic pleocytosis in cerebrospinal fluid (CSF) analysis and two had eschar. Screening for scrub typhus in persistently febrile children residing in highly endemic areas is highly recommended.
Collapse
Affiliation(s)
- Mihir Sarkar
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal, India
| | - Aniket Roy
- Department of Pediatrics, Medical College, Kolkata, West Bengal, India
| | - Subhajit Bhakta
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Rakesh Kumar Mandal
- Department of Pediatrics, Medical College and Hospital, Kolkata, West Bengal, India
| |
Collapse
|
15
|
Mendonça Filho VCM, de Oliveira AG, Maia IDFVC, de Falcone ACM, Betini BG, Rezende LB, Magri Alves FH. COVID-19 in the nervous system: physiopathology and neurological manifestations. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:756-763. [PMID: 37402400 PMCID: PMC10468725 DOI: 10.1055/s-0043-1769123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/24/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although respiratory manifestations have received greater visibility during the pandemic caused by this virus, numerous neurological complaints related to coronavirus 2 infection have been documented in several countries. These records suggest that this pathogen presents neurotropism, and it can cause different neurological conditions of varying intensity. OBJECTIVE To investigate the ability of coronavirus 2 to invade the central nervous system (CNS) and its neurological clinical outcomes. METHODS The present study consists in a comprehensive literature review of the records available in the PubMed, SciELO, and Google Scholar databases. The descriptors COVID-19, brain and physiopathology, associated with the Boolean operator AND, were used in the search. Regarding the inclusion and exclusion criteria, we selected the papers published since 2020 with the highest number of citations. RESULTS We selected 41 articles, most of them in English. The main clinical manifestation associated with COVID-19 patients was headache, but cases of anosmia, hyposmia, Guillain-Barré syndrome, and encephalopathies were also described with considerable frequency. CONCLUSION Coronavirus-2 presents neurotropism, and it can reach the CNS by hematogenous dissemination and by direct infection of the nerve endings. It causes brain injuries through several mechanisms, such as cytokine storm, microglial activation, and an increase in thrombotic factors.
Collapse
Affiliation(s)
| | | | | | | | - Beatriz Gioppo Betini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Ribeirão Preto SP, Brazil.
| | - Lucas Bruno Rezende
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte MG, Brazil.
| | | |
Collapse
|
16
|
Zhang M, Ma Y, Ye X, Zhang N, Pan L, Wang B. TRP (transient receptor potential) ion channel family: structures, biological functions and therapeutic interventions for diseases. Signal Transduct Target Ther 2023; 8:261. [PMID: 37402746 DOI: 10.1038/s41392-023-01464-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/26/2023] [Accepted: 04/25/2023] [Indexed: 07/06/2023] Open
Abstract
Transient receptor potential (TRP) channels are sensors for a variety of cellular and environmental signals. Mammals express a total of 28 different TRP channel proteins, which can be divided into seven subfamilies based on amino acid sequence homology: TRPA (Ankyrin), TRPC (Canonical), TRPM (Melastatin), TRPML (Mucolipin), TRPN (NO-mechano-potential, NOMP), TRPP (Polycystin), TRPV (Vanilloid). They are a class of ion channels found in numerous tissues and cell types and are permeable to a wide range of cations such as Ca2+, Mg2+, Na+, K+, and others. TRP channels are responsible for various sensory responses including heat, cold, pain, stress, vision and taste and can be activated by a number of stimuli. Their predominantly location on the cell surface, their interaction with numerous physiological signaling pathways, and the unique crystal structure of TRP channels make TRPs attractive drug targets and implicate them in the treatment of a wide range of diseases. Here, we review the history of TRP channel discovery, summarize the structures and functions of the TRP ion channel family, and highlight the current understanding of the role of TRP channels in the pathogenesis of human disease. Most importantly, we describe TRP channel-related drug discovery, therapeutic interventions for diseases and the limitations of targeting TRP channels in potential clinical applications.
Collapse
Affiliation(s)
- Miao Zhang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- Experiment Center for Science and Technology, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- The Center for Microbes, Development and Health; Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Yueming Ma
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xianglu Ye
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Ning Zhang
- Experiment Center for Science and Technology, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Lei Pan
- The Center for Microbes, Development and Health; Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200031, China.
- CAS Center for Excellence in Biotic Interactions, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Bing Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- Center for Pharmaceutics Research, Shanghai Institute of Materia Medica Chinese Academy of Sciences, Shanghai, 201203, China.
| |
Collapse
|
17
|
Ousseiran ZH, Fares Y, Chamoun WT. Neurological manifestations of COVID-19: a systematic review and detailed comprehension. Int J Neurosci 2023; 133:754-769. [PMID: 34433369 PMCID: PMC8506813 DOI: 10.1080/00207454.2021.1973000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 08/16/2021] [Indexed: 12/13/2022]
Abstract
The current pandemic caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is accompanied with a rapid increase of reports and papers detailing its neurological effects and symptoms. The virus infection causes respiratory illness named by the world health organization as corona virus 19 (COVID-19).This systematic review aims to study and summarize the different neurological manifestations of this virus. All articles published and indexed via Pubmed, Medline and Google Scholar databases between January 1st 2020 and February 28th 2021 that reported neurological symptoms of SARS-CoV-2 are reviewed following the Preferred Reporting Items for Systemic review and Meta-Analysis (PRISMA) guidelines.We included data from 113 articles: eight prospective studies, 25 retrospective studies and the rest were case reports/series. COVID-19 can present with central nervous system manifestations, such as headache, encephalitis and encephalopathy, peripheral nervous system manifestations, such as anosmia, ageusia and Guillian Barre syndrome, and skeletal muscle manifestations, such as myalgia and myasthenia gravis. Our systematic review showed that COVID-19 can be manifested by a wide spectrum of neurological symptoms reported either in the early stage or within the course of the disease. However, a detailed comprehension of these manifestations is required and more studies are needed in order to improve our scientific knowledge and to develop preventive and therapeutic measures to control this pandemic.
Collapse
Affiliation(s)
- Zeina Hassan Ousseiran
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Wafaa Takash Chamoun
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| |
Collapse
|
18
|
Ali FA, Jassim G, Khalaf Z, Yusuf M, Ali S, Husain N, Ebrahim F. Transient Anosmia and Dysgeusia in COVID-19 Disease: A Cross Sectional Study. Int J Gen Med 2023; 16:2393-2403. [PMID: 37333880 PMCID: PMC10275370 DOI: 10.2147/ijgm.s408706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Objective This study aims to explore the prevalence of anosmia and dysgeusia and their impact on COVID-19 patients. Methods This is a cross-sectional study. Patients diagnosed with COVID-19 between 1st October 2020 and 30th June 2021 were randomly selected from a national COVID-19 registry. COVID-19 cases were diagnosed using molecular testing method which measured the viral E gene. The Anosmia Reporting Tool, and a brief version of the questionnaire on olfactory disorders were used to measure the outcomes via telephone interviews. Data were analysed using SPSS 27 statistics software. Results A total of 405 COVID-19 adults were included in this study, 220 (54.3%) were males and 185 (45.8%) were females. The mean±SD age of participants was 38.2 ± 11.3 years. Alterations in the sense of smell and taste were reported by 206 (50.9%), and 195 (48.1%) of the patients, respectively. Sex and nationality of participants were significantly associated with anosmia and dysgeusia (p < 0.001) and (p-value=0.001) respectively. Among patients who experienced anosmia and dysgeusia, alterations in eating habits (64.2%), impact on mental wellbeing (38.9%), concerns that the alterations were permanent (35.4%), and physical implications and difficulty performing activities of daily living (34%) were reported. Conclusion Anosmia and dysgeusia are prevalent symptoms of COVID-19 disease, especially among females. Although transient, anosmia and dysgeusia had considerable impact on patient's life. Neuropsychological implications of COVID-19 in acute infection phase and prognosis of anosmia and dysgeusia in COVID-19 are areas for further exploration.
