Neurological Manifestation in Hospitalized Patients With Acute SARS-CoV-2 Infection

OBJECTIVE

The main objective of this research is to determine the prevalence and characteristics of neurological manifestations in hospitalized patients with SARS-CoV-2 infection.

METHODS

A cross-sectional study was conducted. 572 hospitalized patients at the COVID Department of Pulmonology of the Mostar University Clinical Hospital in the six-month period from October 31, 2020, to April 30, 2021, were included. We analyzed the incidence of neurological manifestations and the influence of comorbidities and metabolic syndrome on stroke incidence in COVID-19 patients. We analyzed hospital length of stay and mortality in patients with and without neurological manifestations. The research was conducted with respect to all the determinants of the Helsinki Declaration.

RESULTS

572 patients, 351 men (61.4%), and 221 women (38.6%) were included. A fatal outcome was present in a quarter of patients (25.3%). Neurological manifestations were found in 163 patients (28.5%). Myalgia was the most common (16.1%). The following were reported: headache (9.6%), loss of taste (7.34%), loss of smell (6.8%), and vertigo (2.5%). There was a significant difference regarding loss of smell between males and females (p=0.04). The cerebrovascular incident was present in 2.97% of patients and was more frequent in the group of patients with metabolic syndrome. Patients with neurological manifestations had a longer hospital stay, but it was not statistically significant (p=0.9319). The presence of neurological manifestations in general did not influence the mortality rate.

CONCLUSION

Patients with SARS-CoV-2 infection can present with neurologic findings such as myalgia, headache, loss of smell or taste, vertigo, as well as cerebrovascular incidents. Patients with neurological manifestations had longer hospital stays, but the presence of neurological manifestations in general did not influence the mortality rate.

Multimorbidity and Its Effect on Self-Reported Adverse Effects Following COVID-19 Vaccination

Introduction The coronavirus disease 2019 (COVID-19) vaccination has been suggested for those with comorbidities, although there are concerns regarding the vaccine's safety. This study aimed to compare the severity and incidence of post-vaccination side effects in people with and without comorbidities. Another aim of this study was also to look for the effect of multimorbidity on adverse events. Methods This observational study was conducted from November 2021 to February 2022. Data were collected from all over Pakistan using a self-administered online questionnaire that inquired about the subject's demographic, clinical, and COVID-19 vaccination profiles. Data analysis was done by using SPSS software version 22.0. (Chicago, IL, IBM Corp.). Results A total of 421 participants were included in the study, and 31.4% of individuals had underlying comorbidity. The overall mean age was 33 years (range: 13-85 years). This study included recipients of all major types of COVID-19 vaccines being used in Pakistan. Only 67.4% of the subjects had only underlying comorbidity, and hypertension was the most common one out of all comorbidities. Participants with comorbidities were not at a greater risk to produce vaccine-related adverse events when compared to those with no comorbidities. Comorbidity was also found to be statistically non-significant to the severity of the side effects. Only one subject with comorbidity produced a side effect and required hospitalization. Multimorbidity was not associated with a greater incidence of side effects. Multimorbidity was not significantly linked with the severity of the adverse effects, except muscle pain (p<0.05) and breathlessness (p<0.05). Conclusion It can be concluded that comorbidities do not affect the COVID-19 vaccine's reactogenicity but studies on an extensive scale should be conducted regarding individuals with multiple pre-existing comorbidities.

