Prevalence of neurological manifestations in COVID-19 and their association with mortality

Introduction: Articles published in the literature report neurological manifestations or "complications" of SARS-CoV-2 infection and conclude that the different neurological manifestations are relatively similar, but with different frequencies. This study aimed to determine the frequency of neurological manifestations of COVID-19 and to identify which are associated with mortality. Method(s): We performed a retrospective study of all patients diagnosed with SARS-CoV-2 infection by RT-PCR at Hospital 1degree de Octubre, in Mexico, from the beginning of the pandemic to 22 December 2020. A total of 561 patients were identified, 370 of whom presented neurological manifestations. Result(s): The global mortality rate was 37.8% (140/370), increasing to 92.4% among intubated patients (135/146). Of the 370 patients included, approximately 20% of neurological symptoms (headache, neurological impairment, anosmia, ageusia) accounted for 80% of cases of neurological manifestations. Conclusion(s): At our hospital, 80% of the patients with neurological manifestations of COVID-19 presented headache, neurological impairment, ageusia, and/or anosmia. Neurological impairment at admission or before arriving at hospital was identified as a risk factor for mortality.Copyright © 2021 Sociedad Espanola de Neurologia

Tratamientos habituales utilizados en cefaleas, neuralgias y SARS-CoV-2. Posicionamiento del grupo de estudio de cefaleas de la Sociedad Española de Neurología Standard headache and neuralgia treatments and SARS-CoV-2: opinion of the Spanish Society of Neurology's Headache Study Group

Introducción En los últimos meses han surgido dudas por parte de pacientes, médicos de familia y neurólogos sobre la posibilidad de que algunos de los fármacos que habitualmente se utilizan en cefaleas y neuralgias puedan facilitar o complicar la infección por el SARS-CoV-2. Material y métodos Hemos recabado información sobre el posicionamiento de sociedades científicas, así como de las distintas Agencias de Medicamentos (americana, europea y española) para poder esclarecer dudas respecto al uso de fármacos como lisinopril, candesartán, ibuprofeno, corticoides, carbamazepina, anticuerpos monoclonales contra el péptido relacionado con el gen de la calcitonina (CGRP) durante la pandemia por COVID-19. Resultados Planteamos recomendaciones acerca del uso de fármacos habituales en el tratamiento de las cefaleas en el contexto de la pandemia por COVID-19, basándonos en las evidencias de las que disponemos en el momento actual. Conclusiones Actualmente no existe ningún argumento científico robusto para contraindicar formalmente ninguno de los tratamientos que se emplean en cefaleas y neuralgias.

Hyperthyroidism in outpatients during the COVID 19 pandemic. experience of a referral center in the city of buenos aires

Introduction: Different changes in thyroid function have been described in Covid 19 + patients, including subacute postinfection thyroiditis and reactivation of autoimmune hyperthyroidism. Although attention has been focused on the viral infection, the stressful situation arising from the pandemic and especially quarantine, should be considered as another determinant of thyroid changes. This should also affect non- Covid population. OBJECTIVES1) To evaluate new cases of hyperthyroidism diagnosed in non-Covid outpatient from an endocrinology referral center in the City of Buenos Aires during the pandemic 2) Determine its etiology, severity.3) To compare it with cases diagnosed in the same period of the previous year. Case Description: MATERIAL and METHODS There were 435 Total T3 determinations reviewed, between the start of Covid quarantine in Argentina 03/20/2020 and 11/20/2020. The results above the upper reference limit (175 ng/dl) were analyzed. It was possible to establish the number of patients with clinical hyperthyroidism diagnosis who made their first consultation during this period. Thyroid status was confirmed with Total T4 and TSH determinations.The number of cases was established in the same period of the previous year, using the same system. Aetiology was established with clinic, evolution and TSI/TRAb Total T3, total T4, TSH and TSI, were measured by the IMMULITE 2000 XPi enzyme-linked chemoimmunoassay, Siemens.Trab was measured by Cobas e411 electrochemiluminescent assay,Roche Statistics Student T Test- Fischer Test (Table Presented) Conclusions 1) During the pandemic, 15 new cases of hyperthyroidism were diagnosed. Such figure represents half the number of cases in comparison with the previous year. 2) Autoimmune etiology prevalence was similar. 3) No lesional thyroiditis was detected in those outpatients, clinically non-Covid evaluated from elevated T3. 4) Total T3 was significantly higher in 2020, reflecting that only the most severe hyperthyroidism cases attended consultation.