Collapse
Affiliation(s)
- Fatema Ahmed Ali
- Department of Internal Medicine, South West Acute Hospital, Western Health and Social Care Trust, Enniskillen, Northern Ireland, UK
| | - Ghufran Jassim
- Family Medicine Department, Royal College of Surgeons in Ireland — Medical University of Bahrain (RCSI Bahrain), Busaiteen, Kingdom of Bahrain
| | - Zahra Khalaf
- Department of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Manaf Yusuf
- Children’s & Adolescent Services, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sara Ali
- Ministry of Health Bahrain, COVID-19 National Team, Sanabis, Kingdom of Bahrain
| | - Nada Husain
- Department of Internal Medicine, Private Health Sector, Manama, Kingdom of Bahrain
| | - Fatema Ebrahim
- Department of Internal Medicine, Private Health Sector, Manama, Kingdom of Bahrain
| |
Collapse
|
19
|
Dutta D, Liu J, Xiong H. The Impact of COVID-19 on People Living with HIV-1 and HIV-1-Associated Neurological Complications. Viruses 2023; 15:1117. [PMID: 37243203 PMCID: PMC10223371 DOI: 10.3390/v15051117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen of the coronavirus disease 2019 (COVID-19) pandemic, a fatal respiratory illness. The associated risk factors for COVID-19 are old age and medical comorbidities. In the current combined antiretroviral therapy (cART) era, a significant portion of people living with HIV-1 (PLWH) with controlled viremia is older and with comorbidities, making these people vulnerable to SARS-CoV-2 infection and COVID-19-associated severe outcomes. Additionally, SARS-CoV-2 is neurotropic and causes neurological complications, resulting in a health burden and an adverse impact on PLWH and exacerbating HIV-1-associated neurocognitive disorder (HAND). The impact of SARS-CoV-2 infection and COVID-19 severity on neuroinflammation, the development of HAND and preexisting HAND is poorly explored. In the present review, we compiled the current knowledge of differences and similarities between SARS-CoV-2 and HIV-1, the conditions of the SARS-CoV-2/COVID-19 and HIV-1/AIDS syndemic and their impact on the central nervous system (CNS). Risk factors of COVID-19 on PLWH and neurological manifestations, inflammatory mechanisms leading to the neurological syndrome, the development of HAND, and its influence on preexisting HAND are also discussed. Finally, we have reviewed the challenges of the present syndemic on the world population, with a particular emphasis on PLWH.
Collapse
Affiliation(s)
- Debashis Dutta
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | | | - Huangui Xiong
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| |
Collapse
|
20
|
Afzali A, Hatef B, Sahraei H, Meftahi GH, Khaleghi A, Jahromi GP. Changes in psychological and cognitive variables as well as cortisol levels in recovered Covid-19 patients: a longitudinal study. CURRENT PSYCHOLOGY 2023:1-10. [PMID: 36713617 PMCID: PMC9875175 DOI: 10.1007/s12144-022-04211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Decreased psychological and cognitive functioning is one of the complications of Covid-19 disease. We aimed to evaluate mental health, cognitive functioning, and salivary cortisol levels in Covid-19 patients with different disease severities in three 45-day intervals after recovery. METHODS 258 Covid-19 patients were assigned into three groups based on their disease severity: 112 patients in mild group, 67 patients in moderate group and 79 patients in severe group. The participants underwent psychological evaluations (including Depression, Anxiety and Stress Scale questionnaire, Beck Depression Inventory, SpeilBerger State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Inventory), cognitive assessments (The Paced Auditory Serial Addition Test) and salivary cortisol level evaluation in three 45-day periods. Non-parametric statistical methods were applied for psychological and cognitive indicators, while two-way mixed model ANOVA was used to evaluate the cortisol concentration in three replications. RESULTS The group of mild patients became more anxious and the group of moderate patients became more anxious and depressed. But all three groups of patients developed severe sleep disorders over time. For cognitive functioning, although the results showed a decrease in the correct response rate, a significant increase in the correct response rate was observed in all three groups in all three measurements. However, the response speed not only did not increase, but also decreased in severe group. Cortisol level had a markedly increasing trend in all three groups. CONCLUSION Improvement of cognitive functioning was in line with the increase in cortisol. Besides, the decrease in mental health had no effect on the cognitive functioning.
Collapse
Affiliation(s)
- Ahmad Afzali
- Student Research Committee, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Boshra Hatef
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hedayat Sahraei
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gila Pirzad Jahromi
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
21
|
El-Shourbagy KH, Ghith LM, Hablas LT. Radiological manifestations and complications of lung and brain in Egyptian COVID-19 patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC8935109 DOI: 10.1186/s43055-022-00742-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Coronavirus disease COVID-19 is a viral illness, currently affecting millions of people worldwide. Pneumonia is the most common extreme presentation of COVID-19 infection, manifesting by fever, dry cough, difficulty of breathing or shortness of breath and mainly ground-glass infiltrates in radiological images. Chest computed tomography (CT) has a potential role in the diagnosis, detection of complications and prognostication of coronavirus disease COVID-19. In addition to severe respiratory manifestations, there are a wide range of neurological manifestations ranging from nonspecific symptoms to necrotizing encephalopathies and stroke. Our study aimed to review lung and neurological manifestations in recent and post-COVID-19 Egyptian patients and to be familiar with magnetic resonance imaging (MRI) findings of Neuro-COVID patients.
Results The present study included eighty COVID-19 patients with age ranged from 28 to 78 years (mean age 57.84 + 12.58 years) who were 54 males (mean age 56.64 + 12.50) and 26 females (mean age 48.65 + 14.24). All our patients were with recent or previous history of COVID-19 infection and subjected to careful history taking, thorough clinical examination, routine laboratory investigations and CT examination. The reported lung manifestations included normal lung shadows, ground-glass opacifications (GGOs), consolidations, reticulation, reticulation and GGOs (crazy paving) and fibrotic-like changes. Out of eighty COVID-19 patients, twenty showed neurological manifestations ranging from nonspecific symptoms to necrotizing encephalopathies and stroke. Patients with neurological manifestation were in addition to CT submitted to magnetic resonance imaging (MRI) as appropriate. MRI done to neuro-COVID patients showed that 8/20 (40%) had no abnormalities and 12/20 (60%) had abnormalities. The most common abnormalities are infarction, major or lacunar infarction, followed by acute disseminated encephalomyelitis (ADEM), posterior reversible encephalopathy syndrome (PRES) and meningoencephalitis.
Conclusion Old age patients, especially males, were more affected than females. Lung manifestations are common in COVID-19 patients than neurological manifestations. The presence of fibrotic changes in the lung could predict severe COVID-19 affection and bad prognosis. There might be an association between appearance of neurological manifestations and poor outcome in COVID-19 patients.
Collapse
|
22
|
Singh K, Lohiya S, Ganvir S, Damke S. Case of Acute Necrotizing Encephalitis Following Coronavirus Disease 2019 Infection—A Rare Presentation. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0042-1756718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AbstractCoronavirus disease 2019 (COVID-19) results from infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Typical presentations include fever, shortness of breath, and cough though neurological manifestations have been rarely reported. Acute necrotizing encephalitis is a rare manifestation of COVID-19 and can be associated with devastating neurological outcomes. Difficulty in timely acquisition of neuroimaging and high rates of early mortality in these patients hinder timely diagnosis. In this clinicoradiological syndrome, patients suffer from rapidly worsening encephalopathy in first 2 weeks of illness and necrotizing parenchymal changes on neuroimaging. The pathophysiology is hypothesized to occur due to cytokine storm, blood–brain-barrier dysfunction, and viral-mediated immune dysregulation leading to endotheliopathy. Early immunomodulatory treatment with intravenous immunoglobulin and steroids is associated with a favorable outcome. Here, we report a one-and-half-year-old boy who presented with fever, seizures, and decreased activity since 3 days. He was noted to have hypertonia in all four limbs with exaggerated deep tendon reflexes. Nasopharyngeal reverse transcriptase polymerase chain reaction test for SARS-CoV-2 was positive. Magnetic resonance imaging brain was suggestive of acute necrotizing encephalopathy. Patient was treated with steroids.