Fatality Chooses Its Path Through the Orbit: A Study of Rhino-Orbito-Cerebral Mucormycosis as a Complication of COVID-19 Infection

Introduction and aim Mucormycosis is a rare but serious angio-invasive infection caused by a group of fungi called mucormycetes and it mainly affects people who are immunocompromised, or patients already infected with other diseases. The dreaded mucormycosis infection has recently gained gross ill-repute for having claimed many lives in coronavirus disease (COVID-19) and/or post-COVID-19 patients. Hence a need was felt to study the development of mucormycosis in COVID-19 patients to better prevent and treat this fungal infection in anticipated future waves of the pandemic. This study also aims to establish an association between COVID-19 positivity, systemic comorbidities, and treatment modalities with the possibility of occurrence of vision and life-threatening mucor infection of the nose, paranasal sinuses, orbit, and brain. Methods This is a hospital-based, retrospective, case-control study. The study reviewed case files of all patients diagnosed with rhino-orbito-cerebral mucormycosis (ROCM) from April 1, 2021, to May 31, 2021. A set of age-matched COVID-19-positive patients hospitalized during the study period with moderate to severe disease were recruited as controls. We addressed factors that could be associated with the development of fungal infection and studied the period between COVID-19 positivity and the onset of ROCM. Results The age of patients in both groups ranged from 40-60 years with 13 females and 17 males. A statistically significant correlation (p-value = 0.032) was found between positive reverse transcription-polymerase chain reaction (RT-PCR) history and use of intravenous (IV) corticosteroids (11 [73.3%] cases and all controls). The mean duration from COVID-19 positivity to the presentation of mucormycosis was 12.10±7.27 days. Uncontrolled blood sugar was found to be the most significant correlation (p-value = 0.003). Mucormycosis is 13.678 times more likely in people with abnormal hemoglobin A1c (HbA1c). Co-morbidities like anemia, chronic kidney disease (CKD), coronary artery disease (CAD), and leukemia were found in controls, but none of these conditions were seen in patients who developed mucormycosis. Conclusion Judicious use of steroids and strict control of blood sugar levels should be emphasized in the management of COVID-19 patients.

Efficacy of Bamlanivimab in Reducing Hospitalization and Mortality Rates in COVID-19 Patients in a Rural Community

Objective

In this study, we aimed to evaluate the association between the monoclonal antibody infusion, bamlanivimab, and a reduction in 30-day hospitalization and mortality rates in patients with coronavirus disease 2019 (COVID-19) in a rural community setting with various comorbidities.

Methodology

A retrospective data analysis was conducted over a 60-day period for patients who visited the Emergency Department of a community hospital. A group of COVID-19-positive patients who received bamlanivimab was compared with another group of COVID-19 patients with similar characteristics, demographics, and disease severity who did not receive the infusion. Data for 30-day hospitalization rates were analyzed using odds ratio for various individual comorbidities. Fisher’s exact test was used to analyze chronic kidney disease (CKD) and mortality. Logistic regression analysis and subsequent odds ratio estimates were used to adjust for demographics and comorbidities and evaluate for the association of bamlanivimab infusion with 30-day hospitalization rates.

Results

A total of 144 patients were included in the bamlanivimab group and 140 patients in the non-bamlanivimab group of COVID-19 patients. When analyzed by comorbidity using odds ratio analysis, 10.3% of diabetic patients, 6.1% of obese patients, 8% of hypertensive patients, and none of the patients with CKD required hospitalization at 30 days from the initial visit in the bamlanivimab group in contrast to 35.2% of diabetic patients, 38.1% of obese patients, 33.9% of hypertensive patients, and 63.6% of patients with CKD in the non-bamlanivimab group. Logistic regression analysis with odds ratio estimates showed that when adjusted for demographics and various comorbidities, bamlanivimab infusion was associated with decreased hospitalization (p < 0.001; confidence interval [CI] = 0.017-0.135). However, using logistic regression and taking all variables into account, among the evaluated comorbidities, only hypertension was found to be individually associated with decreased hospitalization (p = 0.0174; CI = 0.140-0.827) along with younger age (p = 0.0023; CI = 1.017-1.080) and female gender (p = 0.0077; CI = 0.212-0.789). We could not establish mortality benefit in the subgroups.

Conclusions

Based on the results of this study, there is an association between bamlanivimab use and reduced hospitalization rates in COVID-19 patients.