Neurological diseases caused by coronavirus infection of the respiratory airways

Infections of the central nervous system (CNS) infections are critical problems for public health. They are caused by several different organisms, including the respiratory coronaviruses (CoVs). CoVs usually infect the upper respiratory tract causing the common cold. However, in infants, and in elderly and immunocompromised persons, they can also affect the lower respiratory tract causing pneumonia and various syndromes of respiratory distress. CoVs also have neuroinvasive capabilities because they can spread from the respiratory tract to the CNS. Once infection begins in the CNS cells, it can cause various CNS problems such as status epilepticus, encephalitis, and long‐term neurological disease. This neuroinvasive properties of CoVs may damage the CNS as a result of misdirected host immune response, which could be associated with autoimmunity in susceptible individuals (virus‐induced neuro‐immunopathology) or associated with viral replication directly causing damage to the CNS cells (virus‐induced neuropathology). In December 2019, a new disease named COVID‐19 emerged which is caused by CoVs. The significant clinical symptoms of COVID‐19 are related to the respiratory system, but they can also affect the CNS, causing acute cerebrovascular and intracranial infections. We describe the possible invasion routes of coronavirus in this review article, and look for the most recent findings associated with the neurological complications in the recently published literature.

Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis.

BACKGROUND: Diabetic ketoacidosis (DKA) contributes to 94% of diabetes-related hospital admissions, and its incidence is rising. Due to the complexity of its management and the need for rigorous monitoring, many DKA patients are managed in the intensive care unit (ICU). However, studies comparing DKA patients managed in ICU to non-ICU settings show an increase in healthcare costs without significantly affecting patient outcomes. It is, therefore, essential to identify suitable candidates for ICU care in DKA patients. AIM: To evaluate factors that predict the requirement for ICU care in DKA patients. METHODS: This retrospective study included consecutive patients with index DKA episodes who presented to the emergency department of four general hospitals of Hamad Medical Corporation, Doha, Qatar, between January 2015 and March 2021. All adult patients (> 14 years) fulfilling the American Diabetes Association criteria for DKA diagnosis were included. RESULTS: We included 922 patients with DKA in the final analysis, of which 229 (25%) were managed in the ICU. Compared to non-ICU patients, patients admitted to ICU were older [mean (SD) age of 40.4 ± 13.7 years vs 34.5 ± 14.6 years; P < 0.001], had a higher body mass index [median (IQR) of 24.6 (21.5-28.4) kg/m2 vs 23.7 (20.3-27.9) kg/m2; P < 0.030], had T2DM (61.6%) and were predominantly males (69% vs 31%; P < 0.020). ICU patients had a higher white blood cell count [median (IQR) of 15.1 (10.2-21.2) × 103/uL vs 11.2 (7.9-15.7) × 103/uL, P < 0.001], urea [median (IQR) of 6.5 (4.6-10.3) mmol/L vs 5.6 (4.0-8.0) mmol/L; P < 0.001], creatinine [median (IQR) of 99 (75-144) mmol/L vs 82 (63-144) mmol/L; P < 0.001], C-reactive protein [median (IQR) of 27 (9-83) mg/L vs 14 (5-33) mg/L; P < 0.001] and anion gap [median (IQR) of 24.0 (19.2-29.0) mEq/L vs 22 (17-27) mEq/L; P < 0.001]; while a lower venous pH [mean (SD) of 7.10 ± 0.15 vs 7.20 ± 0.13; P < 0.001] and bicarbonate level [mean (SD) of 9.2 ± 4.1 mmol/L vs 11.6 ± 4.3 mmol/L; P < 0.001] at admission than those not requiring ICU management of DKA (P < 0.001). Patients in the ICU group had a longer LOS [median (IQR) of 4.2 (2.7-7.1) d vs 2.0 (1.0-3.9) d; P < 0.001] and DKA duration [median (IQR) of 24 (13-37) h vs 15 (19-24) h, P < 0.001] than those not requiring ICU admission. In the multivariate logistic regression analysis model, age, Asian ethnicity, concurrent coronavirus disease 2019 (COVID-19) infection, DKA severity, DKA trigger, and NSTEMI were the main predicting factors for ICU admission. CONCLUSION: In the largest tertiary center in Qatar, 25% of all DKA patients required ICU admission. Older age, T2DM, newly onset DM, an infectious trigger of DKA, moderate-severe DKA, concurrent NSTEMI, and COVID-19 infection are some factors that predict ICU requirement in a DKA patient.

COVID-19 Vaccination Status and Operative Outcomes after Kidney Transplantation.

