Effect of Pre-exposure Use of Amantadine on COVID-19 Infection: A Hospital-Based Cohort Study in Patients With Parkinson's Disease or Multiple Sclerosis.

Background: Amantadine has been proposed to inhibit E-channel conductance in reconstituted lipid bilayers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to study whether patients on amantadine have altered risks of contracting COVID-19 infection. Methods: We conducted a hospital-based, observational, retrospective cohort study using data for patients on amantadine supported by data given by the patients through an online questionnaire. We included registered amantadine users in our hospital for 6 months or more on March 1, 2020, and non-amantadine users to act as the control group. We used forced entry, multiple logistic regression models to estimate adjusted ORs for amantadine adjusting for the confounders. Findings: Between September 1, 2019, and March 1, 2020, 212 patients with Parkinson's disease (PD) or multiple sclerosis (MS) received greater than one equal to two prescriptions of amantadine. We selected a random sample of diagnoses which matched 424 patients of non-amantadine users (1:2) as a control group (424 patients). Between March 1, 2020, and March 1, 2021, 256 patients responded to our online questionnaire, 87 patients were on amantadine (group I), and 169 patients were not (control group, group II). COVID-19 disease infection proved to be 5.7 and 11.8% in group I and II patients, respectively. Increased odds of COVID-19 in multivariable-adjusted models were associated with old age and history of contact with COVID cases. Amantadine was associated with a significantly reduced risk of COVID-19 disease infection (adjusted OR 0.256, 95% CI 0.074-0.888). Interpretation: Amantadine is associated with a reduced risk of COVID-19 infection after adjusting for a broad range of variables. History of contact with COVID cases and old age are risk factors for COVID-19 infection. Therefore, we recommended randomized clinical trials investigating amantadine use for the prevention of COVID-19.

Unexplained worsening of parkinsonian symptoms in a patient with advanced Parkinson's disease as the sole initial presentation of COVID-19 infection: a case report.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative condition that has been reported following viral infections in rare occasions. Several neurological complications have emerged in association with coronavirus disease 2019 (COVID-19), since its declaration as a pandemic. Herein, we present a novel case of unexplained worsening of PD as the sole initial presentation of COVID-19, in the absence of fever or respiratory symptoms. CASE PRESENTATION: A 56-year-old male with advanced PD presented with severe rigidity, dystonic posturing of both feet, and confusion of 4 days duration. His condition progressed to an akinetic-rigid state and confusion during the following week, and a routine nasopharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the 9th day of onset. He developed fever and dyspnea later and was intubated on the 10th day. CONCLUSION: To our knowledge, worsening of PD symptoms as the sole initial manifestation of SARS-CoV-2 infection, in the absence of other cardinal features of COVID-19, has not been reported in the literature. We suggest testing for COVID-19 infection in patients with PD, especially advanced cases, who present with unexplained worsening of symptoms, even in the absence of COVID-19 cardinal features.

Physicians' attitude towards webinars and online education amid COVID-19 pandemic: When less is more.

BACKGROUND: Since the declaration of COVID-19 as a pandemic, all scientific medical activities were shifted to an online format, in the form of webinars, to maintain continuing medical education (CME). We aimed to assess physicians' attitude among different medical specialties towards this sudden and unexpected shift of traditional face-to-face meetings into webinars, and to suggest future recommendations. METHODS: We conducted a cross-sectional, internet-based survey study using a 25-item questionnaire, from November 1 and November 15, 2020. The survey was created and distributed to physicians from different medical and surgical specialties and from different countries via several social media platforms, using a snowball technique. RESULTS: A total of 326 physicians responded; 165 (50.6%) were females, mean age of responders was 38.7 ± 7.5 years. The majority of responses (93.2%) came from Arab countries. Of them, 195 (59.8%) reported attending more webinars compared to the same period last year, with average of 3 per month. As regard to the general impression; 244 (74.8%) were "strongly satisfied" or "satisfied", with the most satisfaction for "training courses: by 268 (82.2%), and "International conferences" by 218 (66.9%). However, 246 respondents (75.5%) felt overwhelmed with the number and frequency of webinars during the pandemic, 171 (52.5%) reported attending less than 25% of webinars they are invited to, 205 (62.8%) disagreed that webinars can replace in-person meetings after the pandemic, and 239 (73.3%) agreed that online meetings need proper regulations. CONCLUSIONS: Webinars comprised a major avenue for education during COVID-19 pandemic, with initial general satisfaction among physicians. However, this paradigm shift was sudden and lacked proper regulations. Despite initial satisfaction, the majority of physicians felt overwhelmed with the number and frequency of webinars. Physicians' satisfaction is crucial in planning future educational activities, and considering that this current crisis will most likely have long lasting effects, webinars should be viewed as complementing traditional in-person methods, rather than replacement. In this study, we are suggesting recommendations to help future regulation of this change.