Collapse
Affiliation(s)
- Kushagra Singh
- Department of Pediatrics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sham Lohiya
- Department of Pediatrics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Shubhangi Ganvir
- Department of Pediatrics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sachin Damke
- Department of Pediatrics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| |
Collapse
|
23
|
Kulkarni R, Gupta D, Pujari S, Deshpande V, Naphade P, Deshpande R. Neurological Manifestations in COVID-19 in Three Waves of the Pandemic: An Inpatient Study from India. Ann Indian Acad Neurol 2022; 25:1047-1055. [PMID: 36911448 PMCID: PMC9996479 DOI: 10.4103/aian.aian_204_22] [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: 02/26/2022] [Revised: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/04/2022] Open
Abstract
Background Though severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) virus primarily affects respiratory system, neurological involvement is well known. Aims To describe the neurological manifestations of coronavirus disease 2019 (COVID-19) during three waves of the pandemic. Methodology This was an ambispective observational single-centre study to describe the neurological manifestations of COVID-19 infection among inpatients from a tertiary care referral centre in Western India from March 2020 to January 2022. Results Out of 14,822 patients admitted with COVID-19, 307 (2.07%) had neurological manifestations. Neurological manifestations were seen in 1.87% in first wave (onset to 10 Feb 21); 2.37% in second wave (Feb 11, 2021 to Dec 31, 2021) and 6.26% in third wave (Jan 1, 2022 to Jan 31, 2022). The most common neurological manifestations were encephalopathy (34.5%), ischemic stroke (32.1%), and acute symptomatic seizures (8.8%). Encephalopathy (p = 0.028) was more common in first wave while seizures were more common in third wave (p = 0.001). In patients with encephalopathy, hypoxia (p = 0.0001), shock (p = 0.001), renal involvement (p = 0.002), and sepsis (p = 0.033) were associated with higher mortality; while those with no systemic involvement had better survival (p = 0.0001). Among patients with ischemic stroke, 32.1% did not have any traditional vascular risk factors. These patients were 9 years younger and required 6 days less hospitalization than patients of stroke with vascular risk factors. Conclusion SARS-CoV-2 produces many central and peripheral nervous system manifestations. Encephalopathy was more common in first wave while acute symptomatic seizures were more common in third wave. Encephalopathy was most common neurological manifestation with progressively higher mortality with increased number of systemic comorbidities. Ischemic stroke was seen in patients who had vascular risk factors as well as in patients without them.
Collapse
Affiliation(s)
- Rahul Kulkarni
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Dulari Gupta
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Shripad Pujari
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Vishal Deshpande
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Pravin Naphade
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Rushikesh Deshpande
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| |
Collapse
|
24
|
Khurshid A, Khurshid M, Sohail A, Raza IM, Ahsan MK, Alam Shah MUF, Taseer AR, Nashwan AJ, Ullah I. Facial palsy as a manifestation of COVID-19: A systematic review of cases. Health Sci Rep 2022; 5:e887. [PMID: 36320650 PMCID: PMC9616168 DOI: 10.1002/hsr2.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Aims Facial palsy is a rare complication of the COVID-19 infection. Herein, we conducted a systematic review of all published cases of facial palsy post-COVID-19 infection in an attempt to educate the general population and medical practitioners regarding the likely occurrence of facial palsy in COVID-19 patients, its detection, effective treatment plan, and prognosis of the condition. Methods We searched PubMed, Google Scholar, and Directory of Open Access Journals (DOAJ) from December 1, 2019 to September 21, 2021. Results We included 49 studies bearing accounts of 75 cases who had facial palsy. The mean age of patients was 42.9 ± 19.59 years, with a male-to-female ratio of 8:7. The majority of the cases were reported from Brazil (n = 14), USA (n = 9), Turkey (n = 9), and Spain (n = 9). Noticeably, 30.14% of COVID-19 patients were diagnosed with Guillain-Barré syndrome. In total, 22.97% of patients complained of bilateral facial paralysis (n = 17), whereas ipsilateral paralysis was observed in 77.03% (n = 57). These were common complaints of Lagophthalmos, otalgia, facial drooping, dysarthria, and compromised forehead wrinkling. The treatment regimen mainly included the use of corticosteroids (n = 51) (69.86%), antivirals (n = 23) (31.51%), IVIG (n = 18) (24.66%), antibiotics (n = 13) (17.81%), antiretroviral (n = 9) (12.33%), and antimalarial (n = 8) (10.96%) medications. In all, 35.62% of patients (n = 26) adhered to a combination of antiviral and corticosteroid-based therapy. Positive treatment outcomes were observed in 83.58% (n = 56) of cases. In contrast, 10 patients (14.93%) showed nonsignificant recovery, out of which 3 (4.48%) died from the disease. Conclusion The association of facial palsy with COVID-19 is controversial and therefore requires further investigation and published work to confirm a causal relationship. However, physicians should not overlook the likelihood of facial palsy post-COVID-19 infection and treat it accordingly.
Collapse
Affiliation(s)
- Aiman Khurshid
- Department of Forensic Medicine Abbasi Shaheed Hospital Karachi Pakistan
| | - Maman Khurshid
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Aruba Sohail
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Imran Mansoor Raza
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | | | | | - Anab Rehan Taseer
- Department of Pulmonology, Lady Reading Hospital (LRH) Peshawar Pakistan
| | | | - Irfan Ullah
- Kabir Medical College Gandhara University Peshawar Pakistan
| |
Collapse
|
25
|
Hazra S, Chaudhuri AG, Tiwary BK, Chakrabarti N. Integrated network-based multiple computational analyses for identification of co-expressed candidate genes associated with neurological manifestations of COVID-19. Sci Rep 2022; 12:17141. [PMID: 36229517 PMCID: PMC9558001 DOI: 10.1038/s41598-022-21109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/22/2022] [Indexed: 01/04/2023] Open
Abstract
'Tripartite network' (TN) and 'combined gene network' (CGN) were constructed and their hub-bottleneck and driver nodes (44 genes) were evaluated as 'target genes' (TG) to identify 21 'candidate genes' (CG) and their relationship with neurological manifestations of COVID-19. TN was developed using neurological symptoms of COVID-19 found in literature. Under query genes (TG of TN), co-expressed genes were identified using pair-wise mutual information to genes available in RNA-Seq autopsy data of frontal cortex of COVID-19 victims. CGN was constructed with genes selected from TN and co-expressed in COVID-19. TG and their connecting genes of respective networks underwent functional analyses through findings of their enrichment terms and pair-wise 'semantic similarity scores' (SSS). A new integrated 'weighted harmonic mean score' was formulated assimilating values of SSS and STRING-based 'combined score' of the selected TG-pairs, which provided CG-pairs with properties of CGs as co-expressed and 'indispensable nodes' in CGN. Finally, six pairs sharing seven 'prevalent CGs' (ADAM10, ADAM17, AKT1, CTNNB1, ESR1, PIK3CA, FGFR1) showed linkages with the phenotypes (a) directly under neurodegeneration, neurodevelopmental diseases, tumour/cancer and cellular signalling, and (b) indirectly through other CGs under behavioural/cognitive and motor dysfunctions. The pathophysiology of 'prevalent CGs' has been discussed to interpret neurological phenotypes of COVID-19.
Collapse
Affiliation(s)
- Suvojit Hazra
- CPEPA-UGC Centre for "Electro-Physiological and Neuro-Imaging Studies Including Mathematical Modelling", University of Calcutta, Kolkata, West Bengal, India
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India
| | | | - Basant K Tiwary
- Department of Bioinformatics, School of Life Sciences, Pondicherry University, Pondicherry, India.
| | - Nilkanta Chakrabarti
- CPEPA-UGC Centre for "Electro-Physiological and Neuro-Imaging Studies Including Mathematical Modelling", University of Calcutta, Kolkata, West Bengal, India.
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India.
| |
Collapse
|
26
|
Tziastoudi M, Cholevas C, Stefanidis I, Theoharides TC. Genetics of COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review. Ann Clin Transl Neurol 2022; 9:1838-1857. [PMID: 36204816 PMCID: PMC9639636 DOI: 10.1002/acn3.51631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/08/2023] Open
Abstract
COVID‐19 and ME/CFS present with some similar symptoms, especially physical and mental fatigue. In order to understand the basis of these similarities and the possibility of underlying common genetic components, we performed a systematic review of all published genetic association and cohort studies regarding COVID‐19 and ME/CFS and extracted the genes along with the genetic variants investigated. We then performed gene ontology and pathway analysis of those genes that gave significant results in the individual studies to yield functional annotations of the studied genes using protein analysis through evolutionary relationships (PANTHER) VERSION 17.0 software. Finally, we identified the common genetic components of these two conditions. Seventy‐one studies for COVID‐19 and 26 studies for ME/CFS were included in the systematic review in which the expression of 97 genes for COVID‐19 and 429 genes for ME/CFS were significantly affected. We found that ACE, HLA‐A, HLA‐C, HLA‐DQA1, HLA‐DRB1, and TYK2 are the common genes that gave significant results. The findings of the pathway analysis highlight the contribution of inflammation mediated by chemokine and cytokine signaling pathways, and the T cell activation and Toll receptor signaling pathways. Protein class analysis revealed the contribution of defense/immunity proteins, as well as protein‐modifying enzymes. Our results suggest that the pathogenesis of both syndromes could involve some immune dysfunction.
