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Neurological Sciences ; 43(Supplement 1):S12, 2022.
Article in English | EMBASE | ID: covidwho-2174256


Introduction and objectives: Myelitis is a known parainfective complication of Covid-19 infection and can follow SARS-CoV-2 vaccination. Here, we present two of such cases comparing clinical, laboratory and radiological features. Case 1: A 40-year-old male attended our Emergency Department (ED) with Covid-19 (day-9) infection with new onset urinary retention lower limb sensory-motor weakness and a T10 sensory level. Spinal MRI confirmed subacute thoracic myelitis (T3-T8) with heterogeneous contrast uptake for which high-dose steroids were started. Cerebrospinal fluid (CSF) on day 2 showed 16 leucocytes/microL (mostly polymorphonuclear). PCR for SARS-CoV-2 was still positive on serum but negative on CSF. Clinical deterioration continued to severe upper limbs weakness, paraplegia, a T3 sensory level and a weak cough reflex despite a 5-day course of immunoglobulins. Considering the progressive course and a negative COVID swab (day 5), 6 plasma exchange sessions were arranged. On day 27, CSF showed 1 leucocyte/microL with intrathecal IgG synthesis and no blood brain barrier (BBB) dysfunction and a repeat MRI confirmed progression of myelitis with involvement of cervical segments without contrast enhancement. Eventually, clinical stability was reached after infusion of cyclophosphamide on day 31. Case 2: An 83-year-old man presented to the ED with new-onset left leg sensory-motor deficits associated with haematuria whilst on oral anticoagulants for atrial fibrillation (AF). He had received the 3rd vaccination against COVID-19 (mRNA-based) 3 days prior. Following initial discharge, he experienced urinary retention and progressive ascending weakness. Neurological examination after 3 weeks showed paraplegia, lower limbs areflexia, an extensor plantar response on the left, anesthesia below T5 and upper limbs weakness. MRI of the spine without contrast revealed altered signal in the cord from the bulbar to the thoracic levels and around the conus medullaris, compatible with diffuse myelitis. CSF showed a mild protein increase (67 mg/dL), type 2 oligoclonal bands and BBB dysfunction. A 5-day course of high dose IV methylprednisolone (1g) followed by a tapering regimen led to a good clinical response. Spinal MRI with contrast after 20 days confirmed improvements with intramedullary enhancement suggesting persistent barrier damage. The patient was eventually discharged after 32 days with residual paraparesis. Discussion and conclusions: Our patient with parainfective myelitis showed no evidence of BBB dysfunction, little contrast uptake on MRI and a more severe clinical course refractory to several therapies. Conversely, the post-vaccination case exhibited a more inflammatory and benign phenotype suggesting specific disease-related mechanisms and pathogenesis could account for these differences.

Latin American Economic Review ; 29(1):44, 2020.
Article in English | Web of Science | ID: covidwho-1089360


This document offers estimates of the possible changes in the social structure of the countries of Latin America derived from the consequent economic contraction from the Covid-19 pandemic, and explores the possible costs and benefits of different types of interventions to cushion its impact. The analysis forecasts that the number of people living in poverty (extreme and moderate) would increase by up to 44 thousand million people in the region. It also finds that the policy with the highest benefit-cost ratio is the postponement of payroll taxes and social security contributions. Other alternatives such as granting support to unemployed persons, temporarily doubling the benefits of existing social programs, and the transfer of income to self-employed workers also generate a favorable benefit-cost ratio, with differences among countries.