Neurologic presentations of COVID-19: a case series

Introduction: The new pandemic of coronavirus disease 2019 (COVID-19) has evolved certain neurologic syndromes as a presentation of this disease that should be integrated into the whole disease process. Case Presentations: We present cases of neurologic involvement in adult patients with documented bronchopulmonary COVID-19. Certain signs and symptoms are introduced, including new onset seizures, ischemic stroke, and altered mental status in otherwise minimal clinical signs and symptoms of COVID-19. Conclusions: Many neurologic presentations are diagnosed in resolving COVID respiratory infections or in an otherwise asymptomatic individual.

Type 1 diabetes and environment . . . and other stories

A linked ecological analysis of environmental and demographic variables identified several factors, including poor air quality, outdoor light at night, and higher population density that were negatively associated with the incidence of diabetes (Diabetologia doi:10.1007/s00125-020-05087-7). A case-control study using a database of people known to have autoimmune disease raises anxiety about central nervous system inflammatory events (JAMA Neurol doi:10.1001/jamaneurol.2020.1162). A history of exposure to TNF inhibitors carried a threefold increase in risk both of demyelinating diseases, such as multiple sclerosis and optic neuritis, and of non-demyelinating conditions, such as encephalitis, neurosarcoidosis, and vasculitis.

Peripheral nervous system involvement in SARS-CoV-2 infection: a review of the current pediatric literature.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the pathogen responsible for the pandemic health emergency declared by the World Health Organization in March 2020. During the first part of the pandemic, adults showed mild to severe respiratory symptoms. Children seemed initially exempt, both from acute and subsequent complications. Hyposmia or anosmia were promptly identified as the main symptoms of acute infection, so neurotropism of SARS-CoV-2 was immediately suspected. (1, 2). As the emergency progressed, post infectious neurological complications were described also in pediatric population (3). Cases of cranial neuropathy in connection with acute SARS-CoV-2 infection have been reported in pediatric patients, as an isolate post infectious complication or in the context of the multisystem inflammatory syndrome in children (MIS-C) (4-6). Neuroinflammation is thought to be caused by several mechanisms, among which immune/autoimmune reactions (7), but so far, no specific autoantibody has been identified. SARS-CoV-2 can enter the central nervous system (CNS) directly and/or infect it retrogradely, through the peripheral nervous system (PNS), after replicating peripherally; several factors regulate invasion and subsequent neuroinflammation. Indeed, direct/secondary entry and replication can activate CNS-resident immune cells that, together with peripheral leukocytes, induce an immune response and promote neuroinflammation. In addition, as we will discuss in the following review, many cases of peripheral neuropathy (cranial and non-cranial) have been reported during or after SARS-CoV-2 infection. However, some authors have pointed out that the increase of cranial roots and ganglia in neurological imaging is not always observed in children with cranial neuropathy. (8). Even if a variety of case reports were published, opinions about an increased incidence of such neurologic diseases, linked to SARS-CoV-2 infection, are still controversial (9-11). Facial nerve palsy, ocular movements abnormalities and vestibular alterations are among the most reported issues in pediatric population (3-5). Moreover, an increased screen exposure imposed by social distancing led to acute oculomotion's disturbance in children, not primarily caused by neuritis (12, 13). The aim of this review is to suggest food for thought on the role of SARS-CoV-2 in neurological conditions, affecting the peripheral nervous system to optimize the management and care of pediatric patients.

Neurological manifestations of COVID-19 in pregnancy: a cross-sectional study.

