RNA extraction alternative method for SARS-CoV-2 molecular diagnosis

The devastating COVID-19 outbreak posed serious challenges for the diagnostics laboratories, facing global shortage of reagents and equipment. This study aimed at evaluating an additional RNA extraction method respect to those already recommended by WHO and CDC. A new protocol for RNA extraction from nasopharyngeal swab was set up, adapting a Qiagen kit, and validated on a set of 96 clinical samples. The analysis showed a sensitivity of 94% and a specificity of 97%, but considering samples with Ct< 36.5, the sensitivity and the specificity increased to 100%. The adapted method was also able to detect samples with very low viral load (Ct> 38), indicating that the two approaches can be considered equivalent for the SARS-CoV-2 diagnostics. This extraction method can help in increasing the throughput for SARS-CoV-2 molecular test, even in a low automation setting.

Lessons learned from COVID-19 impact of pandemic on children with neurological disorders in Sfax, Tunisia

To record the experience of caregivers for neurologically impaired children during the lockdown periods. Data from 286 children's caregivers were collected through an administered questionnaire to record: access to care services during the lockdown periods, causes underlying loss of access to care, mitigations adopted by caregivers and patients' outcomes. The mean age of children was 8.11 years-old and sex ratio (F/M) was 0.66. They were mainly followed-up for epilepsy or epileptic encephalopathy (53%) and cerebral palsy (21%). During the lockdown periods, caregivers reported that 45% of children had no access to healthcare majorly for neurorehabilitation (76.7%) and medicines (70.7%). Most caregivers (36%) related limitations in access to fear from catching the virus. The majority resorted to continuation of the same treatment via primary healthcare facilities (41%) and postponement of their appointments (24%). Our results show that access to healthcare for children with neurological disorders was deeply disrupted during the COVID-19 pandemic. The already precarious health systems' infrastructures might have been the main causes for this and should be thus considered in the health policy and planing. © 2023, Intelektual Pustaka Media Utama. All rights reserved.

Impact of clinical pharmacy development in the accounting restatement of hospital pharmacies

As part of the French public hospital accounting restatement, the new work's unit (UO) for pharmacy is more exhaustive and closer to the Societe Francaise de Pharmacie Clinique frame of reference than the oldest one [5, 6]. Redefinition is expected to result in a better understanding of pharmacy organisations. The objective of this work was to examine the interest of the UO in reporting on organisational changes in our pharmacy Groupe Hospitalier Paul Guiraud (GHPG) in favour of quantitative and qualitative development of clinical pharmacy activities. Material and method. This was an observational retrospective study on database. Data was recorded from 2017 [3] and 2021 [4] annual activity reports of pharmacy GHPG, two internal studies on working time, full time hospitalization data during the study period [2] and weighted time calculations by ANAP among 9 psychiatric hospital pharmacies. Data analysis was done using SPSS software (release 28.0.1). Results and discussion. The comparative study based on pharmaceutical dispensing weighted time (reference activity) and medication reconciliation weighted time (one activity of clinical pharmacy) between pharmacy GHPG and the 9 psychiatric hospital pharmacies, shows that both are in the same range. Although our organizations, activities, resources, sizes and budgets are different, weighted time of two main activities are close and reveals some homogeneity between psychiatric hospital pharmacies corpus. During the study period, pharmaceutical dispensing increased by 10% when expressed in number of acts, decreased by 3% in weighted time and their share within the UO reduced by 4.8% from 42% to 40%. In this respect, the UO reports two opposite trends: the increase of health products in the formulary and extension of customers related to the COVID-19 pandemic and the decrease in beds related to the crisis of public psychiatry. Clinical pharmacy activities increased by 2% when expressed in number of acts, increased by 26% in weighted activities and their share within the UO increased by 26% from 5.8% to 7.3%. In that respect UO evolution reflects organizational changes in favour of clinical pharmacy activities deployment. Perspectives. New UO illustrates the reorganization implemented over the last 5 years. But can it guide pharmacist manager and local decision-maker in decree ndegree 2019-489 05/21/2019 implementation related to hospital pharmacy? And will it shed light on the path to be taken within the framework of pharmaceutical cooperation associated with a pooling of technical and administrative functions, robotic dispensing, and deployment of clinical pharmacy activities in partner facilities that are not yet covered...? Copyright © 2022 John Libbey Eurotext.

