ABSTRACT
BACKGROUND: Neurologic events have been reported in patients with coronavirus disease 2019 (COVID-19). However, a model-based evaluation of the spatial distribution of these events is lacking. PURPOSE: Our aim was to quantitatively evaluate whether a network diffusion model can explain the spread of small neurologic events. DATA SOURCES: The MEDLINE, EMBASE, Scopus, and LitCovid data bases were searched from January 1, 2020, to July 19, 2020. STUDY SELECTION: Thirty-five case series and case studies reported 317 small neurologic events in 123 unique patients with COVID-19. DATA ANALYSIS: Neurologic events were localized to gray or white matter regions of the Illinois Institute of Technology (gray-matter and white matter) Human Brain Atlas using radiologic images and descriptions. The total proportion of events was calculated for each region. A network diffusion model was implemented, and any brain regions showing a significant association (P < .05, family-wise error-corrected) between predicted and measured events were considered epicenters. DATA SYNTHESIS: Within gray matter, neurologic events were widely distributed, with the largest number of events (â¼10%) observed in the bilateral superior temporal, precentral, and lateral occipital cortices, respectively. Network diffusion modeling showed a significant association between predicted and measured gray matter events when the spread of pathology was seeded from the bilateral cerebellum (r = 0.51, P < .001, corrected) and putamen (r = 0.4, P = .02, corrected). In white matter, most events (â¼26%) were observed within the bilateral corticospinal tracts. LIMITATIONS: The risk of bias was not considered because all studies were either case series or case studies. CONCLUSIONS: Transconnectome diffusion of pathology via the structural network of the brain may contribute to the spread of neurologic events in patients with COVID-19.
Subject(s)
Brain/diagnostic imaging , Brain/pathology , COVID-19/diagnostic imaging , COVID-19/pathology , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/pathology , Gray Matter/diagnostic imaging , Gray Matter/pathology , Humans , Magnetic Resonance Imaging/methods , White Matter/diagnostic imaging , White Matter/pathologyABSTRACT
Background and Aim: Regional and rural populations with chronic hepatitis C virus (HCV) infection remain undertreated due to low primary care uptake, combined with limited access to specialist care and follow-up. Telehealth (TH) addresses many barriers to treatment access, has previously proven successful for HCV management in rural and prison settings, and has been proposed as an alternative for patients who remain geographically and socioeconomically disadvantaged, particularly in the coronavirus 2019 era. We aimed to report the clinical outcomes and the cascade of care of a novel nurse-led HCV TH clinic set in regional Victoria. Methods: We performed a retrospective cohort analysis of all patients referred to a regional HCV TH service between 1 April 2017 and 10 June 2020. Data were collated from outpatient and electronic medical records, as well as prospectively collected qualitative patient surveys. Results: A total of 55 patients were booked into the HCV TH clinic, and the outcomes are shown in Figure 1. Twenty-five patients (54%) had a history of alcohol use disorder, 24 (52%) had psychiatric comorbidity, and five (11%) had obesity. Thirteen of the 14 (93%) who received treatment achieved sustained virological response. We additionally demonstrated successful TH-driven hepatocellular carcinoma surveillance among the subgroup of patients with cirrhosis. An average of 46.48 km of travel, 54.64 min, and A$30.67 was saved per patient for each visit. Overall patient satisfaction gathered via Likert scale surveys was positive, with observed benefits including increased medical engagement, adherence to treatment, and improvement in long-term health outcomes at a personal and cohort level. Conclusion: Nurse-led HCV management via TH has allowed access for a marginalized regional population with high levels of substance misuse and psychiatric comorbidity. Clinical outcomes were comparable to those previously reported from tertiary and community-based cohorts, with additional cost benefit, efficiency gains, and carbon footprint reduction among a previously unreported regional Victorian population with HCV.