ABSTRACT
Background and aims: Cerebral venous sinus thrombosis with thrombocytopenia syndrome (CVST-TTS) is a rare adverse effect of adenovirus- based SARS-CoV-2 vaccines. After the autoimmune pathogenesis of TTS was discovered, treatment recommendations were issued. The aim of this study was to evaluate if adherence to treatment recommendations was associated with lower mortality. Methods: TTS was defined according to the Brighton criteria. Cases from a prospective international CVT registry with symptom onset within 28 days of adenovirus-based SARS-CoV-2 vaccination were analysed. Treatment recommendations, following the International Society of Thrombosis and Haemostasis, included use of immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusions, unless needed for surgery. Results: Out of 178 CVT cases from 117 centres in 19 countries reported between March 29 and September 3, 2021, 95 patients fulfilled inclusion criteria. Five of 37 (14%), 13/25 (52%), and 29/33 (88%) of patients diagnosed in March, April, and from May onwards, respectively, were treated according to recommendations. Proportion of patients diagnosed in March, April, and from May onwards who received immunomodulation increased from 19/37 (51%) over 15/25 (60%) to 30/33 (90%), and the percentage of patients who were treated with heparins [26/37 (70%), 4/25 (16%), 1/33 (3%)] and platelet transfusion [15/37 (41%), 4/25 (16%), 7/33 (21%), respectively] decreased accordingly. Mortality of patients treated according to recommendations was 14/47 (30%, 95%CI 19-44%) compared to 28/48 (58%, 95%CI 44-71%) in patients not treated according to recommendations (OR 3.30, 95%CI 1.41-7.71). Conclusions: Over time, adherence to treatment recommendations improved, and mortality rate of patients with CVST-TTS decreased.
ABSTRACT
Background and aims: Peripheral and central nervous systems affection as a complication of COVID-19 were reported. This could be related to the direct effects of virus on the nervous system as post-infectious immune mediated effect or neurological complication of systemic effect of COVID-19. Methods: A previously healthy 44 years old male patient presented to our hospital after four weeks of onset of COVID-19 symptoms that included fever, pharyngitis and cough. He complained of left foot paresthesia associated with weakness of left toes, followed by weakness and numbness of right upper limb distally followed by left upper limb weakness distally then few days later numbness of right lower limb. There were no dysautonomic or sphincter abnormalities. Cranial and respiratory nerves were normal. Examination showed generalized areflexia, tenderness of calf muscle and positive straight leg raise test. MRI brain and spinal cord, nerve conduction velocity (NCV), CSF examination, full laboratory including were investigated. Results: MRI brain and cord showed no abnormality. CSF result showed clear colorless fluid, CSF protein 54.4gm/dl, and cell count 3/mm3. NCV, motor figure 1 and sensory figure 2, showed mixed axonal motor and sensory polyneuropathy. A high-dose intravenous human immunoglobulin (IVIG 0.4g/kg for five days) was prescribed. He has been stable for the following two weeks. At last visit, four weeks after IVIG infusion, patient reported significant clinical improvement, persisting only with mild right upper limb numbness. Conclusion: We described a case of acute asymmetrical painful polyneuritis, atypical GBS, and suggest it could be an atypical neurological manifestation related to COVID-19 infection. (Figure Presented).
ABSTRACT
Angiotensin converting enzyme 2 (ACE2) has potentially conflicting roles in health and disease. COVID-19 coronavirus binds to human cells via ACE2 receptor, which is expressed on almost all body organs. Boosting the ACE2 receptor levels on heart and lung cells may provide more cellular enter to virus thereby worsening the infection. Therefore, among the drug targets, ACE2 is suggested as a vital target of COVID-19 therapy. This hypothesis is based on the protective role of the drugs acting on ACE2. Therefore, this review discusses the impact and challenges of using ACE2 as a target in the current therapy of COVID-19.
Subject(s)
Angiotensin-Converting Enzyme 2/antagonists & inhibitors , Antiviral Agents/chemistry , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/chemistry , Adenosine Monophosphate/metabolism , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/chemistry , Alanine/metabolism , Alanine/therapeutic use , Angiotensin-Converting Enzyme 2/metabolism , Anti-Inflammatory Agents, Non-Steroidal/chemistry , Anti-Inflammatory Agents, Non-Steroidal/metabolism , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antiviral Agents/metabolism , Antiviral Agents/therapeutic use , Azithromycin/chemistry , Azithromycin/metabolism , Azithromycin/therapeutic use , COVID-19/virology , Humans , Hydroxychloroquine/chemistry , Hydroxychloroquine/metabolism , Hydroxychloroquine/therapeutic use , SARS-CoV-2/isolation & purification , Vitamin D/chemistry , Vitamin D/metabolism , Vitamin D/therapeutic use , COVID-19 Drug TreatmentABSTRACT
Background: To reduce disease exposure, telemedicine has been used to help healthcare systems that have been faced with challenges since the COIVD-19 outbreak in managing emergency departments, outpatient care clinics and providing ongoing care to those with chronic illnesses such as epilepsy. Objectives: The aim of this study is to assess the emergency implementation of virtual consultations among neurologists in Saudi Arabia in the wake of the COVID-19 pandemic. Methods: A cross-sectional study was conducted from August to September 2020 in survey format distributed electronically to neurologists practicing in Saudi Arabia. Descriptive and correlative statistical analyses were performed to identify factors associated with onsite and virtual clinic visits in those treating patients with epilepsy. Results: A total of 92 neurologists participated in the study. The majority of neurologists (75%) care for COVID-19 patients along with their regular clinic duties. There was statistical significance between the duration of the virtual visit in comparison to the onsite clinic visit and the neurologists' views on the future of teleneurology for epilepsy patients(G(2)(4, N = 92) = 18.673, p = 0.001). Conclusion: Virtual consultations have been a way to decrease personal contact and disease exposure since the start of the COVID-19 pandemic. For those suffering with chronic conditions such as epilepsy, telemedicine may be a useful resource in following up with a neurologist and medication changes may be successfully made.