Collapse
Affiliation(s)
- Maria Tziastoudi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Cholevas
- First Department of Ophthalmology, Faculty of Health Sciences, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - Ioannis Stefanidis
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Theoharis C Theoharides
- Institute of Neuro-Immune Medicine, Nova Southeastern University, Clearwater, FL, USA.,Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology, Tufts University School of Medicine, Boston, Massachusetts, USA.,School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA.,Departments of Internal Medicine and Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Chu JY, Moe GW, Vyas MV, Chen R, Chow CM, Gupta M, Kaliwal Y, Koh M, Ko DT, Liu PP. Epidemiology of COVID-19 and Its Cardiac and Neurologic Complications Among Chinese and South Asians in Ontario: Waves 1, 2, and 3. CJC Open 2022; 4:894-904. [PMID: 36254328 PMCID: PMC9568686 DOI: 10.1016/j.cjco.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although we had previously reported the cardiac and neurologic outcomes of Chinese and South Asian Ontarians in wave 1 of COVID-19, data on subsequent waves of COVID-19 remain unexamined. This is an extension study of this cohort in waves 2 and 3. Methods We identified adult Ontarians with a positive COVID-19 polymerase chain reaction test from January 1, 2020 to June 30, 2021, and they were classified as being Chinese or South Asian using a validated surname algorithm; we compared their outcomes of mortality, and cardiac and neurologic complications with those of the general population using multivariable logistic regression models. Results Compared to the general population (n = 439,977), the Chinese population (n = 15,208) was older (mean age 44.2 vs 40.6 years, P < 0.001) and the South Asian population (n = 46,333) was younger (39.2 years, P < 0.001). The Chinese population had a higher 30-day mortality (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.28-1.61) and more hospitalization or emergency department visits (OR, 1.14; 95% CI, 1.09-1.28), with a trend toward a higher incidence of cardiac complications (OR, 1.03; 95% CI, 0.87-1.12) and neurologic complications (OR, 1.23; 95% CI, 0.96-1.58). South Asians had a lower 30-day mortality (OR, 0.88; 95% CI, 0.78-0.98) but a higher incidence of hospitalization or emergency department visits (OR, 1.17; 95% CI, 1.14-1.20) with a trend toward a lower incidence of cardiac complications (OR, 0.76; 95% CI, 0.67-0.87) and neurologic complications (OR, 0.89; 95% CI, 0.73-1.09). There was also a significant difference in these outcomes between wave 1, 2 and 3, with a greater mortality in all groups in waves 2 and 3. Conclusions Ethnicity continues to be an important determinant of mortality, cardiac and neurologic outcomes, and healthcare use among patients with COVID-19, requiring further studies to understand factors driving these differences.
Collapse
Affiliation(s)
- Joseph Y. Chu
- Division of Neurology, Department of Medicine, William Osler Health System, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada
| | - Gordon W. Moe
- Division of Cardiology, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Manav V. Vyas
- Division of Neurology, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, Department of Medicine, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada
| | - Chi-Ming Chow
- Division of Cardiology, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Milan Gupta
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Dennis T. Ko
- ICES, Toronto, Ontario, Canada
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter P. Liu
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine and Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
28
|
Guillain–Barré Syndrome Associated with COVID-19: Two Cases from a Public Hospital in Damascus, Syria. Case Rep Med 2022; 2022:9722736. [PMID: 36092310 PMCID: PMC9462972 DOI: 10.1155/2022/9722736] [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: 11/04/2021] [Revised: 06/02/2022] [Accepted: 08/06/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To report two cases of COVID-19 complicated with Guillain–Barré syndrome (GBS) from a public hospital in Damascus, Syria. Results Two unvaccinated patients, 49-year-old and 34-year-old men, presented with a history of paresthesia followed by ascending symmetric weakness with absent tendon reflexes. They were diagnosed with coronavirus disease 2019 (COVID-19) using chest CT and RT-PCR. Clinical status and lumbar puncture (LP) findings were consistent with GBS. They were treated with plasma exchange (PE). However, the first patient developed hallucinations and later deteriorated. He passed away after the second session of PE, while the second patient had four sessions of plasma exchange and was later discharged for home rehabilitation. Conclusion It is important to consider GBS in COVID-19 patients who present with acute ascending weakness or cranial nerves involvement. More studies are needed to evaluate correlation between COVID-19, GBS, and development of psychiatric disturbances besides investigating the discrepancy between lung parameters and respiratory failure.
Collapse
|
29
|
Alrajhi F, Seraj H, Taher NO, Alnabihi AN. Bell's palsy in a patient after contracting COVID-19 with signs of aberrant nerve regeneration. Am J Ophthalmol Case Rep 2022; 27:101679. [PMID: 35959246 PMCID: PMC9356593 DOI: 10.1016/j.ajoc.2022.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose To report a 56-year-old male in Saudi Arabia who developed signs of aberrant facial nerve regeneration after recovering from Bell's palsy associated with COVID-19 infection. Observations The patient presented, months following recovery from Bell's palsy associated with COVID-19, with symptoms of aberrant seventh nerve regeneration in the form of tearing with eating “crocodile tears” and synchronous right eyelid closure with the jaw movement. Conclusions and Importance Case reports of Bell's palsy associated with COVID-19 are emerging, but association does not mean causation. That said, we need to report these cases to draw attention to the possible neuroinvasive propensity of this virus. It is also imperative to recognize Bell's palsy as a possible symptom of COVID-19.
Collapse
|
30
|
Estiasari R, Maharani K, Octaviana F, Putri ANM, Ramadhan SL, Rozaliani A, Imran D. Encephalomyelitis associated with coronavirus disease 2019: a case report. J Med Case Rep 2022; 16:329. [PMID: 35999589 PMCID: PMC9396600 DOI: 10.1186/s13256-022-03539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite a considerable number of articles regarding neurological manifestations associated with severe acute respiratory syndrome coronavirus 2 infection, reports on transverse myelitis and encephalitis are scarce. Case presentation We report a 35-year-old Asian Arab female presenting with longitudinally extensive transverse myelitis within 3 weeks after being diagnosed with mild coronavirus disease 2019 infection. Administration of high-dose methylprednisolone led to significant clinical improvement. However, 2 days after discharge, the patient was readmitted with encephalitis manifestations, consisting of fever and loss of consciousness, along with deterioration in myelitis symptoms. Severe acute respiratory syndrome coronavirus 2 antibody was detected in cerebrospinal fluid, but DNA of severe acute respiratory syndrome coronavirus 2 was not found. Clinical recovery was achieved after the administration of intravenous immunoglobulin. Conclusion Longitudinally extensive transverse myelitis can be a neurological manifestation of coronavirus disease 2019 and can be followed by encephalomyelitis episodes. High-dose steroids and intravenous immunoglobulin as an immunomodulator are possible effective treatment options.
Collapse
Affiliation(s)
- Riwanti Estiasari
- Department of Neurology Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta, Jl. Salemba 6, Jakarta, 10430, Indonesia. .,Cipto Mangunkusumo General Hospital Jakarta, Jakarta, Indonesia.
| | - Kartika Maharani
- Department of Neurology Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta, Jl. Salemba 6, Jakarta, 10430, Indonesia.,Cipto Mangunkusumo General Hospital Jakarta, Jakarta, Indonesia
| | - Fitri Octaviana
- Department of Neurology Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta, Jl. Salemba 6, Jakarta, 10430, Indonesia.,Cipto Mangunkusumo General Hospital Jakarta, Jakarta, Indonesia
| | - Anyelir Nielya Mutiara Putri
- Department of Neurology Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - Syifa Laila Ramadhan
- Department of Neurology Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - Anna Rozaliani
- Department of Parasitology Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta, Jl. Salemba 6, Jakarta, 10430, Indonesia.,Cipto Mangunkusumo General Hospital Jakarta, Jakarta, Indonesia
| | - Darma Imran
- Department of Neurology Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta, Jl. Salemba 6, Jakarta, 10430, Indonesia.,Cipto Mangunkusumo General Hospital Jakarta, Jakarta, Indonesia
| |
Collapse
|
31
|
Complications of invasive mechanical ventilation in critically Ill Covid-19 patients - A narrative review. Ann Med Surg (Lond) 2022; 80:104201. [PMID: 35874936 PMCID: PMC9287581 DOI: 10.1016/j.amsu.2022.104201] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/12/2022] [Indexed: 01/08/2023] Open
Abstract
Critically ill COVID-19 patients have to undergo positive pressure ventilation, a non-physiological and invasive intervention that can be lifesaving in severe ARDS. Similar to any other intervention, it has its pros and cons. Despite following Lung Protective Ventilation (LPV), some of the complications are frequently reported in these critically ill patients and significantly impact overall mortality. The complications related to invasive mechanical ventilation (IMV) in critically ill COVID-19 patients can be broadly divided into pulmonary and non-pulmonary. Among pulmonary complications, the most frequent is ventilator-associated pneumonia. Others are barotrauma, including subcutaneous emphysema, pneumomediastinum, pneumothorax, bullous lesions, cardiopulmonary effects of right ventricular dysfunction, and pulmonary complications mimicking cardiac failure, including pulmonary edema. Tracheal complications, including full-thickness tracheal lesions (FTTLs) and tracheoesophageal fistulas (TEFs) are serious but rare complications. Non-Pulmonary complications include neurological, nephrological, ocular, and oral complications. The complications related to IMV in critically ill covid 19 patients can be broadly divided into pulmonary and non-pulmonary complications. Among pulmonary complications the most frequent is Ventilator associated pneumonia. Others are Barotrauma, Cardiopulmonary effects of right ventricular dysfunction & Pulmonary complications mimicking cardiac failure including pulmonary edema, tracheal complications including full thickness tracheal lesions & tracheoesophageal fistulas. Non-Pulmonary complications of prolonged IMV include neurological, nephrological, ocular and oral complications.