The occurrence of neurological manifestations and complications in pregnant women compared to non-pregnant women with COVID-19 is unclear. This cross-sectional study included women aged over 18 years hospitalized with SARS-CoV-2 infection confirmed by RT-PCR from March to June 2020 in Recife, Brazil. We evaluated 360 women, including 82 pregnant patients who were significantly younger (27.5 vs. 53.6 years; p < 0.01) and less frequently obese (2.4% vs. 15.1%; p < 0.01) than the non-pregnant group. All pregnancies were confirmed using ultrasound imaging. Abdominal pain was the only more frequent COVID-19 manifestation during pregnancy (23.2% vs. 6.8%; p < 0.01), but was not associated with the outcomes. Almost half the pregnant women presented neurological manifestations, including anosmia (31.7%), headache (25.6%), ageusia (17.1%), and fatigue (12.2%). However, neurological manifestations occurred similarly in pregnant and non-pregnant women. Four (4.9%) pregnant women and 64 non-pregnant women (23%) presented delirium, but the frequency with age-adjustment was similar in the non-pregnant group. Pregnant women with COVID and preeclampsia (19.5%) or eclampsia (3.7%) were older (31.8 vs. 26.5 years; p < 0.01), and epileptic seizures occurred more often in association with eclampsia (18.8% vs. 1.5%; p < 0.01) regardless of previous epilepsy. There were three maternal deaths (3.7%), one dead fetus, and one miscarriage. The overall prognosis was good. There was no difference in prolonged hospital stay, the need for ICU and mechanical ventilation, or death when comparing pregnant and non-pregnant women.

Trigeminal neuralgia of COVID-19: meta-analysis

Introduction: trigeminal nerve is fifth cranial nerve carrying face sensation and dividing into ophthalmic, maxillary and mandibular divisions. Trigeminal neuralgia is clinical condition can be presenting in Covid19 patients. The current study reviews the clinical cases of trigeminal neuralgia of covid19 and explains the anatomical mechanism of pain and its radiation as present with associated symptoms. On current studies reviews entire cases covid19 since 2019 up to 2022 presenting with Trigeminal pain. It found to be a very rare reason comparing to the previous reasons such as infection, tumor, thrombosis, vasculitis, autoimmune disease leading to direct or indirect effects on trigeminal nerve demyelination. Knowing the case presentation of covid19 patient presenting with trigeminal neuralgia may lead to prevent further complications and saving patients life. Learning new clinical issues based on understanding the basic medical sciences prepare good safe physicians to raise their level of education resulting in good medical services in future. Pediatricians, internist, radiologist, ophthalmologist, Otorhinolaryngologists and surgeons has to be aware of this clinical presentation to be able to take more precaution and avid outbreak of corvid 19 infection between medical staffs in different regions of hospital such as clinics, wards, emergency rooms and operations.

Investigation on the risk factores for mortality of patients with COVID-19 and prioritization these factores using neural network in some southern cities of Iran

