The impact of COVID 19 on the outcomes of thrombectomy in stroke patients: A systematic review and meta-analysis.

We aimed to conduct the current meta-analysis to provide better insight into the efficacy of mechanical thrombectomy (MT) in managing COVID-19 patients suffering from a stroke. An electronic search was conducted through eight databases for collecting the current evidence about the efficacy of MT in stroke patients with COVID-19 until 18 December 2021. The results were reported as the pooled prevalence rates and the odds ratios (ORs), with their corresponding 95% confidence intervals (CI). Out of 648 records, we included nine studies. The prevalence of stroke patients with COVID-19 who received MT treatment was with TICI ≥2b 79% (95%CI: 73-85), symptomatic intracranial haemorrhage 6% (95%CI: 3-11), parenchymal haematoma type 1, 11.1% (95%CI: 5-23), and mortality 29% (95%CI: 24-35). On further comparison of MT procedure between stroke patients with COVID 19 to those without COVID-19, we found no significant difference in terms of TICI ≥2b score (OR: 0.85; 95%CI: 0.03-23; p = 0.9). However, we found that stroke patients with COVID-19 had a significantly higher mortality rate than stroke patients without COVID-19 after MT procedure (OR: 2.99; 95%CI: 2.01-4.45; p < 0.001). Stroke patients with COVID-19 can be safely and effectively treated with MT, with comparable reperfusion and complication rates to those without the disease.

Changes in physical activity during COVID-19 pandemic among Saudi Arabians: Results from a cross-sectional study.

Background and Aims: The COVID-19 pandemic and the resultant change in sedentary behaviors have had immense health, economic, and social implications globally. As governments worldwide imposed lockdowns and curfews, the amount of time spent indoors greatly increased. This lead to a dramatic change in physical activity (PA) levels and profound consequences on daily routines. Our study aimed to investigate patterns of PA during the COVID-19 pandemic among adults residing in Saudi Arabia. Methods: This cross-sectional survey-based study aimed to investigate patterns of PA during the COVID-19 pandemic among adults residing in Saudi Arabia. The International Physical Activity Questionnaire was utilized to measure participants' PA levels between April 2021 and May 2021. Participants were then classified into three groups according to their PA level, and their PA levels and sedentary behaviors were analyzed. Results: We surveyed 463 participants, 315 (68%) of which were female and 134 (32%) of which were male with a median age of 23 (interquartile range, 21-35) years. Moderate-to-high PA was reported by 257 (55.7%) of the participants. There was a significant decrease in PA during the COVID-19 pandemic and resultant lockdowns among the participants (p = 0.04), with higher rates of sedentary behavior among males than females (p = 0.14). Conclusions: The decline in PA is a profound challenge of the COVID-19 pandemic that needs to be addressed by health practitioners and policymakers. Our study highlights the decline in PA levels seen during the COVID-19 pandemic and the importance of promotional programs and interventions to increase PA among the Saudi Arabian population without compromising the essential health restrictions and social distancing.

A Definitive Prognostication System for Patients With Thoracic Malignancies Diagnosed With Coronavirus Disease 2019: An Update From the TERAVOLT Registry.

INTRODUCTION: Patients with thoracic malignancies are at increased risk for mortality from coronavirus disease 2019 (COVID-19), and a large number of intertwined prognostic variables have been identified so far. METHODS: Capitalizing data from the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry, a global study created with the aim of describing the impact of COVID-19 in patients with thoracic malignancies, we used a clustering approach, a fast-backward step-down selection procedure, and a tree-based model to screen and optimize a broad panel of demographics and clinical COVID-19 and cancer characteristics. RESULTS: As of April 15, 2021, a total of 1491 consecutive eligible patients from 18 countries were included in the analysis. With a mean observation period of 42 days, 361 events were reported with an all-cause case fatality rate of 24.2%. The clustering procedure screened 73 covariates in 13 clusters. A further multivariable logistic regression for the association between clusters and death was performed, resulting in five clusters significantly associated with the outcome. The fast-backward step-down selection procedure then identified the following seven major determinants of death: Eastern Cooperative Oncology Group-performance status (ECOG-PS) (OR = 2.47, 1.87-3.26), neutrophil count (OR = 2.46, 1.76-3.44), serum procalcitonin (OR = 2.37, 1.64-3.43), development of pneumonia (OR = 1.95, 1.48-2.58), C-reactive protein (OR = 1.90, 1.43-2.51), tumor stage at COVID-19 diagnosis (OR = 1.97, 1.46-2.66), and age (OR = 1.71, 1.29-2.26). The receiver operating characteristic analysis for death of the selected model confirmed its diagnostic ability (area under the receiver operating curve = 0.78, 95% confidence interval: 0.75-0.81). The nomogram was able to classify the COVID-19 mortality in an interval ranging from 8% to 90%, and the tree-based model recognized ECOG-PS, neutrophil count, and c-reactive protein as the major determinants of prognosis. CONCLUSIONS: From 73 variables analyzed, seven major determinants of death have been identified. Poor ECOG-PS was found to have the strongest association with poor outcome from COVID-19. With our analysis, we provide clinicians with a definitive prognostication system to help determine the risk of mortality for patients with thoracic malignancies and COVID-19.