Collapse
|
32
|
Shahsavarinia K, Mahmoodpoor A, Sadeghi-Ghyassi F, Nedayi A, Razzaghi A, Zehi Saadat M, Salehi-Pourmehr H. Bell's Palsy and COVID-19 Vaccination: A Systematic Review. Med J Islam Repub Iran 2022; 36:85. [PMID: 36128311 PMCID: PMC9448503 DOI: 10.47176/mjiri.36.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Bell's palsy is a rare adverse event reported in COVID-19 vaccines. Given the importance of neurological manifestations, the necessity to highlight and scrutinize the incidence of them following COVID-19 vaccination is needed. This study aimed to systematically review the reported cases of Bell's palsy following vaccination against COVID-19. Methods: This systematic review is conducted based on the Cochrane Collaboration Handbook and PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) and using the Joanna Briggs Institute (JBI) methodology for systematic reviews. The inclusion criteria for the included published studies were patient age ≥18 years, history of Bell's palsy after COVID-19 vaccination and established diagnosis in the patients with COVID-19 vaccination. The exclusion criteria were repeated cases and missing clinical information. The search strategy aimed to find both published and unpublished studies in August 2021 and updated by hand searching in May 2022 using the identified keywords and index terms in Cochrane Library, MEDLINE (PubMed), Web of Science, Scopus, ProQuest, and Google scholar. Finally, the reference lists of all identified reports and articles were searched for additional studies. The JBI critical appraisal tools for case reports or case series were used to assess the risk of bias in the included studies. Results: During the electronic search, hand search, and reference check, we identified 1281 citations, and in hand searching, we detected additional 15 studies. After omitting duplicated citations and assessing the title, abstract, and full text 15 case-report and two case-series studies were included for the critical appraisal process and were included in this study. Pfizer and Moderna vaccines were the most common vaccines among articles that reported the cases of Bell's palsy. Left-sided paralysis was more common than right-sided paralysis. The interval between receiving the vaccine and the onset of facial weakness was between 1 and 48 days. Conclusion: Further studies with larger sample sizes are necessary to assess the association between Bell's palsy and the dose-response of the COVID-19 vaccine.
Collapse
Affiliation(s)
- Kavous Shahsavarinia
- Emergency and trauma care research center, Tabriz University of Medical Sciences, Tabriz, Iran,Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Sadeghi-Ghyassi
- Faculty of Management & Medical Informatics Tabriz University of Medical Science, Tabriz, Iran
| | - Arezou Nedayi
- Emergency and trauma care research center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Razzaghi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Zehi Saadat
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author: Dr Hanieh Salehi-Pourmehr,
| |
Collapse
|
33
|
Chu JY, Kaliwal Y, Koh M, Chen R, Chow CM, Ko DT, Liu PP, Moe GW. COVID-19 and its Cardiac and Neurological Complications among Ontario Visible Minorities. Can J Neurol Sci 2022; 49:504-513. [PMID: 34162448 PMCID: PMC8365110 DOI: 10.1017/cjn.2021.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Due to lack of data on the epidemiology, cardiac, and neurological complications among Ontario visible minorities (Chinese and South Asians) affected by coronavirus disease (COVID-19), this population-based retrospective study was undertaken to study them systematically. METHODS From January 1, 2020 to September 30, 2020 using the last name algorithm to identify Ontario Chinese and South Asians who were tested positive by PCR for COVID-19, their demographics, cardiac, and neurological complications including hospitalization and emergency visit rates were analyzed compared to the general population. RESULTS Chinese (N = 1,186) with COVID-19 were found to be older (mean age 50.7 years) compared to the general population (N = 42,547) (mean age 47.6 years) (p < 0.001), while South Asians (N = 3,459) were younger (age of 42.1 years) (p < 0.001). The 30-day crude rate for cardiac complications among Chinese was 169/10,000 (p = 0.069), while for South Asians, it was 64/10,000 (p = 0.008) and, for the general population, it was 112/10,000. For neurological complications, the 30-day crude rate for Chinese was 160/10,000 (p < 0.001); South Asians was 40/10,000 (p = 0.526), and general population was 48/10,000. The 30-day all-cause mortality rate was significantly higher for Chinese at 8.1% vs 5.0% for the general population (p < 0.001), while it was lower in South Asians at 2.1% (p < 0.001). CONCLUSIONS Chinese and South Asians in Ontario affected by COVID-19 during the first wave of the pandemic were found to have a significant difference in their demographics, cardiac, and neurological outcomes.
Collapse
Affiliation(s)
- Joseph Y. Chu
- Division of Neurology, Department of Medicine, Toronto Western Hospital-University Health Network and William Osler Health System, University of Toronto, Toronto, Canada
| | | | | | - Robert Chen
- Krembil Research Institute, University Health Network and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Chi-Ming Chow
- Division of Cardiology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Dennis T. Ko
- ICES, Toronto, Canada
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Peter P. Liu
- University of Ottawa Heart Institute and Department of Medicine and Cellular & Molecular Medicine, University of Ottawa and Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Gordon W. Moe
- Division of Cardiology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
34
|
Meaney JF, O’Donnell JS, Bridgewood C, Harbison J, McGonagle D. Perspective: The Case for Acute Large Vessel Ischemic Stroke in COVID-19 Originating Within Thrombosed Pulmonary Venules. Stroke 2022; 53:2411-2419. [PMID: 35543127 PMCID: PMC9232249 DOI: 10.1161/strokeaha.121.038056] [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] [Indexed: 01/08/2023]
Abstract
The main burden of SARS-CoV-2 falls on the lungs but neurological manifestations, the most disabling of which are strokes and which correlate with disease severity, are common. We proffer a novel mechanism for acute COVID-19 stroke whereby pulmonary vein clots developing within the characteristic pulmonary intravascular thrombotic lesions can embolize to the brain. Appreciation of this mechanism requires an understanding of the tricompartmental model of lung parenchyma oxygenation (the alveolus, the bronchial artery, and the pulmonary artery), all of which are compromised in COVID-19. Of these 3 sources, the bronchial artery plays a crucial role in COVID-19 stroke because the unique collaterals from bronchial artery to pulmonary vein which exist under normal physiological conditions (and which maintain venous patency when the pulmonary artery is blocked by embolus) are occluded, thus leading to venular thrombosis in the presence of hypercoagulability. Dislodgement of clots from this source translocates the pathology to the brain and is a disease mechanism, formerly rare, which may account for many cases of large vessel occlusion stroke in COVID-19. This mechanism extends the concept of cardioembolic stroke from endocardium retrogradely into the pulmonary circulation with which the left cardiac chambers lie in direct continuity, and which is an accepted stroke mechanism under other circumstances such as lung lobectomy, where surgical ligation of the pulmonary vein creates a blind sac from which thrombi can embolize. The proposed model is supported by postmortem studies which have demonstrated venular thrombosis and by case reports of pulmonary vein thrombosis in COVID-19. This concept provides a more plausible cause for COVID-19 associated large vessel occlusion stroke than other putative mechanisms, such as cerebral endotheliitis, cytokine storm, and hypercoagulopathy, although it is acknowledged that the latter mechanism contributes to the genesis of pulmonary vein clots. Recognizing that extrapulmonary manifestations including stroke arise within thrombosed pulmonary veins is key to understanding of neurological manifestations of SARS-CoV-2 infection.
