Neurological complications associated with COVID-19. Saint Vincent de Paul Hospital, 2021

Background: COVID-19 is caused by the SARS-Cov-2 virus and presents a wide range of symptoms, both in its acute phase and in its chronic phase. Among the systems that it affects is the Nervous, due to its neurotropic mechanism. Objective: to determine the risk of neurological complications associated with the COVID-19 severity in adult patients. Methods: a descriptive and cross-sectional study was carried out, which included 143 positive patients for COVID-19 treated at the San Vicente de Pa & uacute;l Hospital, in Ibarra, Ecuador, during 2021. Neurological complications and the severity of the COVID-19 disease were analyzed. As a measure of association for these variables, the Fisher Test was used (p = <= 0.05) and a bivariate analysis was performed. Results: 54% of the patients presented neurological complications of the Central Nervous System, while 46% were of the Peripheral Nervous System;and mild-moderate severity was the most frequent (41%), and hearing impairment had the highest statistical probability of occurring (OR= 74.968;CI: 95%). The case fatality rate in these patients was 7.1%;and in those with neurological complications, 8.4%.Conclusion: the neurological sequelae most likely to occur were hearing impairment and taste impairment, in patients with mild severity and serious severity, respectively;in addition to polyneuropathy in patients with critical severity, which also occurred in deceased patients. Keywords: Coronavirus infections;neurologic manifestations;central nervous system;peripheral nervous system;severity of illness index

Research Roundup

George Winter provides an overview of recently published articles that are of interest to practice nurses. Should you wish to look at any of the papers in more detail, a full reference is provided.

Vitamin D, Albumin, and D-Dimer as Significant Prognostic Markers in Early Hospitalization in Patients with COVID-19.

SARS-CoV-2 continues to pose a major challenge to scientists and clinicians. We examined the significance of the serum concentrations of vitamin D, albumin, and D-dimer for the severity of the clinical picture and mortality in COVID-19. MATERIALS AND METHODS: A total of 288 patients treated for COVID-19 infection participated in the research. The patients were treated in the period from May 2020 to January 2021. All patients were divided based on the need for oxygen therapy (Sat > 94%) into patients with mild or severe clinical pictures. The biochemical and radiographic parameters of the patients were analyzed. Appropriate statistical methods were used in the statistical analysis. RESULTS: In patients with COVID-19 with confirmed severe clinical pictures, lower values of serum albumin (p < 0.0005) and vitamin D (p = 0.004) were recorded, as opposed to elevated values of D-dimer (p < 0.0005). Accordingly, the patients with fatal disease outcomes had lower levels of albumin (p < 0.0005) and vitamin D (p = 0.002), while their D-dimer (p < 0.0005) levels were elevated. An increase in the radiographic score, as a parameter for assessing the severity of the clinical picture, was accompanied by a decrease in serum albumin (p < 0.0005) and a simultaneous increase in D-dimer (p < 0.0005), without a change in the vitamin D concentration (p = 0.261). We also demonstrated the interrelations of the serum levels of vitamin D, albumin, and D-dimer in patients with COVID-19 as well as their significance as predictors of the outcome of the disease. CONCLUSION: The significance of the predictive parameters in our study indicates the existence of an important combined role of vitamin D, albumin, and D-dimer in the early diagnosis of the most severe patients suffering from COVID-19. Reduced values of vitamin D and albumin, in combination with elevated values of D-dimer, can be timely indicators of the development of a severe clinical picture and death due to COVID-19.

Indicators of Neurobiomarkers in Patients with Chronic Cerebral Ischemia Who Have Had a Coronavirus Infection

Annotation: The causes of the development of cerebrovascular diseases in COVID-19 may be a significant deterioration in the rheological properties of blood, activation of hemostasis, changes in the atrombogenic properties of the vascular wall endothelium. Thrombocytopenia and elevated levels of fibrinogen, D-dimer and coagulation factor VIII are most often observed in COVID-19, Changes in the indicators of neurobiomarkers, namely antibodies to gliadin- fibrillar acid protein (GFAP), S-100 protein, to serotonin and dopamine receptors in CHEM indicate the severity of this disease. The aim of the study was to study the features of neurological and biochemical parameters in patients with CHEM who had a coronavirus infection, to assess the number and prognostic value of markers of brain damage: antibodies to GFAP, serotonin, dopamine receptors and S-100 protein.