Vitamin D and its' role in Parkinson's disease patients with SARS-CoV-2 infection. A review article.

A novel coronavirus reportedly called 2019-nCoV started to spread around the world at the end of 2019. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was later renamed after links with SARS were observed. Multiple studies have reported possible connections between the COVID-19 virus and neurodegenerative diseases, including Parkinson's disease. Theories support that vitamin D deficiency plays a part in the pathogenicity of Parkinson's disease or the credibility of the associated dopamine system. Administration of vitamin D3 was shown to significantly enhance the motor and non-motor manifestations of Parkinson's disease and enhance the quality of life. Also, multiple recent reviews have shown specific ways in which vitamin D reduces the risk of pathogenic infections. Recent studies supported the potential role of vitamin D in reducing the risk of COVID-19 infections and mortality. On the immunological level, immune response regulation remains one of the well-recognized actions of vitamin D. Vitamin D deficiency has been linked to complications in patients with SARS-CoV-2 infection and Parkinson's disease. Whereas more studies are required, Vitamin D supplementation with a moderate and well-calculated dosage of vitamin D3 in patients with Parkinson's disease can help minimize the risk and burden of COVID-19 complications.

Optic neuritis post-COVID-19 infection. A case report with meta-analysis.

BACKGROUND: In December 2019, a global pandemic of Coronavirus 2019 (COVID-19) has invaded entire the world. The virus associated with the COVID-19 infections is SARS-CoV-2; the infections are mainly pulmonary manifesting as severe respiratory complications such as acute respiratory distress syndrome. However, there are some extra-pulmonary manifestations that are reported to be associated with SARS-CoV-2 from the published literature. We aim to report a case manifested as post-COVID-19 optic neuritis, in addition to make a quantitative analysis (meta-analysis) for the published similar case reports around the world. METHODS: We followed CARE guidelines for case reports. Also, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. CASE PRESENTATION: A 32-year-old male patient with no previous relevant medical history, presented to the ophthalmology clinic in a tertiary hospital. He complained of a sudden drop of vision in his left eye, throbbing left sided headaches, central scotoma, color depth affection, elevated intra-ocular pressure; two weeks post-COVID-19 infection. RESULTS: Post-COVID optic neuritis is a possible neurological complication of the novel coronavirus infection. It was shown that females were more affected by optic neuritis and retinal complications, the left eye is more liable to drop of visual acuity post-COVID-19 infection; while there was no significant difference between both eyes regarding accompanied vision loss or blindness. CONCLUSIONS: Optic neuritis either unilateral or bilateral could be one of the possible viral manifestations after COVID-19 infection.

Impact of COVID-19 on neurosurgical service: A one-year experience from a provincial countryside hospital in a rural area in north Egypt.

BACKGROUND: Globally, there is a shooting pandemic that affected many healthcare systems. Healthcare facilities had to set up strategies to avoid exhaustion while facing a catastrophic health problem. Vaccines or perfect therapies were not available over a long pandemic time and also no certified immunity against that disease is guaranteed. Therefore, it is probable that healthcare systems will face it for an exceptionally long period. That already had a grave effect on the strategy of daily practice of different specialties' services at healthcare centers. METHODS: We tried simply to share a countryside hospital's expertise in managing neurosurgical cases amid a dreadful health crisis. Healthcare workers' safety and patient safety were typical priorities for neurosurgical service at Damietta Specialized Hospital. We expose the lines of management, triaging cases, the methods of handling confirmed and suspected neurosurgical patients, and strategies for discharging and following up patients. We identified hospital admission and discharge records starting from February 2020 till February 2021 to track the neurosurgical case burden, the state of service offered and the rate of infection among healthcare workers who participated in surgeries. RESULTS: At the peak time of the COVID­19 pandemic in Egypt starting from February 2020 till February 2021, we have admitted about 500 neurosurgical patients. About 400 (80%) of them did surgeries according to the triaging protocol of the hospital. About 150 (30%) of those who did surgeries were urgent and the rest were borderline or semi­urgent. About 20 (4%) were tested COVID-19 positive and six of them died due to acute respiratory distress syndrome. Only two mortality cases were reported due to post-operative complications and not related to SARS­CoV­2 infection. The rest of the cases (97.6%) were discharged for follow­up without complications. No neurosurgeons but three anesthesia staff were infected with SARS­CoV­2. A successful undisturbed neurosurgical care was available for patients during COVID-19 time. CONCLUSIONS: Following the suggested strategies, a rural area-serving hospital managed to provide uninterrupted neurosurgical care amid COVID-19 pandemic in Egypt. Rural areas in developing countries are in need of strategies to deal with pandemics in the future without dismantling the normal health system, especially for life­saving cases in a critical specialty as neurosurgery.