Background & Aims: Epidemics of human viruses began during the period of Neolithic around 12,000 years ago. Humans developed more densely population which allowed viruses to spread rapidly among communities. Also, plant and livestock viruses increased along with human viruses (2). At the January 2020, the coronavirus disease (COVID-19 7th human coronavirus) was discovered in Wuhan, Hubei province of China. COVID-19 virus caused six million deads in the world to date and cussed infection of more than seven million of cases in Iran (1). This infectious disease caused by the SARS-CoV-2 virus. This virus was contagious and fast-spread. Despite the aquarantine politics, SARS-CoV-2 virus caused many permanent economic and health damages in most countries. Coronaviruses are positive-sense, single- stranded enveloped RNA viruses with helical capsids that infect a wide range of hosts including humans, bats, other mammals, and birds (2). Coronaviruses are belonging to Nidovirales order, Coronaviridae family, Coronovirinae subfamily and four genera of alpha, beta, delta, and gamma. Alpha and beta coronaviruses are known as human infection agents. SARS-COV-2 virus abilities are including: high mortality number, short period of incubation, widespread transmission protocols, asymptomatic infection and affecting on most vital organs (heart, brain, lungs and ...) which have attracted the health system attention and caused neglect to the other chronic and non-communicable diseases (4). Therefore, the disease incidence, prevalence and prioritization around the world may change in the future. From the beginning of COVID-19 pandemic, some symptoms and risk-factors have been introduced to the world as the increase elements of morbidity and mortality. Studies have shown that having any kind of underlying diseases and risk factors will be effective in the COVID-19 disease severity and mortality (6). Some of these important risk factors are including of chronic kidney disease, hypertension, age, gender, obesity, obstructive pulmonary diseases, diabetes, lung diseases, cardiovascular diseases, cancer, and liver disease. Also, each risk factors have different impact in different geographic areas (7). Some factors, such as different viral load kinetics in each individual person, epidemiological history, therapeutic or pharmacological effects and immune response have some major impacts on the laboratory diagnostic results. Due to the successive mutations of the SARS-CoV-2 virus and the high incidence disease, it seems that the vaccination alone cannot prevent the COVID-19 (9). On the other hand, the World Health Organization has warned about the vaccination as the only pandemic control protocol. Therefore, the prevalence of morbidity and mortality have become the public health concerns in the world since the beginning of the COVID-19 epidemic and the vaccination. Recognizing of the risk-factors and symptoms on COVID-19 in different geographic areas can be a helpful source to prevent the mortality. Understanding risk factors can help the world to control of the coronaviruses pandemic period and similar situations in the future. Therefore, the aim of this study was to determine the risk-factors of mortality of COVID-19 patients in three cities of Khuzestan province, Iran. Methods: This research was an analytical cross-sectional study. Some details of 27963 COVID-19 patients such as clinical symptoms, individual characteristics and underlying diseases were gathered from hospitals in Abadan, Shadegan and Khorramshahr cities in Khuzestan province, Iran, from 20 February 2020 to November 2020. All the under-study population was previously investigated in terms of COVID-19 infection by the medical examinations and laboratory methods. This under-study population was categorized into three different groups such as hospitalized, outpatients and dead patients. Hospitalized patients have admitted in general or ICU (Intensive Care Unit) sector. Obtained database of COVID-19 patients was analyzed by IBM SPSS version 22.0 under regression, logistic model (u

Viral shedding time and its influencing factors in different site samples of patients infected with Severe acute respiratory syndrome coronavirus 2 omicron BA.2 variant

Objective: To analyze the viral shedding time and its influencing factors in different site samples of patients infected with severe acute respiratory syndrome coronavirus 2 (SARA-CoV-2) omicron BA.2 variant. Methods: Real-time fluorescence polymerase chain reaction was used to detect SARS-CoV-2 nucleic acid in nasopharyngeal swab, sputum and anal swab from 217 patients with coronavirus disease 2019 (COVID-19) who were infected with severe acute respiratory syndrome coronavirus 2 omicron BA.2 variant confirmed by gene sequencing in The First Affiliated Hospital of Naval Medical University (Second Military Medical University). The differences of viral shedding time of different site samples were compared. Stratified analysis and multiple linear regression analysis were used to explore the influencing factors of viral shedding time in different site samples. Results: The age of the 217 COVID-19 patients was 32.0 (24.0, 50.5) years old, 59.0% of them were males (n=128), and 41.0% were females (n=89). Eight (3.7%) cases were diagnosed with asymptomatic infection, 184 (84.8%) cases were mild type, 21 (9.7%) cases were moderate type, 3 (1.4%) cases were severe type, and 1 (0.5%) case was critical type. A total of 70 (32.3%) patients were treated with molnupiravir. The viral shedding time of SARS-CoV-2 nucleic acid in nasopharyngeal swab, sputum and anal swab was 13.0 (11.0, 17.0) d, 16.5 (13.0, 21.0) d and 10.0 (5.3, 11.0) d, respectively, with the differences being significant between them (all P<0.001). Age 60 years old, underlying diseases (especially hypertension, coronary artery diseases, or neurological diseases), and clinical classification of moderate type were risk factors for prolonged viral shedding time in nasopharyngeal swab;male sex and underlying diseases were risk factors for prolonged viral shedding time in sputum;and male sex was a risk factor for prolonged viral shedding time in anal swab. Multiple linear regression analysis showed that critical type was an independent risk factor for prolonged viral shedding time in nasopharyngeal swab (P<0.05), and male sex and underlying diseases were independent risk factors for prolonged viral shedding time in sputum (both P<0.05). Conclusion: Among patients infected with omicron BA.2 variant, the viral shedding time in sputum is the longest and that in anal swab is the shortest. Male patients and/or patients with underlying diseases have longer viral shedding time in sputum.