THE GLOBAL COVID-19 NEURO RESEARCH COALITION

The Global COVID-19 Neuro Research Coalition was formed in May 2020 by 24 expert neurologists and researchers from around the world. Together, they published a call to the global neurology community in The Lancet Neurology to establish a network where members exchange ideas, share research into the intersection of COVID-19 and neurology, and foster communication between international colleagues and institutions, particularly in low- and middle-income countries (LMICs). Now comprising over 100 members from 34 countries, the Coalition works closely with the WHO Neurology and COVID-19 Global Forum to address pressing questions facing neurologists and their patients. In addition to its LMIC focus, the Coalition works to harmonize research networks and strategies, not only for COVID-19, but also for other neurological challenges and future global research. The Coalition has published five papers on diverse topics related to COVID-19 and neurology. These include methodological approaches to understanding neurological associations of COVID-19, support of the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders, and COVID- 19-associated headache. The Coalition is involved in ongoing reviews into neurological complications of COVID-19 and COVID-19 vaccinations, and as well as studies about accurate diagnoses of these complications and the overall impact of this pandemic on neurological services. It also engages with the WHO-supported Brain Health Clinical Exchange, which invites neurologists around the world to present on relevant neurology topics and engage in interactive discussion. The success of the Global COVID-19 Neuro Research Coalition underlines the need for a platform that brings together the international neurology community in addressing the large burden of neurological disease and shares strategies to face them. With its continent-spanning network of experts, the Coalition will continue to initiate high-quality research that will bring global neurology to the forefront of public health efforts and guide policies that will aid patients everywhere.

Encephalitis during first year of SARS-COV-2 pandemic– first results of the European ENCOVID registry

Background and aims: Objective: Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection. No data about clinical, imaging and biomarkers presentations as well as long-term outcomes are available for SARS-CoV-2 encephalitis in comparison with infectious and autoimmune encephalitis. Methods: The ENCOVID European registry included patients with probable or definite diagnosis of encephalitis with and without SARS-CoV-2 infection admitted for hospitalization in the European recruiting centers between February 1st 2020 and March 30th, 2021. Each patient underwent a standardized assessment including full infectious screening, CSF, EEG, MRI data. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment and outcomes were recorded. Results: Results – Out of 155 cases screened, forty-five cases of encephalitis positive for SARS-CoV-2 infection and 63 without COVID-19 with full available data were included. SARS-CoV-2 encephalitis exhibited common presentation with aphasia and dysarthria compared to non-COVID- encephalitis and exhibited higher prevalence of patients with normal MRI but mild hyperproteinorracchia/pleocytosis. Most SARS-CoV-2 cases appeared during the onset of COVID-19 and exhibited different response to treatment and long-term outcomes compared to non COVID encephalitis. Conclusions: Conclusions –The registry identified a wide spectrum of encephalitis associated with COVID19 infection, with clinical characteristics and course different from classical infectious and autoimmune encephalitis. Biomarkers studies are warranted in order to evaluate the specific inflammatory pathways associated with SARS-Cov-2 encephalitis.

