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1.
European Geriatric Medicine ; 13(Supplement 1):S427-S428, 2022.
Article in English | EMBASE | ID: covidwho-2175529

ABSTRACT

Background: The literature regarding the use of antiviral medications for treating patients affected by coronavirus disease (COVID- 19) is still conflicting. In particular, data regarding the importance of prognostic tools is largely unexplored. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of antiviral medications in hospital. Method(s): Older people hospitalized for COVID-19 in ten European hospitals were followed-up for 90 days after hospital discharge. MPI was calculated using eight different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of antivirals on mortality (overall and in hospital), stratified by MPI = 0.50. Result(s): Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 140 were treated with antiviral medications. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. The use of antiviral medications significantly decreased the risk of overall mortality (hazard ratio, HR: 0.70;95% confidence intervals, CIs: 0.48-0.991;HR = 0.54;95%CI: 0.35-0.83 in propensity score analysis) in the sample as whole. However, the effect was present only in less frail participants (HR = 0.46;95%CI: 0.22-0.96;HR = 0.47;95%CI: 0.22-0.96 in propensity score analysis), but not in frailer individuals. No effect on in hospital mortality was observed. Conclusion(s): MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from antivirals.

2.
Neurological Sciences ; 43(Supplement 1):S324-S325, 2022.
Article in English | EMBASE | ID: covidwho-2174320

ABSTRACT

Aim: This study aims to address the impact of a set of new-onset neurological and mental health symptoms on post-COVID-19 disability. Materials: A total of 83 COVID-19 survivors, without pre-morbid brain conditions, completed the following instruments approximately three months after hospital discharge: the 12-items WHO Disability Assessment Schedule (WHODAS-12), herein used as a primary outcome, the Hospital Anxiety and Depression Score, the Pittsburgh Sleep Quality Index, the Montreal Cognitive Assessment, a standardizedmedical and neurological symptoms checklist, and a neurological examination. Method(s): Neurological and mental health symptoms, assessed through the questionnaires used in the protocol, were considered as variables of interest to address disability variation. The ability of each variable to explainWHODAS- 12 score variation was tested in a univariate regression model and only significant variableswere retained for a subsequentmultivariatemodel. Specifically, the retained variables were analysed with a backward procedure. Result(s): The most common symptoms at follow-up were sleep disturbances, cognitive dysfunctions, and fatigue. As for the impact of neurological and mental health symptoms on disability level, our results showed that cognitive dysfunction, anxiety, fatigue, and hyposmia/hypogeusia explained 28.8% of WHODAS-12 variation. Discussion(s): A previous study [1] has shown that COVID-19 survivors, in addition to reporting long-term symptoms, described persistent functional limitations and reduced quality of life. In line with other studies, our results added evidence on post-COVID-19 brain-related symptoms as potential drivers factor of disability. It is therefore essential to provide early medical and neurorehabilitative interventions, necessary for the recovery of long-term improvement and functional independence of patients. Rehabilitation interventions for anxiety, fatigue, cognitive dysfunction, and hyposmia could affect about a third of the disability found in COVID-19 survivors. Hence the importance of promptly highlighting and treating such symptoms to limit the consequences on the functioning of the individual. For instance, cognitive dysfunctions such as memory deficit are associated with an increased risk of future cognitive deterioration [2], as well as anxiety has a strong impact on the disability level of the general population [3]. Conclusion(s): In summary, our study found that the high prevalence of long-term neurological and mental health symptoms affects the disability and functioning of COVID-19 survivors, predicting almost one-third of WHODAS-12 variation. These findings highlighted the need for longitudinal follow-up assessments in patients and an early comprehensive rehabilitation system, allowing the COVID-19 survivors to restore their level of health and functioning.

