Subjective and Objective Cognitive Deficits in Patients with Post-COVID Syndrome A Challenge for Neuropsychologists

Cognitive impairment is a prominent symptom of the post-COVID syndrome (PCS). However, the correspondence between subjective cognitive complaints (SCC) and objective results is inconsistent. Here, we investigated this discrepancy. This longitudinal study included N = 42 individuals who reported SCC as PCS after mild infection at inclusion. Data collection comprised questionnaires and neuropsychological assessment at baseline and follow-up (FU). At FU - on average 15 months after acute COVID-19 - 88 % of patients reported persisting SCC. There was an approx. 40 % discrepancy between subjective report and test results at both visits. Patients with SCC and objective impairment indicated elevated fatigue and reduced quality of life compared to patients without SCC at FU. A growing number of patients is anticipated to request neuropsychological assessments even after mild infections.

The need for systematic quality controls in implementing N95 reprocessing and sterilization.

BACKGROUND: Due to increased requirement for personal protective equipment during the coronavirus disease 2019 pandemic, many medical centres utilized sterilization systems approved under Food and Drug Administration Emergency Use Authorization for single-use N95 mask re-use. However, few studies have examined the real-world clinical challenges and the role of ongoing quality control measures in successful implementation. AIMS: To demonstrate successful implementation of quality control measures in mask reprocessing, and the importance of continued quality assurance. METHODS: A prospective quality improvement study was conducted at a tertiary care medical centre. In total, 982 3M 1860 masks and Kimberly-Clark Tecnol PFR95 masks worn by healthcare workers underwent sterilization using a vaporized hydrogen peroxide gas plasma-based reprocessing system. Post-processing qualitative fit testing (QFT) was performed on 265 masks. Mannequin testing at the National Institute for Occupational Safety and Health (NIOSH) laboratory was used to evaluate the impact of repeated sterilization on mask filtration efficacy and fit. A locally designed platform evaluated the filtration efficiency of clinically used and reprocessed masks. FINDINGS: In total, 255 N95 masks underwent QFT. Of these, 240 masks underwent post-processing analysis: 205 were 3M 1860 masks and 35 were PFR95 masks. Twenty-five (12.2%) of the 3M masks and 10 (28.5%) of the PFR95 masks failed post-processing QFT. Characteristics of the failed masks included mask deformation (N=3, all 3M masks), soiled masks (N=3), weakened elastic bands (N=5, three PFR95 masks), and concern about mask shrinkage (N=3, two 3M masks). NIOSH testing demonstrated that while filter efficiency remained >98% after two cycles, mask strap elasticity decreased by 5.6% after reprocessing. CONCLUSIONS: This study demonstrated successful quality control implementation for N95 mask disinfection, and highlights the importance of real-world clinical testing beyond laboratory conditions.

Safety and Feasibility of Same-Day Discharge After TAVR, TEER, TMVR, Watchman Device Implantations

Background: Standard of care for elective structural heart disease (SHD) procedures have included at least one overnight stay in the hospital. Same day discharge (SDD) after PCI has been well studied with no difference in cardiovascular outcomes, repeat hospitalizations, or overall complications with SDD following PCI. With the ongoing COVID pandemic, there are several patients and family members who prefer to go home same day to avoid exposure. SDD after structural heart procedures such as valve repair/replacements, Watchman device implantations is not well studied. There are no recommendations on how to do this in a safe and effective way. After rigorous planning, we designed a protocol to assess the safety and feasibility of SDD after structural interventions in selected patients. Methods: A total of 114 patients undergoing elective SHD interventions between July 2020 till November 2021 who opted to go home on the same day in view of the ongoing pandemic were included in the study. These patients had good social support, met our centers safety protocol, TVT registry requirements, lab, and ambulation criteria. We assessed the demographics, safety, and outcomes. Results: Of the 114 patients, 37 underwent transfemoral TAVR, 2 BAV, 8 TEER, 2 transcatheter mitral valve in valve, 48 Watchman and 17 ASD/PFO closure. The mean age was 72.2 years (32 - 89y). The mean creatinine was 1.23 ( 0.6 - 2.6). General anesthesia was used in 96, conscious sedation in 17 and local anesthesia only in one. The mean contrast usage was 64 ml of visipaque (0 - 129 ml). The mean procedure time was 32 min(14 -121min). All patients were ambulated at least twice. The first within 2 hours of procedure and 2nd before discharge. There was no electrical block noted during anytime in the procedural or periprocedural period. The mean length of stay was 8.1 hours(4 - 16.8h). All patients received a cell number to call in case of any concerns and for easy access. All patients received a call in the evening on the same day and on the next day morning. There were no readmissions, bleeding episodes, acute kidney injury or deaths till last follow up. Conclusions: 1. Selective, same-day discharge after TF TAVR, Transcatheter Mitral valve in valve replacements, TEER, Watchman and ASD/PFO closures is safe and feasible and may be considered in patients who opt for it and have a good social fabric. 2. Patients did not enter the Hospital floor/ICU 3. SDD improves patient satisfaction and increases hospital bed availability, importantly in the ongoing pandemic. 4. SDD has enormous potential to reduce overall health care costs.

Neurological implications of COVID-19-results of the LEOSS registry

Background and aims: Register studies and cohort analyses of clinical data are essential to study neurological manifestations of COVID-19 at a large scale. Methods: We analyzed neurological manifestations in COVID-19 patients, diagnosed before Aug 25th 2020, and registered in the European multinational LEOSS registry. Results: Of the 3127 COVID-19 patients, 95.2% were hospitalized. In 54.4% at least one neurological symptom, and in 3.3% a new neurological complication occurred. Preexisting neurological comorbidities were reported in 18.1% of the patients. Neurological symptoms were excessive tiredness (27.6%), headache (15.3%), nausea/emesis (14.0%), muscular weakness (13.2%), smell (6.9%), taste disorder (8.3%) and delirium (6.3%). Intracerebral bleeding occurred in 1.2%, ischemic stroke in 0.5%, and meningitis/ encephalitis in 0.4%. Overall, the death rate was 17.5%. It was higher in patients with the following neurological comorbidities: dementia 38.0%, movement disorders 32.8%, and prior cerebrovascular disease 32.3%. A multivariable logistic regression model found age (OR 1.53), cardiovascular diseases (OR 1.74), muscle weakness (OR 1.40), pulmonary diseases (1.49) and male gender (OR 1.52) to be associated with a significantly increased risk for a critical COVID-19 disease course, failed recovery, and death. Conclusion: The neurological manifestations revealed in COVID-19 patients of this study are mostly in agreement with previously published data. Several neurological conditions, such as prior cerebrovascular diseases or dementia appeared to be associated with a higher risk in unadjusted analyses, which was not confirmed in a multivariable analysis adjusting for confounding variables such as age and sex. These findings contrast previously published studies and stress the importance of considering putative confounds in medical statistics carefully.