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

BACKGROUND: COVID-19 infection has spread so fast in both low- and high-income countries. In December 2019, an outbreak of a respiratory disease occurred in China, and later, it involved different countries. Acute neurological insults are more likely to occur in severely infected patients. METHODS: We tried to evaluate patients with selective criteria including, the age of participants 18 and older with a confirmed diagnosis of SARS-CoV-2, and developed neurological complications post COVID-19 infection. An overall data of 1500 patients were collected from neurological and primary health care departments. About 970 of them had neurological problems. Patients-related data were gathered and assembled from the patients' records at participating hospitals from the Ministry of Health and university hospitals. RESULTS: We presented the results according to several variables including, regional distribution, reasons of presentation, neurological complications, follow-ups, and survival outcome. CONCLUSIONS: To our knowledge, we conducted the first retrospective analysis for neurological problems related to COVID-19 infection in Egypt. COVID-19 patients present with a variety of central and peripheral neurological symptoms, the pathogenic mechanisms of which have not been explained. Robust investigations of the neurological presentations of COVID-19 infection should be recruited for better understanding of the possible association. Moreover, further explaining the pathophysiologic mechanisms will help in designing proper treatment plans.

Analyzing outcomes of neurosurgical operations performed before and during the COVID-19 pandemic in Egypt. A matched single-center cohort study.

BACKGROUND: Since the emergence of the first COVID-19 case in Wuhan, the virus affected several health care systems. Globally, the COVID-19 has a transforming effect on health care provision. Substantial evidence was clear that the global surgical services were impacted. The field of neurosurgery was primarily affected, and most elective surgeries were suspended. There are no current reports from Egypt that describe the mortality outcome of neurosurgical procedures in the context of the pandemic. METHODS: We performed that study at a large tertiary center in Egypt (Cairo University Hospital). It is a single-center matched cohort study. RESULTS: Our results examined about 346 patients earlier during the COVID-19 pandemic. About 46 (13.29%) were unmatched, so we excluded them from the final analysis of the data. About 300 patients' were matched to 304 patients' before the pandemic in 2019. The mortality outcome of neurosurgical interventions was higher during the pandemic. CONCLUSIONS: Amid the COVID-19 pandemic, the mortality outcome of neurosurgical procedures was higher than on regular days at our center. The anesthesia time was prolonged while the operation time was shortened. We strongly suggest further multicenter studies to assess the effect of COVID-19 on neurosurgical mortality and functional outcome.

Impact of COVID-19 pandemic on the management of glioma patients around the world. An evidence-based review.

BACKGROUND: The coronavirus pandemic has affected many health care services worldwide since the emergence of the first case in Wuhan. Surgical neuro-oncology care is a fundamental part of hospital services, making it susceptible to strategic changes amid the COVID-19 pandemic. METHODS: An electronic search on several databases (PubMed/Medline, Scopus, and Google Scholar) from the beginning of the pandemic to the end of 2020, each paper was reviewed independently. The publication inclusion and exclusion criteria were done using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. RESULTS: Eight studies were found to be eligible for our meta-analysis. Most of the studies were on a retrospective basis, except one which was retrospective and prospective. An overall of 951 glioma patients' were included for surgical admission from the beginning of the pandemic until 2020. Seventy-four patients' had mortality outcomes, and 250 patients had complications for both surgical admitted and non-surgical admitted purposes. CONCLUSIONS: To our knowledge, we made the first systematic review and meta-analysis regarding the management of glioma patients' during the pandemic of COVID-19. Our main findings are that the number of surgical admissions for glioma patients' did not significantly differ between COVID-19 negative and COVD-19 positive cases; however, surprisingly, we found that both overall complications and mortality outcomes were more significant COVID-19 negative patients' from the reported studies.

SARS-CoV-2 associated viral encephalitis with mortality outcome.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) appeared in Wuhan, China, in December 2019; apart from common conditions such as cough, fever, and severe respiratory complications, difficulty in breathing, including tachypnea, new studies on neurological manifestations have gained public interest. CASE REPORT: An 89-year-old man was admitted to the neurocritical care department in a specialized hospital with headache, dizziness, hyperpyrexia, myalgia, rash, and tremors. MRI showed viral encephalitis near to basal ganglia and thalami. DISCUSSION: Coronaviruses interfere with target cells by membrane-bound spike proteins. Angiotensin-converting enzyme 2 was identified as an input receptor for SARS-CoV-2. Due to its wide pattern of expression, COVID-19 was shown to affect several organs, including the central nervous system, where the receptor is mainly expressed as neurons. CONCLUSIONS: In the current pandemic, there is a rising number of global infections, the aim of our case to increase the awareness about SARS-CoV-2 possible complications, even if there are possible further mutations for the virus, especially in the central nervous system.