3.
Neurological Sciences ; 43(Supplement 1):S66, 2022.
Article in English | EMBASE | ID: covidwho-2174318

ABSTRACT

Objectives: Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated demyelinating disorder of the Central Nervous System (CNS), often occurring post-infections and post-immunization, although a causal relationship has never been established. The most common vaccinations associated with ADEM are the non-neural measles, mumps and rubella vaccines, yet a few cases have been reported after SARS-CoV2 vaccination. Material(s) and Method(s): Here we describe a case of ADEMpresenting 4 weeks after receiving the first dose of SARS-CoV2 mRNA-1273 vaccine. Result(s): A 61 years-old woman, with a history of rheumatoid arthritis and cryoglobulinemia requiring immunosuppressive treatment, developed headache and fever two weeks after vaccination. Symptoms persisted for 1 week, but then spontaneously improved. At 4 weeks from the vaccine dose, she was admitted to the ER for acute onset of speech impairment, diplopia, hearing loss and dizziness. On admission, neurological examination showed mild aphasia, sensorineural hear impairment, abducens nerve palsy in the right eye and ataxic gait. Bloodwork excluded inflammatory abnormalities and infectious disorders;extensive immunological screening, including anti-myelin oligodendrocyte glycoprotein (MOG) antibodies, anti-acquaporine4 (AQP4) antibodies, antigangliosides antibodies and HLA-B51 typing, was unremarkable, except for the presence of cryoglobulins. Cerebrospinal fluid (CSF) analysis revealed increased protein count, mild pleiocytosis with a high percentage of lymphocytes and positive oligoclonal bands. CSF-screening for infectious agents, namely herpes simplex virus, enterovirus, Epstein-Barr virus, and mycoplasma, was negative. Brain and spinal cord Magnetic Resonance Imaging (MRI) demonstrated T2-weighted and fluidattenuated inversion recovery (FLAIR) hyperintense multiple lesions, involving the basal ganglia, cortical-subcortical temporal lobe and cerebellar hemispheres, characterized by partial gadolinium-enhancement. The absence of cerebral vascular abnormalities at MRI excluded the diagnosis of vasculitis and ophthalmologic evaluation was negative for other rare immunological disorders, namely Susac and Cogan Syndrome. As first line therapy, high-dose IV methylprednisolone was administrated, followed by IV immunoglobulin treatment, both showing a poor response. The patient was finally treated with seven plasma exchanges every other day, with significant progressive clinical improvement. Discussion(s): The typical clinical presentation, the temporal association with SARS-CoV2 vaccination and the neurological improvement with plasma exchange are suggestive for diagnosis of post-vaccination ADEM. At one-year follow-up evaluation, the patient referred a complete resolution from symptoms, as confirmed by neurological examination and MRI improvement. Conclusion(s): To note, demyelinating syndromes with heterogeneous clinical presentation have been described after mRNA-based vaccine, often occurring in patients with history of immune-mediated disease. Prompt diagnosis and treatment are warranted to improve neurological outcome and prognosis.

4.
Neurological Sciences ; 43(Supplement 1):S370-S371, 2022.
Article in English | EMBASE | ID: covidwho-2174279

ABSTRACT

Introduction:Myastenia Gravis (MG) is a rare neurological immune-mediated disease characterized by defective transmission at the neuromuscular junction (NMJ). Experimental and clinical evidence suggests that some forms of MG are initiated in the thymus, where acethilcolyne receptor expression is activated through cytokine and receptor signalling, potentially triggered by a virus. Since the emergence of Covid-19 pandemia, SARS-CoV2 has been implicated in the development of a range of autoimmune diseases, notwithstanding the association between immunological diseases and infections is still poor understood. In this observational study we aimed to describe the incidence and clinical features of patients with new-MG diagnosis after Covid-19 burden. Method(s): Out of 220 MG outpatients evaluated at our neuroimmunological center, 44 cases (20%) had a new diagnosis of MG after SARS-CoV2 infection outbreak (February 2020). Demographic and clinical data were extracted from digital records and compared to a control group of 57 patients (26%) diagnosed with MG from January 2017 till January 2020. Result(s): Patients with MG diagnosis after Covid-19 onset showed similar age (61.1 + 15.2 vs 61.3 + 16.5, p=0.940), sex distribution (female %, 42.3% vs 52.6%, p= 0.843), and history of immunological diseases (%, 20.5% vs 15.8%, p=0.605) compared to the control cases. Acetylcholine-receptor antibody positivity rate and the prevalence of thymic disorders, namely thymic hyperplasia and thymoma, were similar in the two groups. Clinical features at onset in the patients diagnosed withMGafter Sars-CoV2 diffusion showed the same percentage of ocular (68.4% vs 63.6%, p= 0.674) and bulbar (19.3% vs 27.3%, p=0.352) phenotypes, with no differences in terms of Myasthenia Gravis Foundation of America (MGFA) classification, compared to MG patients diagnosed before Covid-19 outbreak. Discussion(s): Our observational single-center study showed a similar incidence of MG cases before and after Covid-19 pandemic diffusion, with comparable clinical features at onset. Historically, viral infections have had a complex relationship with a variety of autoimmune systemic and neurological diseases, includingMG. To date, it is speculated that SARS-CoV-2 can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells;the consequence of this immune dysregulation ranges from the production of autoantibodies to the onset of immunological disease, namely thyroiditis, vasculitis and arthritis. Conclusion(s): Extensive long-term studies are warranted to shed light on pathogenesis of neuro-immunological disorders in order to identify predictive factors and improve therapeutic targets.