Association of COVID-19 Pandemic and Rate of Cognitive Decline in Patients with Dementia and Mild Cognitive Impairment: A Cross-sectional Study.

Introduction: Since the declaration of coronavirus disease 2019 (COVID-19) as a pandemic, patients with dementia, were specifically vulnerable to the negative impact of the outbreak. Objective: To examine the association between lockdown amid COVID-19 pandemic and the rate of cognitive decline among patients with dementia and mild cognitive impairment (MCI). Methods: We conducted a cross-sectional observational study on patients with dementia and MCI who attended the outpatient clinic at Ibn Sina Hospital, the main tertiary neurology center in Kuwait, during the month of September 2020. The rate of cognitive decline, estimated by MMSE scores, was compared between the period prior to, and during lockdown. Results: We evaluated 36 consecutive patients with cognitive impairment (23 females [63.9%], mean age 71 ± 10.8 years, mean disease duration 34.6 ± 29 months). Eleven patients (30.6%) progressed to a more severe stage during the study period; 1 MCI (2.8%) converted to mild dementia, 6 (16.6%) mild to moderate, and 4 (11.1%) moderate to severe dementia. Monthly decline of MMSE scores before lockdown was 0.2 ± 0.1 points, while it was 0.53 ± 0.3 points during lockdown, which was statistically significant (p = .001). The most affected cognitive domain was the memory with a mean decline of 1.5 ± 0.8 points. Conclusions: This study provides "real-world" data suggesting rapid cognitive decline in patients with dementia during the lockdown period. Healthcare systems should pay more attention to this vulnerable group, to help them maintain their mental, physical and social well-being during this crisis.

Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study.

BACKGROUND: Since the declaration COVID-19 as a pandemic, healthcare systems around the world have faced a huge challenge in managing patients with chronic diseases. Patients with migraine were specifically vulnerable to inadequate medical care. We aimed to investigate the "real-world" impact of COVID-19 pandemic on migraine patients, and to identify risk factors for poor outcome. METHODS: We administered an online, self-reported survey that included demographic, migraine-related, COVID-19-specific and overall psychosocial variables between July 15 and July 30, 2020. We recruited a sample of patients with migraine from headache clinic registry and via social media to complete an anonymous survey. Outcomes included demographic variables, change in migraine frequency and severity during the lockdown period, communication with treating physician, compliance to migraine treatment, difficulty in getting medications, medication overuse, symptoms of anxiety and/or depression, sleep and eating habits disturbance, screen time exposure, work during pandemic, use of traditional medicine, effect of Botox injection cancellation, and overall worries and concerns during pandemic. RESULTS: A total of 1018 patients completed the survey. Of the respondents, 859 (84.3%) were females; 733 (71.9%) were aged 20 to 40 years, 630 (61.8%) were married, and 466 (45.7%) reported working during the pandemic. In comparison to pre-pandemic period, 607 respondents (59.6%) reported increase in migraine frequency, 163 (16%) reported decrease in frequency, and 105 (10.3%) transformed to chronic migraine. Severity was reported to increase by 653 (64.1%) respondents. The majority of respondents; 626 (61.5%) did not communicate with their neurologists, 477 (46.9%) reported compliance to treatment, and 597 (58.7%) reported overuse of analgesics. Botox injections cancellation had a negative impact on 150 respondents (66.1%) from those receiving it. Forty-one respondents (4%) were infected with COVID-19; 26 (63.4%) reported worsening of their headaches amid infection period. Sleep disturbance was reported by 794 (78.1%) of respondents, and 809 (79.5%) reported having symptoms of anxiety and/or depression. CONCLUSIONS AND RELEVANCE: COVID-19 pandemic had an overall negative impact on patients with migraine. Several risk factors for poor outcome were identified. Long-term strategies should be validated and implemented to deliver quality care for patients with migraine, with emphasis on psychosocial well-being.