The regulation of host cytoskeleton during SARS-CoV-2 infection in the nervous system

The global economy and public health are currently under enormous pressure since the outbreak of COVID-19. Apart from respiratory discomfort, a subpopulation of COVID-19 patients exhibits neurological symptoms such as headache, myalgia, and loss of smell. Some have even shown encephalitis and necrotizing hemorrhagic encephalopathy. The cytoskeleton of nerve cells changes drastically in these pathologies, indicating that the cytoskeleton and its related proteins are closely related to the pathogenesis of nervous system diseases. In this review, we present the up-to-date association between host cytoskeleton and coronavirus infection in the context of the nervous system. We systematically summarize cytoskeleton-related pathogen-host interactions in both the peripheral and central nervous systems, hoping to contribute to the development of clinical treatment in COVID-19 patients.

Clinical-epidemiological behavior of post-COVID-19 syndrome in patients at Andres Ortiz Polyclinic, 2021

Introduction: post-COVID-19 syndrome is the set of signs and symptoms that develop during or after an infection compatible with COVID-19, that persist for more than 12 weeks and are not explained by an alternative diagnosis. Background: to characterize the clinical-epidemiological behavior of the post-COVID-19 syndrome in patients at the Andres Ortiz Polyclinic. Method: a descriptive and cross-sectional observational study was carried out from October to December 2021, in a population of 51 subjects that was studied in its entirety. The analysis was descriptive. Results: patients with 50-59 years (n = 20;39.2%), female (n = 32;62.7%) predominated. The most frequently affected organ system was the respiratory (n = 19;37.2%), while the symptoms were: chronic fatigue (n = 15;29.4%), shortness of breath (n = 11;21.5%) and cough (n = 8, 15.6%). Among the patients with respiratory (n = 30), cardiovascular (n = 24) and neurological (n = 10) diseases, the most frequent were, respectively: pulmonary fibrosis (n = 17;56.7%), cardiac arrhythmias (n = 11;45.8%) and peripheral neuropathies (n = 5;50%). Conclusions: post-COVID-19 syndrome occurred mainly between the ages of 50 and 59, in female patients, with symptoms of chronic fatigue, shortness of breath and cough, as well as pulmonary fibrosis, cardiac arrhythmias and peripheral neuropathies as main comorbidities.

clinical-laboratory interaction in the diagnosis of autoimmune neurological conditions: focus on the coVid-19 pandemic.

The interaction between clinic and laboratory is crucial for the diagnostic process of neurological disorders, in particular in patients with autoimmune/inflammatory conditions. In these conditions, different diagnostic assays with specific sensitivity and specificity are available. Many laboratories use commercial assays based on line-blot techniques (for the detection of antibodies to intracellular antigens, such as Hu and Yo) or fixed cell-based-assays (for the detection of antibodies to surface antigens such as NMDAR or LGI1 or to oligodendrocytes-MOG- or astrocytes-AQP4). However, assays with higher sensitivity, such as live CBA or immunohistochemistry on rat brain/cerebellum are available and allow the detection of additional antibodies, also to unknown antigens, by evaluating specific patterns of positivity. In this context, the continuous interaction between clinicians and laboratory physicians is necessary to guide antibody testing and select those cases which need additional advanced investigations. This concept was even more relevant during the COVID-19 pandemic, which led to an increase of samples referred to reference laboratories, in particular from patients with encephalitis or myelitis, for whom the differential diagnosis between an infectious vs. postinfectious vs. inflammatory vs. autoimmune process was challenging. The interaction between clinicians and laboratory physicians in this area focused on solving some important questions, and in particular: 1) to understand whether SARS-CoV-2 infection could cause autoimmune neurological diseases;2) to clarify the course of SARS-CoV-2 infection in patients with autoimmune neurological diseases;3) to understand if vaccines could induce autoimmune neurological diseases;and 4) to understand the effect of vaccination in patients with autoimmune neurological diseases. The constant scientific exchange between the various professional figures led to an improvement of the diagnostic process of these neurological disorders, with a significant impact on patients' prognosis and quality of life.Copyright © 2022 EDIZIONI MINERVA MEDICA.