5.
Neurological Sciences ; 43(Supplement 1):S34, 2022.
Article in English | EMBASE | ID: covidwho-2174276

ABSTRACT

Objectives: Severe acute respiratory syndrome coronavirus two (SARS-CoV- 2) is a pathogenic coronavirus that was discovered in later 2019 and has caused a pandemic of acute respiratory disease, named 'coronavirus disease 2019 (COVID-19)', which can lead to systemic complications. From the beginning of the pandemic, global efforts have been focused on developing vaccines for COVID-19 prevention, which have been distributed worldwide. However various complications have been reported so far, among which neurological ones include seizures, Guillain Barre, autoimmune encephalitis. (1). We report a case of autoimmune encephalitis following contemporary administration of anti SARS-COV2 and influenza vaccines. Material(s) and Method(s): A 73 years -old caucasian woman received the third dose of the COVID-19 Vaccine Moderna mRNA -1273 and quadrivalent influenza vaccine in the same day. In the following two days she experienced side effects such as malaise, localized pain, fever which lasted one day. After six days from vaccine administration neurological condition worsened with appearance of expressive aphasia, bilateral ideomotor apraxia and agraphia without meningism. Her medical history was unremarkable. Result(s): Electroencephalogram revealed fronto-temporal bilateral epileptiform activity while lumbar puncture with cerebrospinal fluid (CSF) revealed pleocytosis of 61 leukocytes (mononucleated cells)/mul with elevated protein levels (61 mg/dL, reference range: 15-45). Brain magnetic resonance was normal particularly excluding stroke, herpes encephalitis, brain tumors. FILMARRAYTM Meningitis/Encephalitis Panel for common pathogens that cause central nervous system infections (including viruses, bacteria and yeast) in CSF resulted negative. Blood exams resulted all normal except for erythrocyte sedimentation rate (42 mm, reference range: one-32) and C reactive protein (5.3 mg/L, reference range: <5.0).

6.
Neurological Sciences ; 43(Supplement 1):S35-S36, 2022.
Article in English | EMBASE | ID: covidwho-2174275

ABSTRACT

Objectives: Severe acute respiratory syndrome coronavirus two (SARSCoV- 2) is a pathogenic coronavirus that was discovered in later 2019 and has caused a pandemic of acute respiratory disease, named coronavirus disease 2019 (COVID-19), which can lead to systemic complications. From the beginning of the pandemic, global efforts have been focused on developing vaccines for COVID-19 prevention, which have been distributed worldwide. However various complications, among which neurological ones, have been reported so far. Vaccine related longitudinal extensive transverse myelitis (LETM) is rare (estimated acute myelitis is approximately 1.739/per million people). Early diagnosis and treatment of LETM can benefit the recovery and prevent recurrence. We report the case of a 60 years-old Caucasian woman who developed LETM after third dose of SARS-COV2 Vaccine. Material(s) and Method(s): She was evaluated due at our emergency ward due to acute paraparesis with bilateral lower limbs sensory involvement and neurological bladder started about seven days after administration of vaccine (Moderna mRNA-1273) anti SARS-COV2. She hadn't noticed any reaction after previous two doses of vaccine. Her medical history was unremarkable. Infectious disease of central nervous system was ruled out by the cerebrospinal fluid (CSF) analysis and virus culture while CSF study revealed intrathecal oligoclonal bands synthesis. SARS-COV2 PCR and swab resulted negative. Brain magnetic resonance imaging (MRI) with contrast of the whole spine was performed revealing intramedullary-enhancing lesion over the spinal cord from T2 to T5 segments. Blood immunological and coagulation exams resulted all normal. The patient received pulse therapy with 1000 mg of methylprednisolone daily for 5 days and had a dramatic improvement in the limb weakness such as sensory symptoms. Discussion(s): Acute transverse myelitis is a neurologic condition characterized by bilateral lower extremity weakness, sensory loss and bowel and bladder dysfunction.Whereas the time of onsetmay be hours to days, the time to either partial or complete recovery may require months. Variable etiologies have been recognized even sometimes it can be idiopathic. LETM is a very uncommon condition, even rare after vaccine administration. However, some studies have reported acute myelitis occurrence following administration of other vaccines, including diphtheria, tetanus toxoids and pertussis vaccine and many others. Case reports have also been reported after SARS-COV2 vaccines administration. Conclusion(s): Clinicians should be aware of possible adverse events potential dependent on vaccines administration, in order to be able diagnose and promptly treat them, even if benefits of vaccination still outweigh the associated risks.