Collapse
Affiliation(s)
- James F.M. Meaney
- The Thomas Mitchell Centre for Advanced Medical Imaging, St James’s Hospital (J.F.M.M.), Trinity College Dublin, Ireland
| | - James S. O’Donnell
- Irish Centre for Vascular Biology, Royal College of Surgeons of Ireland (J.S.O.)
| | - Charles Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, United Kingdom (C.B.)
| | - Joseph Harbison
- Department of Stroke Medicine (J.H.), Trinity College Dublin, Ireland
| | - Dennis McGonagle
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, United Kingdom (D.M.)
| |
Collapse
|
35
|
Jungbauer F, Gerhards C, Thiaucourt M, Behnes M, Rotter N, Schell A, Haselmann V, Neumaier M, Kittel M. Anosmia Testing as Early Detection of SARS-CoV-2 Positivity; A Prospective Study under Screening Conditions. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070968. [PMID: 35888058 PMCID: PMC9319241 DOI: 10.3390/life12070968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/11/2022]
Abstract
Sudden onset of anosmia is a phenomenon often associated with developing COVID-19 disease and has even been described as an initial isolated symptom in individual cases. In this case-control study, we investigated the feasibility of this condition as a suitable screening test in a population at risk. We performed a prospective study with a total of 313 subjects with suspected SARS-CoV-2 infection. In parallel to routine PCR analysis, a modified commercial scent test was performed to objectify the presence of potential anosmia as a predictor of SARS-CoV-2 positivity. Furthermore, a structured interview assessment of the participants was conducted. A total of 12.1% of the study participants had molecular genetic detection of SARS-CoV-2 infection in the nasopharyngeal swab. It could be demonstrated that these subjects had a significantly weaker olfactory identification performance of the scents. Further analysis of the collected data from the scent test and medical history via random forest (Boruta) algorithm showed that no improvement of the prediction power was achieved by this design. The assay investigated in this study may be suitable for screening general olfactory function. For the screening of COVID-19, it seems to be affected by too many external and internal biases and requires too elaborate and selective pre-test screening.
Collapse
Affiliation(s)
- Frederic Jungbauer
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (F.J.); (N.R.); (A.S.)
| | - Catharina Gerhards
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (C.G.); (M.T.); (V.H.); (M.N.)
| | - Margot Thiaucourt
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (C.G.); (M.T.); (V.H.); (M.N.)
| | - Michael Behnes
- German Center for Cardiovascular Research, First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, DZHK, Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
| | - Nicole Rotter
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (F.J.); (N.R.); (A.S.)
| | - Angela Schell
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (F.J.); (N.R.); (A.S.)
| | - Verena Haselmann
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (C.G.); (M.T.); (V.H.); (M.N.)
| | - Michael Neumaier
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (C.G.); (M.T.); (V.H.); (M.N.)
| | - Maximilian Kittel
- Institute for Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (C.G.); (M.T.); (V.H.); (M.N.)
- Correspondence: ; Tel.: +49-621-383-8417
| |
Collapse
|
36
|
Son SA, Kim YJ, Lim SY, Kim HB. Bilateral Vocal Fold Paralysis After COVID-19 mRNA Vaccination: A Case Report. J Korean Med Sci 2022; 37:e201. [PMID: 35762144 PMCID: PMC9239840 DOI: 10.3346/jkms.2022.37.e201] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was noted to cause coronavirus disease 2019 (COVID-19) in 2019, there have been many trials to develop vaccines against the virus. Messenger ribonucleic acid (mRNA) vaccine as a type of the vaccine has been developed and commercialized rapidly, but there was not enough time to verify the long-term safety. An 82-year-old female patient was admitted to the emergency room with dyspnea accompanied by stridor three days after the 3rd COVID-19 mRNA vaccination (Comirnaty, Pfizer-BioNTech, USA). The patient was diagnosed with bilateral vocal fold paralysis (VFP) by laryngoscope. Respiratory distress was improved after the intubation and tracheostomy in sequence. The brain, chest, and neck imaging tests, serological tests, cardiological analysis, and immunological tests were performed to evaluate the cause of bilateral VFP. However, no definite cause was found except for the precedent vaccination. Because bilateral VFP can lead to a fatal condition, a quick evaluation is necessary in consideration of VFP when dyspnea with stridor occurs after vaccination.
Collapse
Affiliation(s)
- Soo Ah Son
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Ji Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Yun Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Bum Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
37
|
Zhao Y, Lukiw WJ. SARS-CoV-2 Neuroinvasion, Inflammatory Neurodegeneration and Alzheimer's Disease. Front Cell Neurosci 2022; 16:937961. [PMID: 35783095 PMCID: PMC9247146 DOI: 10.3389/fncel.2022.937961] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yuhai Zhao
- LSU Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA, United States
- Department of Cell Biology and Anatomy, LSU Health Science Center, New Orleans, LA, United States
| | - Walter J. Lukiw
- LSU Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA, United States
- Department of Ophthalmology, LSU Health Science Center, New Orleans, LA, United States
- Department of Neurology, Louisiana State University Health Science Center, New Orleans, LA, United States
| |
Collapse
|
38
|
Atypical Eclampsia in a Pregnant Woman Infected by COVID-19. Case Rep Obstet Gynecol 2022; 2022:9952355. [PMID: 35531127 PMCID: PMC9068329 DOI: 10.1155/2022/9952355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease 2019, also called (COVID-19), is an infectious disease which is caused by a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first report was in December 2019, and on March 12, 2020, the World Health Organization (WHO) declared this disease a pandemic. COVID-19 targets many major organs causing life-threatening systemic complications. It can cause lung damage and respiratory failure in addition to systemic inflammation and immune dysregulation. Hypercoagulable state and numerous neurological abnormalities also have been reported due to this condition. Going through the literature review, we found some cases of pregnant women with novel coronavirus infection, being mostly mild illnesses, and most of these cases were focused on maternal-fetal transmission and neonatal outcomes. In this case report, we present the case of a COVID-19 positive woman who came to our emergency department at 34 weeks of gestation with tonic-clonic seizures. This case was a challenge for us because we faced a new an unknown manifestation of both COVID and eclampsia.
Collapse
|
39
|
Anjum Z, Iyer C, Naz S, Jaiswal V, Nepal G, Laguio‐vila M, Anandaram S, Thapaliya S. Guillain‐Barré syndrome after mRNA‐1273 (Moderna) COVID‐19 vaccination: A case report. Clin Case Rep 2022; 10:e05733. [PMID: 35441015 PMCID: PMC9010569 DOI: 10.1002/ccr3.5733] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/13/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Charoo Iyer
- Rochester General Hospital Rochester New York USA
| | - Sidra Naz
- Harvard Medical School Boston Massachusetts USA
| | | | - Gaurav Nepal
- Tribhuvan University Institute of Medicine Kathmandu Nepal
| | | | | | | |
Collapse
|
40
|
Quarleri J, Delpino MV. SARS-CoV-2 interacts with renin-angiotensin system: impact on the central nervous system in elderly patients. GeroScience 2022; 44:547-565. [PMID: 35157210 PMCID: PMC8853071 DOI: 10.1007/s11357-022-00528-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/08/2022] [Indexed: 01/18/2023] Open
Abstract
SARS-CoV-2 is a recently identified coronavirus that causes the current pandemic disease known as COVID-19. SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as a receptor, suggesting that the initial steps of SARS-CoV-2 infection may have an impact on the renin-angiotensin system (RAS). Several processes are influenced by RAS in the brain. The neurological symptoms observed in COVID-19 patients, including reduced olfaction, meningitis, ischemic stroke, cerebral thrombosis, and delirium, could be associated with RAS imbalance. In this review, we focus on the potential role of disturbances in the RAS as a cause for central nervous system sequelae of SARS-CoV-2 infection in elderly patients.
Collapse
Affiliation(s)
- Jorge Quarleri
- Instituto de Investigaciones Biomédicas en Retrovirus Y Sida (INBIRS), Universidad de Buenos Aires-CONICET, Paraguay 2155-Piso 11 (1121), Buenos Aires, Argentina.
| | - M Victoria Delpino
- Instituto de Investigaciones Biomédicas en Retrovirus Y Sida (INBIRS), Universidad de Buenos Aires-CONICET, Paraguay 2155-Piso 11 (1121), Buenos Aires, Argentina.
| |
Collapse
|
41
|
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: 31] [Impact Index Per Article: 15.5] [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.
Collapse
|
42
|
Bhola S, Trisal J, Thakur V, Kaur P, Kulshrestha S, Bhatia SK, Kumar P. Neurological toll of COVID-19. Neurol Sci 2022; 43:2171-2186. [PMID: 35034236 PMCID: PMC8761097 DOI: 10.1007/s10072-022-05875-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/04/2022] [Indexed: 02/08/2023]
Abstract
The first case of coronavirus illness was discovered in Wuhan, China, in January 2020 and quickly spread worldwide within the next couple of months. The condition was initially only linked with respiratory disorders. After the evolution of various variants of the SARS-CoV-2, the critical impact of the virus spread to multiple organs and soon, neurological disorder manifestations started to appear in the infected patients. The review is focused on the manifestation of various neurological disorders linked with both the central nervous system and peripheral nervous system. Disorders such as cytokine release syndrome, encephalitis, acute stroke, and Bell's palsy are given specific attention and psychological manifestations are also investigated. For a clear conclusion, cognitive impairment, drug addiction disorders, mood and anxiety disorders, and post-traumatic stress disorder are all fully examined. The association of the SARS-CoV-2 with neurological disorders and pathway is yet to be clear. For better understanding, the explanation of the possible mechanism of viral infection influencing the nervous system is also attempted in the review. While several vaccines and drugs are already involved in treating the SARS-CoV-2 condition, the disease is still considered fatal and more likely to leave permanent neurological damage, which leads to an essential requirement for more research to explore the neurological toll of the COVID-19 disease.
