A case report of restless leg syndrome worsened after COVID-19 vaccine

Case Report Restless legs syndrome (RLS) is a poorly understood underdiagnosed neurological, sensorimotor disorder. RLS arises from central nervous system dysfunction leading to both sensory and motor symptoms. Limited cases of COVID-19 vaccines related neurological sequelae, such as Guillain-Barré syndrome (GBS), have been reported. Case presentation A 77-year-old male patient with a past medical history of well-controlled hypertension, diabetes mellitus, hypothyroidism, coronary artery disease status post percutaneous coronary intervention, obstructive sleep apnea on CPAP at night, and restless leg syndrome diagnosed 20 years ago, presented complaining of a 3-month history of worsening of his restless leg symptoms although being compliant with his medications 2 weeks after his 2nd dose of Moderna vaccine. He stated that the frequency and severity of his symptoms had increased from 3-4 times a week lasting for minutes to a daily basis lasting for hours at night, had improved partially with exercise, and affected his sleep hygiene and daily morning activities. He requested several refills of his previously prescribed ropinirole. A comprehensive evaluation, including clinical examination, laboratory workup, brain computed tomography, and polysomnography was unremarkable. He was commenced on pramipexole 0.5 mg daily and instructed to follow up in the clinic in 3 months and call back with no improvement or worsening of his symptoms. Conclusion This case fulfilled the four essential features of RLS, urge to move, worsening with rest, improvement with exercise, and worsening in the evening. To date, no case of RLS associated with COVID-19 vaccines has been previously reported. Although COVID-19 vaccines are relatively safe, long-term complications should be monitored closely.

Coeliac disease in the COVID-19 pandemic: does HLA have a protective effect?

BACKGROUND: The coronavirus disease 2019 (COVID-19), an acute respiratory disease caused by a novel coronavirus (SARS-CoV-2), is emerging as a worldwide public health emergency. Several scientific contributions reported the potential relevance of human leukocyte antigen (HLA) polymorphism and susceptibility to viruses, such as SARS-CoV. In our study, we examined a population of coeliac subjects presenting the HLA haplotype DQ2 and/or DQ8. Our aim was to evaluate whether HLA DQ2 and/or DQ8 haplotype play a role in SARS-CoV-2-infection. The aim was also to evaluate the difficulty in following the gluten-free diet due to all the adversities produced by the pandemic, such as the food supply disruption, and the difficulties in managing the clinical follow-up. METHODS: 191 consecutive coeliac patients completed a questionnaire on their current clinical status, psychological effects, and management of the gluten-free diet experienced during the COVID-19 pandemic and questions regarding possible SARS-CoV-2 infection. RESULTS: Out of the 191 patients who participated in the study, 42 were full-blown coeliac and 149 were in remission. From the answers provided, 84.8% of patients declared that they no longer consider themselves vulnerable to COVID-19 as they suffer from coeliac disease; 94.2% of patients did not encounter any difficulties in managing the gluten-free diet or in acquiring specific foods and 64.9% of patients in our study underwent diagnostic testing for SARS-CoV-2. Out of this number, 31.5% did so due to contacts with subjects affected by COVID-19, 26.6% for work related reasons, 11.3% due to flu-like symptoms and 30.6% for other reasons. Only 5.8% of the enrolled patients received a diagnosis of COVID-19. Out of all the patients in our population who were diagnosed with COVID-19, 94.8% developed no symptoms and none of them needed hospitalization or intensive care. CONCLUSION: The hypothesis that the HLADQ2 and/or DQ8 haplotype plays a protective role against SARS-CoV-2 infection, as against other viral infections, is intriguingly suggestive.KEY MESSAGESCOVID-19 as a public health emergency;SARS-CoV-2 and possible complications in coeliac disease;Role of HLA DQ2 and/or DQ8 in SARS-CoV-2 infection.

ExMed: An AI Tool for Experimenting Explainable AI Techniques on Medical Data Analytics

Local Interpretable Model-Agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP) algorithms have been widely discussed by the Explainable AI (XAI) community but their application to wider domains are rare, potentially due to the lack of easy-to-use tools built around these methods. In this paper, we present ExMed, a tool that enables XAI data analytics for domain experts without requiring explicit programming skills. It supports data analytics with multiple feature attribution algorithms for explaining machine learning classifications and regressions. We illustrate its domain of applications on two real world medical case studies, with the first one analysing COVID-19 control measure effectiveness and the second one estimating lung cancer patient life expectancy from the artificial Simulacrum health dataset. We conclude that ExMed can provide researchers and domain experts with a tool that both concatenates flexibility and transferability of medical sub-domains and reveal deep insights from data. © 2021 IEEE.