7.
Neurological Sciences ; 43(Supplement 1):S336, 2022.
Article in English | EMBASE | ID: covidwho-2174268

ABSTRACT

Background: SARS-CoV-2 vaccination has been associated with rare neurological syndromes. The aim of this study is to evaluate the risk of association between specific neurological symptoms and syndromes and SARS-CoV-2 vaccination. Method(s): In this prospective single center cohort study, we included all adult inpatients consecutively admitted to a tertiary Neurological Centre from January 2021 to February 2022. Vaccinated cases were subgrouped according to the onset of neurological manifestation in the first 30 days (V<30d), 30-60 days (V30-60d) and more than 60 days (V>60d) following SARS-CoV-2 vaccination. The incidence and characteristics of neurological syndromes were compared between unvaccinated and vaccinated cases (including subgroups) adjusting for the effect of age, sex and premorbid conditions in linear regression analyses. Result(s): 830 subjects entered the study, namely 398 unvaccinated (UVC) and 432 vaccinated cases;these groups were comparable for demographic characteristics and clinical diagnosis distribution and. Compared to UVC, V<30d exhibited higher prevalence of Medical unexplained symptoms (MUS, 24.5% vs 10.6%), primary headache (10.9% vs 5%) and lower number of cerebrovascular diseases (30.7% vs 41.9%). V30-60d cases exhibited higher number of primary headache (13% vs 5%) compared to UVC, whereas V>60d showed similar diagnosis distribution with UVC. Conclusion(s): Unexplained transient neurological symptoms and primary headache appeared to be the most common neurological conditions following SARS-CoV-2 vaccination. The findings confirmed the safety of SARS-CoV-2 vaccination and argued against a prominent role in the pathogenesis of either cerebrovascular or inflammatory-mediated neurological disorders, exception made for rare CVT cases.

8.
Medical Mycology ; 60(SUPP 1):124-124, 2022.
Article in English | Web of Science | ID: covidwho-2123101
9.
Med Mycol ; 60(Suppl 1), 2022.
Article in English | PMC | ID: covidwho-2042604

ABSTRACT

 : Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIt is known that the incidence and epidemiology of candidemia vary according to different geographic regions and/or hosts. Between 1998 and 2019, the incidence in a university hospital in the city of Buenos Aires Argentina, ‘HCJSM’, was 2.19/1000 discharges. The coronavirus disease 2019 (COVID-19) pandemic altered the previously recognized course of severe infections, including candidemia. Objective: The aim of this report is to determine the incidence of candidemia in critically ill COVID-19 patients, and the clinical and microbiological aspects of these episodes hospitalized at HCJSM. Methods: The source documents of this retrospective study are medical records from patients with Sars-Cov-2 and candidemia who were diagnosed between March 1, 2020 and June 30, 2021. At the onset of the pandemic, the HCJSM began admitting patients with COVID-19, and elective procedures were canceled. Demographic, clinical, and laboratory data were reviewed. All data were analyzed using RStudio, a statistical computing platform (version 4.0.2). Results: During the period under review, 61 episodes of candidemia were identified: 23 episodes (39.7%) in COVID-19 patients, and 38 episodes (60,3%) in no COVID-19 patients. Incidence (x 1000 admission) in no COVID-19 patients was 2.5 (38/14 903): in COVID-19 patients 14.4 (23/1595) and in COVID-19–ICU was 42.3 (20/472). The average age of patients is of 65 years (32-84 range years). The time from admission to ICU to the development of candidemia had a median of 18 days (RIC 9-23). A total of 87.5% of the patients had been on mechanical ventilation and 100% of the patients received broad-spectrum antibiotics and had catheters. Episodes were caused by C. parapsilosis (39.7%), C. albicans (35%), C. glabrata (14%), and other species of Candida (11%). A total of 62% of COVID-19 patients who developed episodes of candidemia died during the period under examination. The survival likelihood at 30 days of COVID-19 patients who developed candidemia was higher for C. parapsilosis episodes and lower for C. glabrata episodes. Conclusion: The incidence of candidemia showed an increase in COVID-19 hospitalized severe patients. The use of broad-spectrum antibiotics, the presence of catheters, and the use of ventilatory support in COVID-19 patients were the risk factors most associated with the development of candidemia. Although the number of episodes of candidemia is low, without the strength of statistical analysis, it is important to consider that the likelihood of survival of patients with episodes of candidemia varies according to the species recovered.