Collapse
Affiliation(s)
- Shivam Bhola
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Jhillika Trisal
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Vikram Thakur
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin-160012, India
| | - Parneet Kaur
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Saurabh Kulshrestha
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India
| | - Shashi Kant Bhatia
- Department of Biological Engineering, Konkuk University, Seoul, 05029, Republic of Korea
| | - Pradeep Kumar
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan, Himachal Pradesh, India.
| |
Collapse
|
43
|
dos Santos PK, Sigoli E, Bragança LJ, Cornachione AS. The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection. Front Physiol 2022; 13:813924. [PMID: 35492595 PMCID: PMC9040683 DOI: 10.3389/fphys.2022.813924] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Patty K. dos Santos
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | | | | | - Anabelle S. Cornachione
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| |
Collapse
|
44
|
Sood A, Goyal R, Singh H, Behl T, Arora S, Saini B, Kaur R. Implication of Covid-19 on Neurological Complications with Specific Emphasis on Alzheimer's and Parkinson's Disease. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:235-245. [PMID: 34414876 DOI: 10.2174/1871527320666210820092817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/02/2021] [Accepted: 06/25/2021] [Indexed: 01/10/2023]
Abstract
It is noticeable how the novel coronavirus has spread from the Wuhan region of China to the whole world, devastating the lives of people worldwide. All the data related to the precautionary measures, diagnosis, treatment, and even the epidemiological data are being made freely accessible and reachable in a very little time as well as being rapidly published to save humankind from this pandemic. There might be neurological complications of COVID-19 and patients suffering from neurodegenerative conditions like Alzheimer's disease and Parkinson's disease might have repercussions as a result of the pandemic. In this review article, we have discussed the effect of SARS-CoV-2 viral infection on the people affected with neurodegenerative disorders such as Parkinson's and Alzheimer's. It primarily emphasizes two issues, i.e., vulnerability to infection and modifications of course of the disease concerning the clinical neurological manifestations, the advancement of the disease and novel approaches to support health care professionals in disease management, the susceptibility to these diseases, and impact on the severity of disease and management.
Collapse
Affiliation(s)
- Ankita Sood
- Chitkara College of Pharmacy, Chitkara University, Punjab,India
| | - Ravi Goyal
- Chitkara College of Pharmacy, Chitkara University, Punjab,India
| | - Harshdeep Singh
- Chitkara College of Applied Engineering, Chitkara University, Punjab,India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab,India
| | - Sandeep Arora
- Chitkara College of Pharmacy, Chitkara University, Punjab,India
| | - Balraj Saini
- Chitkara College of Pharmacy, Chitkara University, Punjab,India
| | - Rajwinder Kaur
- Chitkara College of Pharmacy, Chitkara University, Punjab,India
| |
Collapse
|
45
|
Darvishnia D, Ahmadi H, Sanei Motlagh A. Successful Treatment of Encephalitis Following SARS-Cov-2 Infection: A Case Report. TANAFFOS 2022; 21:257-260. [PMID: 36879728 PMCID: PMC9985132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/10/2021] [Indexed: 03/08/2023]
Abstract
Background The SARS-CoV-2 invades the cells by attachment of virus spike proteins (S1, S2) to cell membrane and engages angiotensin-converting enzyme 2 (ACE2), which is highly expressed in the epithelium of cerebral vasculature. Here, we describe a patient with encephalitis following SARS-CoV-2 infection. Case presentation A 77-year-old male patient presented with mild cough and coryza lasting for eight days without a prior history of underlying disease or neurologic disorder. Oxygen saturation (SatO2) was decreased and behavioral changes, confusion, and headaches were started within three days prior to admission. Bilateral ground glass opacifications and consolidations were noted on chest CT scan. Lymphopenia, highly elevated D-Dimer and ferritin were noted in laboratory results. Brain CT and MRI showed no changes regarding encephalitis. Cerebrospinal fluid was collected as the symptoms persisted. The results of SARS-CoV-2 RNA RT-PCR from CSF and nasopharyngeal samples were positive. The combination therapy with remdesivir, interferon beta-1alpha and methylprednisolone was started. Due to deterioration of the patient's status and SatO2, he was admitted to the ICU and intubated. Tocilizumab, dexamethasone, and mannitol were started. The patient was extubated on the 16th day of ICU admission. The patient's level of consciousness and SatO2 were improved. He was discharged from the hospital a week later. Conclusion RT-PCR of CSF sample along with brain imaging can help with diagnosis when encephalitis due to SARS-CoV-2 is suspected. However, no changes regarding encephalitis may be seen on brain CT or MRI. Combination therapy with antivirals, interferon beta, corticosteroids, and tocilizumab can help patients recover in these conditions.
Collapse
Affiliation(s)
- David Darvishnia
- Department of Infectious Diseases, Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hanieh Ahmadi
- Department of Ophthalmology, School of Medicine, Sari Bu Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | | |
Collapse
|
46
|
Bosdriesz JR, Ritsema F, Leenstra T, Petrignani MWF, Bruisten SM, Coyer L, Schreijer AJM, van Duijnhoven YTHP, Schim van der Loeff MF, Matser AA. Self-reported symptoms as predictors of SARS-CoV-2 infection in the general population living in the Amsterdam region, the Netherlands. PLoS One 2022; 17:e0262287. [PMID: 35089936 PMCID: PMC8797231 DOI: 10.1371/journal.pone.0262287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Most COVID-19 symptoms are non-specific and also common in other respiratory infections. We aimed to assess which symptoms are most predictive of a positive test for SARS-CoV-2 in symptomatic people of the general population who were tested. METHODS We used anonymised data of all SARS-CoV-2 test results from the Public Health Service of Amsterdam from June 1,2020 through August 31, 2021. Symptoms were self-reported at time of requesting a test. Multivariable logistic regression models with generalized estimating equations were used to identify predictors of a positive test. Included symptoms were: cough, fever, loss of smell or taste, muscle ache, runny nose, shortness of breath, and throat ache; adjustments were made for age and gender, and stratification by month. RESULTS Overall, 12.0% of 773,680 tests in 432,213 unique individuals were positive. All symptoms were significantly associated with a positive test result, the strongest positive associations were: cough (aOR = 1.78, 95%CI = 1.75-1.80), fever (aOR = 2.11, 95%CI = 2.07-2.14), loss of smell or taste (aOR = 2.55, 95%CI = 2.50-2.61), and muscle ache (aOR = 2.38, 95%CI = 2.34-2.43). The adjusted odds ratios for loss of smell or taste slightly declined over time, while that for cough increased. CONCLUSION Cough, fever, loss of smell or taste, and muscle ache appear to be most strongly associated with a positive SARS-CoV-2 test in symptomatic people of the general population who were tested.
Collapse
Affiliation(s)
- Jizzo R. Bosdriesz
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Feiko Ritsema
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tjalling Leenstra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Mariska W. F. Petrignani
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Sylvia M. Bruisten
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Microbiology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja J. M. Schreijer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | | | - Maarten F. Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Amy A. Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
47
|
Theoharides TC. Could SARS-CoV-2 Spike Protein Be Responsible for Long-COVID Syndrome? Mol Neurobiol 2022; 59:1850-1861. [PMID: 35028901 PMCID: PMC8757925 DOI: 10.1007/s12035-021-02696-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 infects cells via its spike protein binding to its surface receptor on target cells and results in acute symptoms involving especially the lungs known as COVID-19. However, increasing evidence indicates that many patients develop a chronic condition characterized by fatigue and neuropsychiatric symptoms, termed long-COVID. Most of the vaccines produced so far for COVID-19 direct mammalian cells via either mRNA or an adenovirus vector to express the spike protein, or administer recombinant spike protein, which is recognized by the immune system leading to the production of neutralizing antibodies. Recent publications provide new findings that may help decipher the pathogenesis of long-COVID. One paper reported perivascular inflammation in brains of deceased patients with COVID-19, while others showed that the spike protein could damage the endothelium in an animal model, that it could disrupt an in vitro model of the blood-brain barrier (BBB), and that it can cross the BBB resulting in perivascular inflammation. Moreover, the spike protein appears to share antigenic epitopes with human molecular chaperons resulting in autoimmunity and can activate toll-like receptors (TLRs), leading to release of inflammatory cytokines. Moreover, some antibodies produced against the spike protein may not be neutralizing, but may change its conformation rendering it more likely to bind to its receptor. As a result, one wonders whether the spike protein entering the brain or being expressed by brain cells could activate microglia, alone or together with inflammatory cytokines, since protective antibodies could not cross the BBB, leading to neuro-inflammation and contributing to long-COVID. Hence, there is urgent need to better understand the neurotoxic effects of the spike protein and to consider possible interventions to mitigate spike protein-related detrimental effects to the brain, possibly via use of small natural molecules, especially the flavonoids luteolin and quercetin.
