The Neurology® Resident & Fellow Section(RFS): Performance, Internationalization, and Recent Challenges

Objective: To (1) determine the proportion of international submissions and accepted manuscripts in the Neurology® Resident & Fellow Section (RFS);(2) identify the most popular subsections;(3) assess the impact of the COVID-19 pandemic and introduction of consent to disclose for case-based submissions. Background: The trainee-run Neurology® RFS was started in 2004. There have been several adjustments to expand the global reach of the RFS. However, recent changes from the COVID-19 pandemic and a new requirement for informed consent for all case-based manuscripts may negatively affect authors. Design/Methods: We analyzed submissions and acceptance rates by year and classified them by origin as US or international. We assessed whether the changes described above affected the overall submission rate (comparing 1.5 years before/after March 11, 2020 for COVID-19 and 6 months before/after new consent requirement). Results: Between 2005 and 2020, the RFS received 6,822 submissions and 6,522 (42% from US authors) were included in this analysis. Of them, 1,904 manuscript were accepted (51% from US authors). Over this period, acceptance rates declined from 67% to 17%. The proportion of manuscripts submitted from outside the US has increased from 50% (2004) to 61% (2020) (p<0.0001). Acceptance rates for US and international papers in 2005 were 73% and 60%, respectively (difference: 13.3%;95%-CI -19.5-21%). In 2020, they decreased to 20% and 15%, respectively (difference: 4.73%;95%-CI 0.09-9.59%). The most popular subsection was Teaching NeuroImages, constituting 39% and 58% of submissions from US and international authors, respectively. The number of submissions increased by 28% in the 18 months after COVID-19 was declared a global pandemic (1,594 vs. 1,241 in the preceding 18 months). After the consent requirements went into effect, we did not see a decline of submissions. Conclusions: The RFS has become increasingly international in terms of submissions, acceptance rate, and participation of members located outside the US.

Characterization and Analysis of Neurologic Adverse Events Associated with COVID-19 Vaccination

Objective: To characterize the incidence and spectrum of neurological adverse events (AE) after COVID-19 vaccination. Background: The devastating COVID-19 pandemic has led to 230 million people diagnosed and greater than 4.8 million deaths worldwide. Widespread vaccination efforts have resulted in administration of over 6 million vaccine doses to curb the significant health and socioeconomic impacts of the disease. While there are numerous reports of adverse events following COVID-19 vaccine, there is limited characterization of the spectrum of neurological AEs post-vaccination. Design/Methods: Data was gathered from the publicly available Vaccine Adverse Event Reporting System (VAERS), a passive reporting system not implying causality. Among individuals who received the J&J, Moderna, and Pfizer vaccines from 1/1/2021-6/14/2021, 314,610 adverse events were reported and these were reviewed by Neurology trained clinicians to determine the presence of various neurological AEs (40 conditions coded). Results: 306,473,169 COVID vaccine dose were administered in the USA during the study period with 314,610 total AEs (0.10%) and 105,930 neurological AEs (0.03%) reported. J&J vaccine was associated with the most AEs (17,670, 0.15%), followed by Moderna (42656, 0.03%) and Pfizer (42267, 0.03%). On average more events were reported in women (71%) and a majority occurred after the first dose (54%). < 1 events were reported per million vaccine doses for serious neurological conditions such as Bell's palsy (0.0007%), Guillain-Barre syndrome (0.00009%), cerebral venous thrombosis (0.00005%), transverse myelitis (0.00003%), and acute disseminated encephalomyelitis (0.00006%). Overall neurological complications following vaccine were drastically lower than complications post-COVID infection (14-80%). Conclusions: Adverse neurological events following COVID-19 vaccination are extremely rare and significantly less common than adverse neurological effects following SARS-CoV-2 infection. Current evidence suggests that along with being up to 100,000 times more likely to experience a major complication from COVID infection vs. vaccine, the risk of neurological complication is up to 5000 times more likely from infection itself.

Educating traineesthrough social media-The Resident and Fellow Section Social Media Initiative

Objective: To describe the use of social media by the Resident and Fellow Section (RFS) of Neurology to expand and engage readers in research and educational content. Background: Social media is used by medical journals to disseminate health research [1], a practice more common since the COVID-19 pandemic. Delivering educational materials and engaging readership through social media may also be used to educate trainees. Design/Methods: In January 2019, the RFS developed and implemented a strategy for disseminating educational materials through Instagram. The initiative expanded to Facebook and Twitter in January 2020 and February 2020, respectively. Each post highlighted a recent RFS publication, summarized the key teaching point, and included key images and/or videos when appropriate. In June 2020, posts were expanded to include interactive quizzes to maximize audience engagement. Posts were shared in the American Academy of Neurology's (AAN) social media accounts. Reach and readership engagement were measured by tracking social media account users and average engagement. Results: From January 2019 to October 2020, 70 posts were delivered across three social media platforms: 54 were Teaching (Video) NeuroImages, 6 Pearls and Oy-sters, 7 e-Pearls, 2 Mystery Cases, and 1 Child Neurology post. Over this time, social media followers increased on all platforms: 312.5% on Instagram, 12.9% on Twitter, 10% on Facebook. On Twitter, there was an increase in impressions (74.5%), engagements (121%), and post link clicks (38.7%). On Facebook, there was a 34.6% increase in total engagements. Overall, teaching Video NeuroImages produced the highest level of engagement. Posts with polls and/or quizzes were well received by audience on all platforms and also received high levels of participation. Conclusions: The RFS successfully used social media to increase visibility of trainee publications and deliver educational content. Content with interactivity (e.g., quizzes) and that included patient videos tended to produce the most engagement.