Correlation between inflammatory parameters and thyroid hormones in patients with COVID-19

Introduction: Non-thyroidal illness syndrome (NTI), (decreased T3 and/or T4 without increased TSH), has been reported in COVID-19 infection. In patients admitted with COVID-19 we found classic NTI presentation and a high prevalence of low T3, high freeT4 (FT4) and normal TSH, which could represent a different presentation of NTI. Low T3 and high FT4 have been associated with mortality1. Objectives: 1-To evaluate correlation of thyroid hormones with biochemical markers of inflammation and association with disease outcome in hospitalized patients with COVID-19. 2-To evaluate these parameters in the two profiles of NTI. Methods: Prospective single- center study that included 55 consecutively patients with COVID-19 hospitalized from August to November 2020. 28/55 (50 %) were male, median age 56y (21-89). Clinical presentation: asymptomatic 3,6% (n=2), mild 14,3% (n=8), moderate 28,6% (n=16), severe 53,6% (n=30). 74,1% had pneumonia, 3.6% (n=2) died and 79,3% had favorable evolution. Thyroid hormones (T4, T3, FT4, FT3) and their ratios (T3/T4, FT3/FT4) were correlated with inflammatory parameters (albumin, ferritin, fibrinogen, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], lactate dehydrogenase [LDH], D-dimer). Comparison between hormone levels, clinical presentation and outcome was performed. Statistical analysis: Spearman correlation, Mann Whitney test and Kruskal-Wallis test. Results: We found correlation between thyroid hormones and their ratios with inflammatory parameters (Table). T3/T4 ratio was lower in severe vs mild/moderate disease [7.5 (4.5-15.5) vs 9.2 (5.8-18.1);p=0.04] and in patients who died vs those discharged [5 (4.53-5.6) vs 8.1 (4.7-18.1);p=0.03]. High FT4 NTI had lower albumin [3.4 (3-4) vs 3.7 (3-4);p=0.03], higher ferritin [1202 (930-7127) vs 435 (101-2232);p<0.05] and tendency to higher fibrinogen [681(583-798) vs 508 (307- 807);p=0.06] than normal/low FT4 NTI. No patient with mild disease at onset had high FT4. Image: Conclusion: In this cohort, both thyroid hormones correlated with inflammation parameters and worse clinical outcome. In NTI group with high FT4, inflammatory parameters were more marked and presentation of the disease more severe.

Standard headache and neuralgia treatments and SARS-CoV-2: opinion of the Spanish Society of Neurology's Headache Study Group. / Tratamientos habituales utilizados en cefaleas, neuralgias y SARS-CoV-2. Posicionamiento del grupo de estudio de cefaleas de la Sociedad Española de Neurología.

INTRODUCTION: In recent months, doubts have arisen among patients, general practitioners, and neurologists as to whether some drugs commonly used in patients with headaches and neuralgia may favour or complicate the disease caused by SARS-CoV-2. MATERIAL AND METHODS: We collected information on the opinions of scientific societies and medicines agencies (American, European, and Spanish) to clarify doubts regarding the use of drugs such as lisinopril, candesartan, ibuprofen, corticosteroids, carbamazepine, and monoclonal antibodies targeting the calcitonin gene-related peptide in the context of the COVID-19 pandemic. RESULTS: We make recommendations about the use of standard headache treatments in the context of the COVID-19 pandemic, based on the current scientific evidence. CONCLUSIONS: At present, there is no robust scientific argument to formally contraindicate any of the standard treatments employed for headaches and neuralgias.