The relationship of online pre-recorded neurology mini-lectures to medical student assessment: a pilot study.

INTRODUCTION: eLearning has become an essential part of medical education. However, there is a lack of published research on student engagement with online pre-recorded mini-lectures and its relation to assessment. The aim of this pilot study is to explore the relationship between newly introduced neurology pre-recorded mini-lectures and undergraduate medical students engagement and assessment. This may encourage the wider use of mini-lectures in undergraduate medical curricula. METHODS: The engagement of medical students with 48 online pre-recorded neurology mini-lectures was assessed through a Learning Management System. To measure engagement, data was stratified according to the number of watched/downloaded mini-lectures. A point system was used (out of 5): - 1 point = watching/downloading 0-10 mini-lectures, 2 points = watching/downloading 11-20 mini-lectures, 3 points = watching/downloading 21-30 mini-lectures, 4 points = watching/downloading 31-40 mini-lectures and, 5 points = watching/downloading 41-48 mini-lectures. The students' engagement was correlated with their neurology assessments [Objective Structured Clinical Examination (OSCE), and knowledge-based assessment 10 Multiple Choice Questions (MCQs) and one 10-mark Short Answer Question, (SAQ)], internal medicine grade and annual grade point average (GPA) using the Pearson correlation coefficient. RESULTS: The mean engagement of 34, Year 5, medical students is 3.9/5. There is a significant positive correlation between engagement and internal medicine grade (r = 0.35, p = 0.044). There is a moderate correlation between engagement and neurology OSCE (r = 0.23), annual Year 5 GPA (r = 0.23), neurology knowledge-based score (r = 0.22) and composite neurology knowledge/OSCE (r = 0.27). The knowledge-based assessment included SAQ and MCQs: there was a moderate correlation with SAQ (r = 0.30), but a weak negative correlation with the MCQs (r =-0.11). Sub-groups analysis comparing the top- and low- or non- engaging students made these weaker correlations stronger. CONCLUSION: This pilot study indicates a high rate of engagement with an online pre-recorded mini-lectures resource and evidence of moderate correlation between engagement and assessment. Online pre-recorded mini-lectures should be used more in delivering the curriculum contents of the clinical clerkships. Further studies are needed to evaluate the relation and the impact of the mini-lectures on assessment.

Special Issue: Mutagenic factors in the environment impacting human and animal health. (Special Issue: Mutagenic factors in the environment impacting human and animal health.)

This special issue includes 15 articles that discuss the mutagenic effect of tobacco smoke on male fertility;environmental and occupational exposure of metals and female reproductive health;free radical biology in neurological manifestations;paternal factors in recurrent pregnancy loss;mechanical dependency of the SARS-CoV-2 virus and the renin-angiotensin-aldosterone (RAAS) axis;a perspective review on medicinal plant resources for their antimutagenic potentials;asystematic review and meta-analysis of the impacts of glyphosate on the reproductive hormones;impact of ginseng on neurotoxicity induced by cisplatin in rats.

Outcomes of AstraZeneca vaccine for relapse and COVID-19 infection in people with multiple sclerosis