BACKGROUND: Kidney transplantation remains the best available treatment for end-stage renal disease. However, promoting graft longevity and preventing allosensitization requires strict adherence with a stringent immunosuppression regimen. The COVID-19 pandemic has offered new challenges for kidney transplant patients and many transplant centers are denying transplantation to unvaccinated patients. The aim of this study was to evaluate whether unvaccinated patients had inferior adherence after kidney transplantation along with a reduction in graft survival. STUDY DESIGN: Patients undergoing a deceased donor kidney transplantation at a single academic medical center from February 2021 to May 2022 were retrospectively reviewed. February 2021 was chosen as the start date for record review because it was 3 months after the first COVID-19 vaccination was authorized for emergency use. Patients were considered to be vaccinated if they received at least 1 dose of any mRNA vaccine by their transplantation date. RESULTS: Of the 301 patients who met study criteria, 234 were vaccinated and 67 were unvaccinated. Cohorts stratified by vaccination status were well matched. Younger age was an independent risk factor for nonvaccination. Interestingly, unvaccinated patients had worse postoperative adherence with a greater average number of missed postoperative clinic visits (p = 0.03) and a strong trend toward missing 3 or more postoperative clinic visits (p = 0.07). Finally, unvaccinated patients had statistically more subtherapeutic tacrolimus troughs (p = 0.01). CONCLUSIONS: Patients not vaccinated against COVID-19 had higher rate of postoperative nonadherence in key areas of immunosuppression monitoring and clinic visit attendance. Providers should be cognizant that an unvaccinated status may be a harbinger for poor adherence; therefore, stricter strategies for patient outreach are critical to ensure graft success in this vulnerable patient population.

Impact of Coronavirus Disease (COVID-19) Pandemic on Psychological Well-Being of the Pakistani General Population.

Background and Objectives: In order to curb the spread of coronavirus disease 2019 (COVID-19), the countries took preventive measures such as lockdown and restrictions of movements. This can lead to effects on mental health of the population. We studied the impact of COVID-19 on psychological well-being and associated factors among the Pakistani general population. Methods: An online cross-sectional survey was conducted between 26th April and 15th May and included participants from all over the Pakistan. Attitudes and worriedness about COVID-19 pandemic were assessed using a structured questionnaire. A validated English and Urdu version of the World Health Organization Well-Being Index (WHO-5) was used to assess the well-being. Factor analysis was done to extract the attitude item domains. Logistic regression was used to assess the factors associated with poor well-being. Results: A total of 1,756 people participated in the survey. Almost half 50% of the participants were male, and a similar proportion was employed. About 41% of the participants were dependent on financial sources other than salary. News was considered a source of fear as 72% assumed that avoiding such news may reduce the fear. About 68% of the population was worried about contracting the disease. The most common coping strategies used during lockdown were spending quality time with family, eating healthy food, adequate sleep, and talking to friends on phone. Prevalence of poor well-being was found to be 41.2%. Female gender, being unemployed, living in Sindh and Islamabad Capital Territory (ICT), fear of COVID-19, and having chronic illness were significantly associated with poor well-being. Similarly, coping strategies during lockdown (doing exercise; spending time with family; eating healthy food; having good sleep; contributing in social welfare work and spending time on hobbies) were also significantly associated with mental well-being. Conclusion: We found a high prevalence 41.2% of poor well-being among the Pakistani general population. We also investigated risk factors of poor well-being which included female gender, unemployment, being resident of ICT and Sindh, fear, chronic illness, and absence of coping strategies. This calls for immediate action at population level in the form of targeted mass psychological support programs to improve the mental health of population during the COVID-19 crises.

The Effects of Long Working Hours on Mental Health Among Resident Physicians in Saudi Arabia.

Purpose: To examine the effect of long working hours on anxiety and depression among resident physicians working in Makkah, Saudi Arabia. Methods: This is a cross-sectional study using an anonymous and confidential self-administered electronic questionnaire. Mental health status (depression and anxiety) is measured using hospital anxiety and depression scale. A multi-stage stratified sampling technique was used. Data were analyzed using the SPSS version 24.0. The Chi-square test and ordinal logistic regression (OLR) were used to test the association. Results: A total of 258 medical residents participated in the study. The prevalence of anxiety was 39.5% (n=102) and depression was 20.9% (n=54). In multivariate OLR against anxiety, working more than 64 hours per week was significantly associated (p=0.013) with an increase in the odds of observing a higher level of anxiety (odds ratio=2.91, 95% confidence interval (CI):1.25-6.77) compared with working up to 40 hours per week after adjusting for age, amount of sleep and exposure to injustice. For the depression multivariate OLR, it would increase the odds of observing a higher level of depression for working 41-48, 49-64 and more than 64 hours per week by 2.21 (95% CI:1.07-4.58, P=0.033), 2.07 (95% CI:1.01-4.27, P=0.049) and 2.37 (95% CI:1.03-5.50, P=0.044) respectively, compared with working up to 40 hours per week and adjusting for the amount of sleep and exposure to injustice. Conclusion: Resident physicians are at increased risk of developing anxiety and depression which is influenced by long working hours and a variety of other factors. Therefore, attention needs to be paid to this association. The implementation of interventions for the prevention and screening of physicians' mental health disorders is needed.