FEVER-INDUCED BRUGADA SYNDROME

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Brugada syndrome (BrS) is a rare cause of sudden cardiac death in asymptomatic healthy adults. We present a case of BrS unmasked by fever secondary to COVID-19 infection. CASE PRESENTATION: 38-year-old male with no prior medical history presented with a two-day history of subjective fevers, chills, productive cough, dyspnea, and left-sided pleuritic chest pain. He was noted to be febrile, tachypneic, tachycardic and hypoxic to the low-90s on room air. Bloodwork revealed elevated inflammatory markers with leukocytosis. Imaging and bloodwork were consistent with severe bilateral multifocal pneumonia secondary to COVID-19 infection. EKG on admission showed evidence of sinus tachycardia and type I Brugada pattern in leads V1 and V2 without ischemic changes. He was admitted for treatment of COVID-19 pneumonia with intravenous (IV) Remdesivir, IV steroids, and oxygen supplementation. Despite this, patient continued to be febrile, and interestingly, serial EKGs showed persistent type 1 Brugada pattern, which transformed into type 2 Brugada pattern after day 2 of admission, to persist for the next seven days. Echocardiogram showed normal left ventricular systolic function (ejection fraction 65%) with no significant valvular abnormalities. The Brugada pattern was thought to be induced by the febrile episodes, therefore all fevers were aggressively treated, and patient was closely monitored for any ventricular arrhythmias. Patient was educated on avoiding tricyclic antidepressants and sodium channel blockers as they are contraindicated in BrS. He was discharged home with plans for outpatient electrophysiological study. DISCUSSION: BrS is a clinical entity that can lead to sudden cardiac death and is associated with ECG changes of a 2mm J-point elevation and 1mm ST-segment elevation in two or more of the right precordial leads;type 1 is characterized by coveted-ST elevation in V1 and V2 whereas type 2 involves a saddle-back appearance. Diagnosis is made after excluding all other known causes of ST-segment elevation in right precordial leads, known as phenocopies. Known triggers include fever, intoxication, vagal stimulation, electrolyte imbalances, and various medications. Fever-induced BrS is more common among men in an age group of 30 to 60 years [4], it can precipitate cardiac arrest due to increased arrhythmogenicity of cardiac sodium channels at higher temperatures. Thus, timely and aggressive control of fever is crucial in preventing fatal arrhythmias, with fever-induced BrS leading to cardiac arrest in 18-20% of patients [2,3]. CONCLUSIONS: Clinicians need to be aware of the circumstances that can induce BrS, including fevers and medications, as BrS can be fatal, leading to cardiac arrest in many patients. Early recognition can lead to early intervention, through placement of an implantable pacemaker for documented arrhythmia, to decrease morbidity and mortality. REFERENCE #1: 1. Bayés de Luna A, Brugada J, Baranchuk A, et al. Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report. J Electrocardiol. 2012;45:433-442. [PubMed] [Google Scholar] REFERENCE #2: 2. Amin AS, Meregalli PG, Bardai A, Wilde AA, Tan HL. Fever increases the risk for cardiac arrest in the Brugada syndrome. Ann Intern Med. 2008;149:216-218. [PubMed] [Google Scholar] DISCLOSURES: No relevant relationships by Muhammad Hanif, source=Web Response No relevant relationships by Sudheer Konduru, source=Web Response No relevant relationships by Marino Leonardi, source=Web Response No relevant relationships by SANA MULLA, source=Web Response No relevant relationships by Ruqqiya Mustaqeem, source=Web Response No relevant relationships by Vihitha Thota, source=Web Response

Neuro-telehealth for fragile patients in a tertiary referral neurological institute during the COVID-19 pandemic in Milan, Lombardy

BACKGROUND: Lombardy was severely hit by the COVID-19 pandemic since February 2020 and the Health System underwent rapid reorganization. Outpatient clinics were stopped for non-urgent patients: it became a priority to manage hundreds of fragile neurological patients who suddenly had less reference points. In Italy, before the pandemic, Televisits were neither recognized nor priced. METHODS: At the Fondazione IRCCS Istituto Neurologico C. Besta, we reorganized outpatient clinics to deliver Neuro-telemedicine services, including Televisits and Teleneurorehabilitation, since March 2020. A dedicated Working Group prepared the procedure, tested the system, and designed satisfaction questionnaires for adults and children. RESULTS: After a pilot phase, we prepared a procedure for Telemedicine outpatient clinics which was approved by hospital directions. It included prescription, booking, consenting, privacy and data protection, secure connection with patients (Teams Microsoft 365), electronic report preparation and delivery, reporting, and accountability of the services. During the March-September 2020 period, we delivered 3167 Telemedicine services, including 1618 Televisits, to 1694 patients (972 adults, 722 children) with a wide range of chronic neurological disorders. We successfully administered different clinical assessment and scales. Satisfaction among patients and caregivers was very high. CONCLUSIONS: During the dramatic emergency, we were able to take care of more than 1600 patients by organizing Neuro-telehealth in a few weeks, lessening the impact of the pandemic on fragile patients with chronic neurological disorders;this strategy is now stably embedded in our care pathways. In Italy, Telehealth is at present recognized and priced and is becoming a stable pillar of the health system.