Background: People with chronic diseases of the immune system, such as multiple sclerosis (MS), are at risk for Covid-19 disease. However, more research is needed with long-term follow-up. The aim of the study was to follow up people with MS (PwMS) for up to three months after AstraZeneca vaccination for the recurrence of MS and Covid-19 infection. Methods: This study was a case study (descriptive-analytical) of follow-up type. The study population was PwMS over 18 years of age in Kermanshah province who received both doses of the AstraZeneca vaccine. This study was conducted from August to November 2021. Sampling was done with existing methods based on the National MS Registry of Iran (NMSRI). Demographic information of patients was extracted from NMSRI. A researcher-made form was used to collect information by telephone three months after vaccination about clinical characteristics, Covid-19 infection, and recurrence of MS. Data were analyzed using SPSS-25 software. Results: Study participants were 40 MS patients with a mean (SD) age of 39.27 (8.8) years, including 32 (80.0%) women. A mean of 9.39 (4.6) years had passed since The patients were diagnosed with MS, and 29 (76.4%) had RR type MS. Four patients (10%) relapsed between the second dose and three months later, of whom two (50%) had sensory symptoms, one (25%) had optic nerve involvement, and one (25%) had motor symptoms and pyramidal pathway involvement. The symptoms of Covid-19 were mild in three patients (10%), while severe symptoms developed in one patient (10%) who received rituximab. Among the patients, no cases of thrombosis were observed. Infusion therapy, a leg fracture, and kidney stones were the only hospitalized cases. Conclusion: Covid-19 and MS relapse prevalence did not differ significantly in the three months before and after vaccination. There is a need for further studies with a longer follow-up period.

Two Case Reports of Chronic Inflammatory Demyelinating Polyneuropathy After COVID-19 Vaccination.

The occurrence of chronic inflammatory demyelinating polyneuropathy (CIDP) related to coronavirus disease 2019 (COVID-19) has rarely been reported. We describe two patients who were diagnosed with CIDP after COVID-19 vaccination. A 72-year-old man presented with a progressive tingling sensation and weakness below both knees for two weeks. He had been vaccinated against COVID-19 (mRNA-1273 vaccine) a month before the appearance of symptoms. Demyelinating polyneuropathy was observed in the nerve conduction studies (NCS). Intravenous immunoglobulin (IVIg) was administered under the diagnosis of Guillain-Barré syndrome (GBS), and his symptoms were improved. However, his symptoms relapsed at 10 weeks from the onset. Oral prednisolone, azathioprine, and IVIg were administered as treatment. The second case was a 50-year-old man who complained of a bilateral leg tingling sensation and gait disturbance lasting four weeks. He had received the Ad26.COV2.S vaccine against COVID-19 five weeks prior. Demyelinating polyneuropathy was observed in the NCS. He was treated with oral prednisolone, azathioprine, and IVIg for CIDP because his symptoms had lasted for more than 12 weeks from the onset. A causal relationship has not been established between COVID-19 vaccination and CIDP; however, CIDP may follow COVID-19 vaccination. As CIDP treatment is different from that for GBS, clinicians should closely monitor patients diagnosed with GBS associated with COVID-19 whether they deteriorate after initial treatment.

Metformin: new applications for an old drug.

Metformin is a biguanide, evolved as one of the most widely used medicines. The applications of this component include but are not limited to reducing blood glucose, weight loss, and polycystic ovary syndrome. Studies about other probable indications have emerged, indicating that this agent can also be utilized for other purposes. In this review, applications of metformin are noticed based on the current evidence. Metformin commonly is used as an off-label drug in non-alcoholic fatty liver disease (NAFLD), but it worsens inflammation and should not be used for this purpose, according to the latest research. Metformin decreased the risk of death in patients with liver cirrhosis. It is an effective agent in the prevention and improvement of survival in patients suffering hepatocellular carcinoma. There is evidence of the beneficial effects of metformin in colorectal cancer, early-stage prostate cancer, breast cancer, urothelial cancer, blood cancer, melanoma, and bone cancer, suggesting metformin as a potent anti-tumor agent. Metformin shows neuroprotective effects and provides a potential therapeutic benefit for mild cognitive impairment and Alzheimer's disease (AD). It also has been shown to improve mental function and reduce the incidence of dementia. Another condition that metformin has been shown to slow the progression of is Duchenne muscular dystrophy. Regarding infectious diseases, tuberculosis (TB) and coronavirus disease (COVID-19) are among the conditions suggested to be affected by metformin. The beneficial effects of metformin in cardiovascular diseases were also reported in the literature. Concerning renal function, studies showed that daily oral administration of metformin could ameliorate kidney fibrosis and normalize kidney structure and function. This study reviewed the clinical and preclinical evidence about the possible benefits of metformin based on recent studies. Numerous questions like whether these probable indications of metformin can be observed in non-diabetics, need to be described by future basic experiments and clinical studies.