Asymptomatic olfactory dysfunction in nonintubated patients with moderate and severe COVID-19

Objective: To evaluate the frequency of asymptomatic olfactory dysfunction (OD) in nonintubated patients with moderate and severe coronavirus disease 2019 (COVID-19). Background: Many patients with COVID-19 reported OD. However, most studies relied on selfreported data. A few studies have recently used olfactory psychophysical assessment tools, but it is difficult to implement such strategies in a real-life setting. Asymptomatic OD (aOD) has been anecdotally reported during the early stages of COVID-19. Nevertheless, there is currently no study focusing on the prevalence of OD clinically identified through a typical neurologic examination in those patients with COVID-19 who denied this symptom during history taking. Design/Methods: Adult inpatients at the Hospital Juárez de México (Mexico City) were recruited if they were nonintubated and SARS-CoV-2 was detected by real-time RT-PCR in any biological specimen. Olfactory function was assessed using a widely known technique in general neurologic practice. Standard definitions were also taken from the same authoritative source. COVID-19 severity was classified according to Gandhi et al (2020). Results: 23 patients (10 women) were included. The mean age was 45.7±13.6 years. Only five patients reported OD during history taking. Of those who denied this symptom (n = 18), any OD was identified in 8 patients through neurologic examination (44.4%). Two of these patients with aOD reported taste impairment during focused history taking. No differences according to gender were found in OD identified through neurologic examination. OD prevalence increased from 21.7% using history taking alone to 56.5% with the addition of a standard neurologic examination (difference: 34.7%;P = 0.007). Conclusions: In daily practice, simply asking for OD may not be enough to detect this impairment in nonintubated patients with moderate and severe COVID-19. If these findings can be replicated in further studies, consideration should be given to modify our current screening strategies for OD during the COVID-19 pandemic.

Mexican registry of neurologic manifestations in patients with confirmed COVID-19: Preliminary results

Objective: To describe the neurologic manifestations and complications of Mexican patients with confirmed coronavirus disease 2019 (COVID-19). Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed to have reached Mexico in February 2020. At present, Mexico is one of the most affected countries by the pandemic of COVID-19 worldwide. In the first months of the pandemic, only a few Mexican studies on COVID-19 had been reported. Scarce national data limited our understanding of the unique nuances that may occur in our setting and hindered the interpretation of evidence from other countries in the local context. Design/Methods: In March 2020, the Mexican Academy of Neurology (MAN) launched a national registry to have a clearer picture of the full spectrum of neurologic manifestations and complications of COVID-19 in Mexican patients. This online registry was available to all MAN members. Only patients with SARS-CoV-2 detected by real-time RT-PCR were included in this analysis. Results: At the end of August 2020, 89 patients (31 women, 34.8%) have been included. Their mean age was 50.5±18.8 years. Most cases were reported in central and southern regions (96%). Most patients showed respiratory symptoms (87%) and were admitted to hospital (88%). Among severe neurologic manifestations, vascular etiologies were the most commonly reported: ischemic stroke (n=17), intraparenchymal hemorrhage (n=6), and subarachnoid hemorrhage (n=4). Olfactory and gustatory dysfunctions were reported in 34 and 26 patients. Headache and delirium were reported in 54 and 18 patients. 7 patients had seizures. Meningitis and encephalitis were reported in 2 and 5 patients. 5 cases of Guillain-Barré syndrome were reported;three of them were classified as axonal variants. Neurologic sequelae were reported in 30 patients (33%). 19 (21%) patients died. Conclusions: In this nationwide registry, one in five patients with COVID-19 and neurologic manifestations died. Cerebrovascular insults were the most common severe neurologic manifestations.

Neurological manifestations in coronavirus disease 2019

Coronavirus disease 2019 (COVID-19), an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently hitting the world in the form of a pandemic. Given that some reports suggest that this infection can also occur with neurologic manifestations, this narrative review addresses the basic and clinical aspects concerning the nervous system involvement associated with this disease. More than one third of patients hospitalized for COVID-19 can present with both central and peripheral neurological manifestations. The former includes dizziness and headache, while the latter includes taste and smell disturbances. Other reported neurological manifestations are cerebrovascular disease and epileptic seizures. According to published reports, neurological disorders are not uncommon in COVID-19 and can sometimes represent the first manifestation of the disease;therefore, neurologists should consider this diagnostic possibility in their daily practice. Since maybe not all COVID-19 neurological manifestations are due to SARS-CoV-2 direct effects, it is important to monitor the rest of the clinical parameters such as, for example, oxygen saturation. Similarly, follow-up of patients is advisable, since whether neurological complications may develop lately is thus far unknown.