Collapse
Affiliation(s)
- Theoharis C Theoharides
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology, Tufts University School of Medicine, 136 Harrison Avenue, Suite 304, Boston, MA, 02111, USA.
- School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, 02111, USA.
- Departments of Internal Medicine and Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, MA, 02111, USA.
- Institute of Neuro-Immune Medicine, Nova Southeastern University, Clearwater, FL, 33759, USA.
| |
Collapse
|
48
|
Castro VM, Hart KL, Sacks CA, Murphy SN, Perlis RH, McCoy TH. Longitudinal validation of an electronic health record delirium prediction model applied at admission in COVID-19 patients. Gen Hosp Psychiatry 2022; 74:9-17. [PMID: 34798580 PMCID: PMC8562039 DOI: 10.1016/j.genhosppsych.2021.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To validate a previously published machine learning model of delirium risk in hospitalized patients with coronavirus disease 2019 (COVID-19). METHOD Using data from six hospitals across two academic medical networks covering care occurring after initial model development, we calculated the predicted risk of delirium using a previously developed risk model applied to diagnostic, medication, laboratory, and other clinical features available in the electronic health record (EHR) at time of hospital admission. We evaluated the accuracy of these predictions against subsequent delirium diagnoses during that admission. RESULTS Of the 5102 patients in this cohort, 716 (14%) developed delirium. The model's risk predictions produced a c-index of 0.75 (95% CI, 0.73-0.77) with 27.7% of cases occurring in the top decile of predicted risk scores. Model calibration was diminished compared to the initial COVID-19 wave. CONCLUSION This EHR delirium risk prediction model, developed during the initial surge of COVID-19 patients, produced consistent discrimination over subsequent larger waves; however, with changing cohort composition and delirium occurrence rates, model calibration decreased. These results underscore the importance of calibration, and the challenge of developing risk models for clinical contexts where standard of care and clinical populations may shift.
Collapse
Affiliation(s)
- Victor M. Castro
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Research Information Science and Computing, Mass General Brigham, 399 Revolution Drive, Somerville, MA 02145, USA
| | - Kamber L. Hart
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA
| | - Chana A. Sacks
- Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA 02114, USA
| | - Shawn N. Murphy
- Research Information Science and Computing, Mass General Brigham, 399 Revolution Drive, Somerville, MA 02145, USA,Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Roy H. Perlis
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA
| | - Thomas H. McCoy
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Corresponding author at: Simches Research Building, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114, USA
| |
Collapse
|
49
|
Chavda V, Jan AT, Yadav D. Mini-Review on SARS-CoV-2 Infection and Neurological Manifestations: A Perspective. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2021; 21:210-216. [PMID: 34967301 DOI: 10.2174/1871527320666210706103422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/09/2020] [Accepted: 05/31/2021] [Indexed: 01/08/2023]
Abstract
The coronavirus, also known as SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus-19), with its rapid rate of transmission, has progressed with a great impact on respiratory function and mortality worldwide. The nasal cavity is the promising gateway of SARS-CoV-2 to reach the brain via systemic circulatory distribution. Recent reports have revealed that the loss of involuntary process of breathing control into the brainstem that results in death is a signal of neurological involvement. Early neurological symptoms, like loss of smell, convulsions, and ataxia, are the clues of the involvement of the central nervous system that makes the entry of SARS-CoV-2 further fatal and life-threatening, requiring artificial respiration and emergency admission in hospitals. Studies performed on patients infected with SARS-CoV-2 has revealed three-stage involvement of the Central Nervous System (CNS) in the progression of SARS-CoV-2 infection: Direct involvement of CNS with headache, ataxia, dizziness, altered or impaired consciousness, acute stroke or seizures as major symptoms, peripheral involvement with impaired taste, smell, vision, and altered nociception, and skeletal muscle impairment that includes skeletal muscle disorders leading to acute paralysis in a particular area of the body. In the previous era, most studied and researched viruses were beta coronavirus and mouse hepatitis virus, which were studied for acute and chronic encephalitis and Multiple Sclerosis (MS). Although the early symptoms of SARS-CoV are respiratory pathogenesis, the differential diagnosis should always be considered for neurological perspective to stop the mortalities.
Collapse
Affiliation(s)
- Vishal Chavda
- Division of Anaesthesia, Dreamzz IVF Centre and Women\'s Care, Ahmedabad, Gujarat 382350, India
| | - Arif Tasleem Jan
- School of Biosciences & Biotechnology, Baba Ghulam Shah Badshah University, Rajaori, India
| | - Dhananjay Yadav
- Department of Medical Biotechnology, Yeungnam University, Gyeongsan 712-749, Korea
| |
Collapse
|
50
|
Richard SA, Pollett SD, Lanteri CA, Millar EV, Fries AC, Maves RC, Utz GC, Lalani T, Smith A, Mody RM, Ganesan A, Colombo RE, Colombo CJ, Lindholm DA, Madar C, Chi S, Huprikar N, Larson DT, Bazan SE, English C, Parmelee E, Mende K, Laing ED, Broder CC, Blair PW, Chenoweth JG, Simons MP, Tribble DR, Agan BK, Burgess TH. COVID-19 Outcomes Among US Military Health System Beneficiaries Include Complications Across Multiple Organ Systems and Substantial Functional Impairment. Open Forum Infect Dis 2021; 8:ofab556. [PMID: 34909439 PMCID: PMC8664684 DOI: 10.1093/ofid/ofab556] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background We evaluated clinical outcomes, functional burden, and complications 1 month after coronavirus disease 2019 (COVID-19) infection in a prospective US Military Health System (MHS) cohort of active duty, retiree, and dependent populations using serial patient-reported outcome surveys and electronic medical record (EMR) review. Methods MHS beneficiaries presenting at 9 sites across the United States with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test, a COVID-19-like illness, or a high-risk SARS-CoV-2 exposure were eligible for enrollment. Medical history and clinical outcomes were collected through structured interviews and International Classification of Diseases-based EMR review. Risk factors associated with hospitalization were determined by multivariate logistic regression. Results A total of 1202 participants were enrolled. There were 1070 laboratory-confirmed SARS-CoV-2 cases and 132 SARS-CoV-2-negative participants. In the first month post-symptom onset among the SARS-CoV-2-positive cases, there were 212 hospitalizations, 80% requiring oxygen, 20 ICU admissions, and 10 deaths. Risk factors for COVID-19-associated hospitalization included race (increased for Asian, Black, and Hispanic compared with non-Hispanic White), age (age 45-64 and 65+ compared with <45), and obesity (BMI≥30 compared with BMI<30). Over 2% of survey respondents reported the need for supplemental oxygen, and 31% had not returned to normal daily activities at 1 month post-symptom onset. Conclusions Older age, reporting Asian, Black, or Hispanic race/ethnicity, and obesity are associated with SARS-CoV-2 hospitalization. A proportion of acute SARS-CoV-2 infections require long-term oxygen therapy; the impact of SARS-CoV-2 infection on short-term functional status was substantial. A significant number of MHS beneficiaries had not yet returned to normal activities by 1 month.
Collapse
Affiliation(s)
- Stephanie A Richard
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Simon D Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Anthony C Fries
- US Air Force School of Aerospace Medicine, Wright-Patterson, Ohio, USA
| | - Ryan C Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Naval Medical Center San Diego, San Diego, California, USA
| | - Gregory C Utz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Naval Medical Center San Diego, San Diego, California, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Alfred Smith
- Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Rupal M Mody
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher J Colombo
- Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David A Lindholm
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Sharon Chi
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Nikhil Huprikar
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Derek T Larson
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | | | - Caroline English
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Edward Parmelee
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Paul W Blair
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Austere environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Josh G Chenoweth
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Austere environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Mark P Simons
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | |
Collapse
|