News and Current Events. COVID-19 Infection Related to Three-Times-Higher Risk of Neuropathy

The article reports on the findings of a study conducted by researchers at Washington University School of Medicine revealing that people who tested positive for COVID-19 are more at risk of neuropathy.

The Negative Pricing of the May 2020 WTI Contract

This paper sheds light on the negative pricing of the May 2020 WTI futures contract (CLK20) on April 20, 2020. The super contango of early 2020, triggered by COVID-19 lockdowns and geopolitical tensions, incentivized cash and carry (C&C) traders to be long CLK20 and short distant contracts, while simultaneously booking storage at Cushing. Our investigation reveals that C&C arbitrage largely contributed to the lack of storage capacity at Cushing in April 2020 and the price crash relates to the reversing trades of many long CLK20 traders without pre-booked storage. Additional aggravating factors included a liquidity crush, staggering margin calls and potential price distortions due to the trade-at-settlement mechanism. The analysis suggests that claims from experts that hold index trackers responsible for the crash are unwarranted: Index trackers did not trigger the negative pricing, nor widen the futures-spot spread by rolling their positions to more distant contracts ahead of maturity.

Brain MRI and Neuropsychological Findings at Long-Term Follow-Up After COVID-19 Hospitalisation: An Observational Cohort Study...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system. Ambidirectional observational cohort study. All patients (n=734) previously hospitalized with a laboratory-confirmed COVID-19 in a total regional population in Sweden during the period March 1st to May 31st 2020. A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI. N/A. Findings on brain MRI, neurocognitive test results and reported fatigue. Twenty-five patients (71%) had abnormalities on MRI;multiple white matter lesions were the most common finding. Six patients had had MRI performed in the acute phase during their hospitalisation, and all of these patients had additional white matter lesions at the follow-up MRI. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings. A majority in this group of patients selected to undergo MRI after a clinical evaluation, showed signs of possible COVID-19 related brain affection detectable by brain MRI and/or neurocognitive test results. Even in a previously fairly healthy group of patients, COVID-19 might have a substantial negative impact on cognition in several domains, persisting several months post discharge. Abnormal findings were not restricted to patients with severe disease. Thus, for clinicians it is important to consider post-covid related changes when facing patients' reports of neuropsychological deficiency, regardless of severity of disease. The authors declare no competing interests.

Specific changes in the nervous system in patients with postocovidal syndrome

We have investigated the functions of the suprasegmental division of the vegetative nervous system in patients with post-COVID syndrome (PS). During the research vegetative tone (VT), vegetative reaction (VR) and vegetative support of activity (VSA) were investigated. A comparative analysis of the aforecited indicators was carried out in 46 male and 32 female patients with the control group. Vegetative functions were investigated for 4 to 12 weeks. The investigation of vegetative functions in patients with PS showed the presence of local, generalized, permanent and paroxysmal vegetative disorders in each of them.

Hyperammonaemia in a positive COVID-19 patient. A rare cause of altered consciousness in patients without liver failure. A case report

A case report of COVID-19 infection in a patient presenting with upper and lower gastrointestinal and respiratory symptoms, ending in respiratory failure and the need for invasive mechanical ventilation, presenting with improvement in his respiratory and gastrointestinal symptoms, but with limitations for extubation due to altered state of consciousness despite weaning from analgesia for more than 72 hours, in whom elevated levels of ammonia were found without signs of liver failure. Diarrhoea and liver involvement are frequent manifestations in patients with COVID-19, which can possibly lead to a decrease in carnitine levels and secondary hyperammonaemia, becoming a challenge for clinicians. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo