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COVID-19 lockdown measures have impacted the environment with both positive and negative effects. However, how human populations have perceived such changes in the natural environment and how they may have changed their daily habits have not been yet thoroughly evaluated. The objectives of this work were to investigate (1) the social perception of the environmental changes produced by the COVID-19 pandemic lockdown and the derived change in habits in relation to i) waste management, energy saving, and sustainable consumption, ii) mobility, iii) social inequalities, iv) generation of noise, v) utilization of natural spaces, and, vi) human population perception towards the future, and (2) the associations of these potential new habits with various socio-demographic variables. First, a SWOT analysis identified strengths (S), weaknesses (W), opportunities (O), and threats (T) generated by the pandemic lockdown measures. Second, a survey based on the aspects of the SWOT was administered among 2370 adults from 37 countries during the period from February to September 2021. We found that the short-term positive impacts on the natural environment were generally well recognized. In contrast, longer-term negative effects arise, but they were often not reported by the survey participants, such as greater production of plastic waste derived from health safety measures, and the increase in e-commerce use, which can displace small storefront businesses. We were able to capture a mismatch between perceptions and the reported data related to visits to natural areas, and generation of waste. We found that age and country of residence were major contributors in shaping the survey participants ´answers, which highlights the importance of government management strategies to address current and future environmental problems. Enhanced positive perceptions of the environment and ecosystems, combined with the understanding that livelihood sustainability, needs to be prioritized and would reinforce environmental protection policies to create greener cities. Moreover, new sustainable jobs in combination with more sustainable human habits represent an opportunity to reinforce environmental policy.
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Background and aims: Intensive Care Units(ICUs) are a necessary resource for many patients with large vessel occlusion stroke(LVOS) after endovascular treatment(EVT). However, ICUs have a limited availability of beds and ventilators, situation that has been worsened by the current Covid-19 pandemic. We analyze predicting factors for prolonged mechanical ventilation(PMV) after EVT in patients with LVOS. Methods: Retrospective study of patients admitted to our stroke center from 2012-2019 for LVOS who were treated with EVT. We identified patients that required PMV(defined as >24h intubation with admission in ICU) after EVT, and evaluated the association with clinical and radiological factors on admission. Results: N=438. 236(53.9%) women. Mean age 69(DE 14.6). 411(93.8%) anterior circulation stroke, 27(6.2%) posterior. 82(19%) required general anesthesia and intraprocedural intubation, and 47 of them(10.7%) required PMV. Median length of stay(LOS) in ICU: 3 days(1-7). 12/47(25.5%) had prolonged LOS for another reason (6 neurological worsening, 4 hemodynamic instability, 1 respiratory infection, 1 no available beds at Stroke Unit). 19/47(44%) died and 22/47(52.4%) were functionally dependent at three months. Factors associated to a higher risk of PMV after EVT were: basilar occlusion (OR=12.3, IC95%[5.3-28.4],p<0,001);ASPECTS ≤7 (OR=3, IC95%[1.4-6.1],p=0,003) and NIHSS ≥18 (OR=2.8, IC95%[1.3- 5.8],p=0,006). Patients with PMV had a higher risk of mortality (OR=6.5, IC95%[3.3-12.8],p<0,001) and functional dependence (OR=5.1, IC95%[2.4-1],p<0,001) at three months. Conclusions: In our study, patients with basilar occlusion, high NIHSS and lower ASPECTS had higher probability of requiring PMV after EVT, which also led to worse outcome. These are aspects to consider in scenarios with limited availability of ICU beds.
Subject(s)
COVID-19 , Cysts , COVID-19/complications , Cysts/complications , Cysts/diagnostic imaging , Hemorrhage/complications , HumansABSTRACT
Objective: We aim to characterize this symptom and identify factors associated with headache in COVID-19. Background: Previous studies have demonstrated that headache is an important neurological manifestation during SARS-CoV-2 infection. However, little is known about the characteristics of COVID-19 patients that exhibit headache. Design/Methods: This retrospective study includes COVID-19 patients with headache hospitalized during March 2020. Controls comprise COVID-19 patients without headache. Demographic, clinical and laboratory data were obtained from the medical records. Headache characteristics were evaluated by semi-structured telephonic interview after discharge. Results: Of a total of 379 COVID-19 patients, 48 (13%) developed headache. Among these, 30 (62%) were men and the median age was 57.9 (47-73) years. Headache was associated with younger age, less comorbidities and reduced mortality, as well as with low levels of C-Reactive Protein, mild acute respiratory distress syndrome (ARDS) and oropharyngeal symptoms. A logistic multiple regression model revealed that headache was directly associated with D-dimer and creatinine levels, the use of high flow nasal cannula and arthromyalgia, while urea levels, beta-lactamic treatment and hypertension were negatively associated with headache. COVID- 19-associated headache characteristics were available in 23/48 (48%) patients. Headache was the onset symptom in 8/20 (40%), of mild or moderate intensity in 17/20 (85%) patients, with oppressive characteristics in 17/18 (94%) and holocranial 8/19 (42%) or temporal 7/19 (37%) localization. Conclusions: Our results show that headache is associated with mild pulmonary disease and inflammation during SARS-CoV-2 infection. COVID-19-associated headache appears in most cases as an early symptom and as a novel headache with characteristics of headache attributed to systemic viral infection. Further research addressing the underlying mechanisms to confirm these findings is warranted.