Evaluation of SARS-CoV-2 in humansemen and effecton total sperm number: A prospective observational study

INTRODUCTION AND OBJECTIVE: The severe acuterespiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created a surge of research to help better understand the breadth of possible sequelae. However, little is known regarding the impact on semen parameters and fertility potential. Our study sought to evaluate the impact of SARS-CoV-2 on male reproduction among American men. We collected semen samples from men who recovered from SARS-CoV-2 infection to evaluate for the presence of SARS-CoV-2. We also assessed the impact of SARS-CoV-2 infection on total sperm number (TSN) in ejaculate both during the acute phase after testing positive and a smaller cohort of men at follow-up. METHODS: We prospectively recruited thirty men diagnosed with acute SARS-CoV-2 infection using real-time reverse transcriptasepolymerase chain reaction (RT-PCR) of pharyngeal swab specimens. Semen samples were collected from each individual using mailed kits. Follow-up semen samples were done with mailed kits or inperson in office setting. Semen analysis and PCR was performed after samples were received. RESULTS: Thirty semen samples from recovered men were obtained 11-64 days after testing positive for SAR-CoV-2 infection. The median duration between positive SAR-CoV-2 test and semen collection was 37 days (IQR=23). The median total sperm number (TSN) in ejaculate was 12.5 million (IQR=53.1). When compared with age-matched SARS-CoV-2(-) men, TSN was lower among SARS-CoV-2(+) men (p=0.0024). Five men completed a follow-up sperm analysis (median 3 months) and had a median TSN of 18 million (IQR=21.6). No RNA was detected by means of RT-PCR in the semen in 16 samples tested. CONCLUSIONS: SARS-CoV-2 infection, though not detected in semen of recovered men, can affect TSN in ejaculate in the acute setting. Whether SARS-CoV-2 can affect spermatogenic function longterm remains to be evaluated.

Hypertension and COVID-19: The possible role of metalloproteinase-9 in COVID-19 pathophysiology

Objective: The pathophysiological mechanism of acute lung injury in COVID-19 includes a cascade of local and systemic responses with activation of several proinflammatory cytokines, including metalloproteinases. The aim of this study is investigate the role of matrix metalloproteinase-9 (MMP-9) in plasma from patients with severe COVID-19 hospitalized in a Brazilian ICU Design and method: The study was designed to analyze the MMP-9 plasmatic in COVID-19 severe infection. Epidemiological data and blood samples were obtained from 42 subjects hospitalized in the ICU with clinically SARS-CoV-2 infection con firmed by RT-PCR (COVID), and 15 healthy subjects (Control). Zymography methods obtained the MMP-9 plasma activity. Continuous variables are shown by mean±STDV and analyzed by the Mann-Whitney test. Categorical variables were compared by the Chi-squared test. The MMMP-9 activity is shown in the log of normalized and analyzed by unpaired T-test. Two-way ANOVA was used to analyze subgroups divided by gender, age greater or less than the median 60.4-year-old, hypertensive or normotensive, non-obese or obese Results: The COVID and Control groups did not differ signi ficantly by age (62.6±13vs.57.6±12.2 years old, p=0.097) and BMI (30.3±6.1vs.29.33±5.7 kg/m2, p=0.338). The COVID group has fewer women than the Control group (28.6%vs.80%, p=0.0008). The COVID subjects with hypertension were 42% vs.67% in the Control group (p=0,2), and diabetes was similar in both groups The hospital stay in the COVID group was 14.5±11.5 days and the hospitalization death rate was 32.5% The COVID-19 group has shown an increase in MMP-9 activity compared with the Control group (0.38±0.072 UA;95%CI=0.23-0.52,p<0.0001). The MMP-9 activity increasing was independent of gender (p=0.45), age (p=0.93), BMI (p=0.3) or hypertension (p=0.6) and dependent of the COVID-19 infection (p<0.0001). Therefore, our data are showing that the COVID-19 infection was responsible for MMP-9 improvement in plasma of severe COVID-19 infection (p<0.0001) while all different analyses consistently showed a signi ficant effect of COVID-19 infection (p<0.0001) Conclusions: There is a signi ficant increase in the MMP-9 plasmatic activity in severe COVID-19 patients independently of sex, age, obesity, and hypertension Therefore, MMP-9 may be a potential new target for acute lung injury therapy in patients with COVID-19.

AN EVALUATION OF SEMEN PARAMETERS IN MEN WITH CONFIRMED COVID-19 INFECTION

Objective: Our aim was to evaluate the semen parameters of men with COVID-19 infection. Design: A prospective study was performed to evaluate the gross semen parameters in men with COVID-19 infection. Samples of saliva and semen were collected and analyzed. Materials and Methods: We included men age 18-70 years old who tested positive for COVID-19. Subjects were contacted about willingness to participate. Packages with sterile specimen containers were mailed to the subject’s house with a preaddressed package included to return to our lab. The semen then underwent gross semen analysis for volume, concentration, pH and motility. Results: A total of 12 men were enrolled in the study with a median age of 35.5 (IQR = 19.5) (Table 1). The median duration of infection was 37 days (IQR = 21) and 2/12 (16.7%) had associated orchitis symptoms during the infective period. For the 11/12 men who returned a semen specimen, median volume was 1.6cc (IQR = 1.65), median pH was 7.2 (IQR = 0.2), median concentration was 14 million/cc (IQR = 30.25), and median motility of 0% (IQR = 12.5). Conclusions: We evaluated 11 men’s gross semen parameters after confirmed infection with COVID-19. The median concentration for these men is abnormally low compared to World Health Organization guidelines, and further evaluation is needed to determine the impact that COVID-19 infection can have on the testis and for what duration. [Formula presented]