Assessing Physical Activity and Perceived Barriers Among Physicians in Primary Healthcare in Makkah City, Saudi Arabia

IntroductionAdvocating a healthy lifestyle is the cornerstone of primary healthcare physicians. As physicians are the ultimate role models for patients regarding health and well-being, we focused on physicians working in primary healthcare centers (PHCs) in Makkah because they work on the frontline of disease prevention and are considered the first point of contact for patients entering the health system. This study aimed to estimate the physical activity levels in physicians working in the PHCs of Makkah and any perceived barriers to engage in physical activity.MethodologyWe conducted a cross-sectional study at PHCs in Makkah from October 2021 to December 2021. We used a multistage cluster random sampling technique to select primary healthcare physicians in Makkah city. We recruited 196 physicians working in PHCs for this study. We used the short version of the International Physical Activity Questionnaire to measure physical activity levels, and we used the barriers to being active questionnaire to identify the barriers. Descriptive analysis was performed using frequencies. Bivariate associations between the most frequently reported barriers and sociodemographic variables were determined using the chi-square test, Student t-test, and analysis of variance via IBM SPSS Statistics for Windows, version 22.0 (Armonk, NY: IBM Corp.).ResultsApproximately 45.9% of physicians were overweight, while 69.4% were not gym members. In the seven days prior to answering the surveys, approximately 71.9% did not report any vigorous activity, and 30.6% had performed moderate activity. The most significant barrier to being active was a lack of time (70.9%), followed by a lack of resources (69.9%). In bivariate analysis, we noted a significant negative relationship between gym membership, vigorous and moderate physical activity, and perceived barriers scores (p<0.001).ConclusionMost of the physicians in PHCs are not physically active. The main barrier to their physical activity is lack of time. There is a need to encourage them and motivate them to be physically active to model more healthy behaviors to the general population.

Spontaneous tension pneumothorax as a complication of Coronavirus disease 2019: Case report and literature review.

Primary spontaneous tension pneumothorax (STP) is a rare and life-threatening condition. We report a case of COVID-19-pneumonia patient who developed STP as a complication. He had a prolonged hospital stay and was ultimately discharged asymptomatic. A systematic literature search was performed to review studies (N=12) reporting STP in the setting of COVID-19.

Gender Difference In Awareness And Behaviours Of Medical And Dental Students About Corona Virus Disease (Covid-19) In Pakistan.

BACKGROUND: Medical and dental students are the future of health workforce and a potential volunteer pool in the COVID-19 crises. This study aimed to assess the level and gender differences in the awareness, attitude and behaviours of medical and dentals students about COVID-19 in Pakistan. METHODS: An online cross-sectional survey was conducted among medical and dental undergraduate students in Khyber Pakhtunkhwa province. Data was collected using a structured questionnaire having four sections: socio-demographics, knowledge, attitude and practices. RESULTS: A total of 1770 medical and dental students participated and completed the questionnaire. About 1239 (70%) of the respondents were female and 1526 (87%) were MBBS students. We found that 1685 (95%) of the students had adequate knowledge. Majority, 1565 (89%) of the students was concerned about COVID-19 and 1480 (84%) believed that disease will ultimately be controlled. Only about 1129 (64%) of the participants in our study had adequate practices. Male gender was associated with higher risk of inadequate practices. CONCLUSIONS: There were good knowledge and attitudes about COVID-19 among medical and dental students. However, one third of the participants did not have adequate practices and female had better practices than male students. This gap in the knowledge and practice calls for urgent interventions to improve practices.

Psychological Well-Being and Coping Strategies among Pakistani Heads of Households during COVID-19 Pandemic: An Online Survey.

Background: Coronavirus Disease (COVID-19) pandemic can affect mental health. Heads of the household are at higher risk of this effect because of their financial and social responsibilities. This study aimed to assess the psychological well-being and its associated factors during the COVID-19 pandemic among heads of households in Pakistan. Methods: We conducted an online survey in May 2020. A convenience sampling strategy was used to enroll the heads of the households from all regions of Pakistan. A validated English and Urdu version of the WHO-5 well-being scale was used to assess well-being. The prevalence of poor well-being and its associated factors among heads of the households was measured using logistic regression. Results: A total of 509 heads of households participated in the survey. About 35% of the participants were dependent on financial sources other than salary. The news was considered a source of fear as 70% assumed that avoiding such news may reduce the fear. The most common coping strategies used during lockdown were; spending quality time with family, eating healthy foods, adequate sleep and talking to friends on the phone. The prevalence of poor well-being was found to be 41% (95% CI: 36.62-45.51). Individuals with any chronic illness were at a higher risk of poor wellbeing adjusted odds ratio of 1.64 (95% CI: 1.04-2.59). Worriedness was also found to be associated with a higher risk of poor wellbeing adjusted OR 1.13 (95% CI: 1.06-1.19). Reading books showed a protective association with poor mental wellbeing adjusted OR 0.64 (95% CI: 0.42-0.98). Conclusion: There was a high prevalence of poor mental wellbeing among heads of households in Pakistan. Worriedness related to the pandemic and having chronic illness were significant predictors of poor psychological wellbeing. Actions are required in the form of targeted mass psychological support systems for the heads of the families to improve their mental health during the COVID-19 crises.

Cavitary pulmonary tuberculosis with COVID-19 coinfection.

The COVID-19 pandemic has strained the healthcare system worldwide, leading to an approach favoring judicious resource allocation. A focus on resource preservation can result in anchoring bias and missed concurrent diagnosis. Coinfection of Mycobacterium tuberculosis (TB) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has implications beyond morbidity at the individual level and can lead to unintended TB exposure to others. We present six cases of COVID-19 with newly diagnosed cavitating pulmonary tuberculosis to highlight the significance of this phenomenon and favorable outcomes if recognized early.

Fluid Replacement Versus Fluid Restriction in COVID-19 Associated Hyponatremia.

Hyponatremia is one of the most frequently observed electrolyte abnormalities in coronavirus disease 2019 (COVID-19). Literature describes syndrome of inappropriate anti diuretic hormone (SIADH) as the mechanism of hyponatremia in COVID-19 requiring fluid restriction for management. However, it is important to rule out other etiologies of hyponatremia in such cases keeping in mind the effect of an alternate etiology on patient management and outcome. We present a case of hypovolemic hyponatremia in a patient with COVID-19, which unlike SIADH, required fluid replacement early in the disease course for its correction. A 52-year-old Filipino gentleman presented with a three-week history of diarrhea and symptomatic hyponatremia. There was no history of fever or respiratory symptoms. Physical examination revealed a dehydrated and confused middle-aged gentleman. Labs revealed lymphopenia, thrombocytopenia, and severe hyponatremia (108 mmol/L). Blood cultures and stool workup were negative. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nasopharyngeal swab was positive. Hyponatremia workup excluded SIADH. The patient had hypovolemic hyponatremia due to gastrointestinal (GI) losses and was managed with saline infusion for correction of hyponatremia with improvement in his clinical status. Hyponatremia in COVID-19 is not only secondary to SIADH but can also be due to other etiologies. Hypovolemic hyponatremia should be distinguished from SIADH as these conditions employ different management strategies, and early diagnosis and management of hypovolemic hyponatremia affects morbidity and mortality.

Estimating the public response to mitigation measures and self-perceived behaviours towards the COVID-19 pandemic.

OBJECTIVES: Since March 2020, a rapid increase has been observed in the prevalence of the COVID-19 pandemic, which has essentially resulted from increased disease transmission and intensified testing and reporting. The international guidelines for the prevention and treatment of the COVID-19 pandemic have been frequently updated. Such guidelines assist the governmental regulatory bodies in taking optimal measures and safeguarding their citizens against the pandemic. We conducted a short survey with a Saudi cohort to understand the awareness about COVID-19 and estimate the responses for mitigation strategies. METHODS: An electronic survey was conducted, and the first 388 responses were analysed for publishing an initial report. The questionnaire comprised 27 items and was divided into three sections, namely demographic, awareness, and response to mitigation strategies and participants' self-perceived behaviours regarding COVID-19. The perceptions of the participants were compared with their responses to mitigation measures. RESULTS: In our study, 89.7% understood the meaning of pandemic, while 82.2% correctly identified that the elderly belonged to a high-risk group for the COVID-19 infection. As many as 96.1% agreed that staying at home was one of the mitigation strategies. Nearly 35% preferred self-medication. Higher educational level (OR: 2.09, 95% CI: 1.02-4.29) and longer working hours were found to be significantly associated with a positive response to mitigation measures with p < 0.04 and p < 0.02, respectively. CONCLUSIONS: We report better understanding and appropriate response to mitigation measures towards the COVID-19 pandemic among the general population in KSA. Nevertheless, the tendency towards self-medication was reported by one-third of the responders.