10.
European Journal of Neurology ; 29:723, 2022.
Article in English | EMBASE | ID: covidwho-1978456

ABSTRACT

Background and aims: Rare neurological syndromes have been associated with SARS-CoV-2 vaccination. Despite the growing number of cases reported, the characteristics of neurological diagnosis following SARS-CoV-2 vaccination and the underlying etiologic mechanisms still need further investigations. The aim of this study is to evaluate the association between specific neurological symptoms and syndromes and SARS-CoV-2 vaccination. Methods: In this retrospective, single center cohort study, we included all adult inpatients consecutively admitted to the Department of Clinical and Experimental Sciences, Neurology Unit, of the ASST Spedali Civili Hospital, Brescia, from January 2021 to August 2021. Results: Out of 871 consecutive patients admitted to Neurology Department, 102 and 61 subjects reported SARS-CoV-2 vaccination within 60 and 30 days, respectively. The most common neurological diagnosis following vaccination included cerebrovascular diseases (n=32), transient medical/neurological unexplained symptoms with negative instrumental tests (MUS, n=25), epileptic disorders (n=11) and demyelinating diseases (n=10). When compared to non-vaccinated cases, MUS emerged as the only diagnosis with higher prevalence in post-vaccine cases at 60 and 30 days (24,5% and 38% vs 7,2% of whole cohort). Conclusion: Unexplained transient neurological symptoms appeared to be the most common neurological condition following SARS-CoV-2 vaccination in comparison to nonvaccinated cases.

11.
EUROPEAN JOURNAL OF NEUROLOGY ; 29:316-316, 2022.
Article in English | Web of Science | ID: covidwho-1965468
14.
EUROPEAN JOURNAL OF NEUROLOGY ; 29:723-724, 2022.
Article in English | Web of Science | ID: covidwho-1965322
16.
Milano University Press. Chapter ; 7:02, 2021.
Article in English | MEDLINE | ID: covidwho-1836694
17.
Acta Myologica ; 40(SUPPL 1):32, 2021.
Article in English | EMBASE | ID: covidwho-1663114

ABSTRACT

Background. COVID-19 is caused by SARS-CoV-2 virus and in many cases lead to a pneumonia. However a number of neumuscular manifestations have been associated to SARS-CoV-2 infection. Furthermore, multiorgan symptoms after COVID-19 are being reported by increasing numbers of patients, ranging from cough to fatigue and muscle pain. However, the long-term health consequences of COVID-19 remain largely unclear. Methods: We evaluated 124 patients hospitalized between march and May 2020 for SARS-COV-2 associated pneumonia at 6 and 12 months. We retrospectively collected clinical, laboratory and radiological information available. for each patient, cognitive tests, scales for depression and anxiety and a specific Fatigue Severity Scale (FSS) were performed. Results. Twenty-five patients died during hospitalization. At 12 months follow up 85 patient were evaluated. Eighty-seven (70%) patiens were male and mean age was 67.3 years. During hospitalization 43 (36.5%) of patients complain of myalgia. This patients had higher CK levels than patients who did not (534 U/L vs 93 U/l, p < 0.001). At 12 months 42% of patients complain about myalgia while 34% about fatigue. Mean FSS value were 32.93, and were significatively higher in patiets who complain about fatigue (41.52 vs 27.08 p < 0.001) and Muscle pain (40.84 vs 26.80, p < 0.001) compared to who did not. Conclusions. During hospitalization for COVID-19 myalgia was associated with an higher level of CK, suggesting a possible muscle involvement. At 12 month myalgia and fatigue were present in a more than a third of patient suggesting that this manifestation could be one of the main COVID-19 sequelae.

20.
Journal of the Neurological Sciences ; 429, 2021.
Article in English | EMBASE | ID: covidwho-1466659

ABSTRACT

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.

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