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Background and aims: In early 2020, the novel coronavirus disease (COVID-19) pandemic has impaired medical care of chronic neurological diseases, including epilepsy. The objective of this study is to evaluate the impact of the COVID-19 pandemic in the levels of anxiety, depression, somnolence and quality of life using validated scales in patients with epilepsy in real-life clinical practice. Methods: Self-administered scales of anxiety disorders (GAD-7), depression (NDDI-E), somnolence (Epworth Sleepiness Scale;ESS) and quality of life (QOLIE-31-P) in patients with epilepsy treated in the Refractory Epilepsy Unit of a tertiary hospital were longitudinally analyzed with Generalized Linear Mixed Models. Data were collected before the beginning (December 2019-March 2020) and during the COVID-19 pandemic (September 2020-January 2021). Results: 37 patients, 45.0±17.3 years of age, 43.2% women, epilepsy duration 23.0±14.9 years, number of anti-epileptic drugs 2.1±1.4, answered in the two periods. Significant longitudinal reduction of QOLIE-31-P scores (from 58.9±19.7 to 56.2±16.2, p=0.035) was identified. No statistically significant longitudinal changes in NDDI-E (from 12.3±4.3 to 13.4±4.4, p=0.293) or the number of seizures (from 0.9±1.9 to 2.5±6.2, p=0.125) were found. Significant higher ESS (from 4.9±3.7 to 7.4±4.9, p=0.001) and lower GAD-7 scores (from 8.8±6.2 to 8.3±5.9, corrected p=0.024 adjusted by refractory epilepsy and sleep disturbance) were found during the COVID-19 pandemic. Conclusion: During the COVID-19 pandemic, quality of life was lower in patients with epilepsy, levels of anxiety were reduced and sleepiness levels were raised, without seizure change. Additional studies would be useful to adequately manage these comorbidities.
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Background: Tocilizumab is a monoclonal antibody against IL-6 that has been used to treat Neuromyelitis Optica spectrum disorders (NMOSD), generally intravenous. The evidence about its subcutaneous formulation to treat these diseases is scarce, but its efficacy seems to be similar. During SARS-CoV-2 pandemic, decreasing hospital attendance became a priority. According to this, subcutaneous formulations may represent a good therapeutic option in this context. Objectives: We present 3 cases of NMSOD who initiated subcutaneous tocilizumab during SARS-CoV-2 pandemic, with very good tolerability in all the cases. Methods: Retrospective and observational study. We reviewed clinical charts, patients' outcomes and available bibliography. Results: Patient 1: 74 year-old male, diagnosed with Neuromyelitis Optica (NMO) in 2010. He was started on rituximab in 2012. In 2018, he suffered from two optic neuritis (despite the absence of CD19+ and CD27+ cells in peripheral blood). Because of that, in 2019, rituximab was switched to intravenous tocilizumab, with good response and tolerability. In April 2020, due to SARS-CoV-2 pandemic, it was switched to subcutaneous tocilizumab in order to avoid hospital attendance, with very good tolerability. Patient 2: 40 year-old female, diagnosed with NMOSD vs CRION (chronic relapsing inflammatory optic neuropathy). Positive anti-NMO antibodies and negative anti-MOG antibodies were found. She was started on rituximab in 2015. In December 2019, she suffered from an optic neuritis despite having no CD19+ cells in peripheral blood. Hence, rituximab was switched to intravenous tocilizumab without any incidence. In March 2020, she was started on subcutaneous tocilizumab once a week because of the pandemic, with very good tolerability. Patient 3: 28 year-old female, diagnosed with seropositive NMO in 2012, treated with rituximab since 2014, free of relapses since them. In May 2020, we decided to switch to tocilizumab (subcutaneous to decrease hospital visits due to SARS-CoV-2 pandemic) because of hypogammaglobulinemia and repeated respiratory tract infections. Conclusions: Tocilizumab may be an option to treat NMOSD patients. Subcutaneous form decreases hospital visits and, according to our experience, is very well tolerated. Therefore, we postulate it can be a good alternative in the current situation.
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TITLE: Hemorragias cerebrales múltiples secundarias a coagulación intravascular diseminada en un paciente con COVID-19.
Subject(s)
COVID-19 , Disseminated Intravascular Coagulation , Cerebral Hemorrhage/etiology , Disseminated Intravascular Coagulation/etiology , Humans , SARS-CoV-2ABSTRACT
TITLE: Parálisis facial periférica aislada en un paciente con COVID-19.