The Role of Serum Cathepsin S as Predictors of COVID-19 severity

COVID-19 is a rapidly growing pandemic with its first case identified during December 2019 in Wuhan, Hubei Province, China. Due to the rampant rise in the number of cases in China and globally, WHO declared COVID-19 as a pandemic on 11th March 2020. The disease is transmitted via respiratory droplets of infected patients during coughing or sneezing and affects primarily the lung parenchyma. The spectrum of clinical manifestations can be seen in COVID-19 patients ranging from asymptomatic infections to severe disease resulting in mortality. Although respiratory involvement is most common in COVID-19 patients, the virus can affect other organ systems as well. The systemic inflammation induced by the disease along with multisystem expression of Angiotensin Convertin Enzyme 2 (ACE2), a receptor which allows viral entry into cells, explains the manifestation of extra-pulmonary symptoms affecting the gastrointestinal, cardiovascular, hematological, renal, musculoskeletal, and endocrine system. To date, many biomarkers reflecting the main pathophysiological characteristics of the disease have been identified and associated with the risk of developing severe disease. Proteolytic enzymes, or proteases, are known to play important roles in the maintenance of pulmonary homeostasis. However, during disease, proteolytic activity can become dysregulated and cause damage to the lung, contributing to the pathology of conditions like cystic fibrosis, chronic obstructive pulmonary disease, asthma, pulmonary fibrosis and ARDS. we first evaluated the status of CTSS in the context of ARDS and models of ARDS. These investigations revealed that CTSS levels and activity were elevated in the lungs of patients with ARDS, and that elevated CTSS activity was also detectable in the plasma of these patients. Altogether, these findings support a role for CTSS in the pathogenesis of ARDS and the fact that Corona virus infects the respiratory system and the severity of the infection increases with the increase in the severity of the inflammation.

Potential Health Survey of Traditional Spices & Herbs in Prevention and Treatment of COVID-19: A Review

The coronavirus (COVID-19) is a global public health pandemic disease emerged from the novel strain of the coronavirus 2 (SARS-CoV-2) that caused severe acute respiratory syndrome. It is the most significant respiratory illness that has affected the world since World War II. Currently, there is no globally approved drug for the treatment of pandemic COVID-19 except for some recently approved vaccines. Instead, various non-specific treatment options are being utilized by different countries. While some of these are effective, there is a lack of well-documented studies on the impact of traditional medicines on the management of SARS-CoV-2 in vitro and in silico. For thousands of years, traditional healers have been using various herbs and spices products and dietary plants to treat various diseases. This review aims to provide information on the use of traditional spices & herbs in COVID-19 protection and treatment and present the main characteristics of these products and their potential antiviral actions. Various databases were searched for articles related to the use of various herbs for the treatment of viral infections. Many of these studies show that various plant compounds can be utilized for the treatment of viral infections. This study aims to summarize the common used of herbal products and dietary supplements with potent bioactive compounds in treatment or prevent of COVID-19.

Interleukin-10 gene polymorphism in COVID-19 patients and outcome of disease

More than 2 years into the COVID-19 pandemic with more than 6 million death worldwide, a dysregulated immune response to the pathogen associated with super-activation of pro-inflammatory cytokines, which may cause tissue injury, particularly lung tissue, IL-10 levels can impact on the clinical performance of the patients. this search conducted to detect the effect of Interleukin-10 gene polymorphisms on severity and outcome COVID-19 patients. A case - control study design for 120 COVID-19 patients that divided into sever, critical and moderate/mild patients in addition to 60 healthy subjects as control group to compare IL-10 serum level by ELISA technique and IL-10 gene polymorphism by ARMS-PCR assay. The result illustrated that 120 patients with covid-19 disease m classified as Critical cases 33 (27.5%), sever 42 (35%) and Mild/Moderate were 45 (37.5%). IL-10 increased in the serum of Covid-19 pneumonia patient's to (48.76 ± 12.3) pg / ml in compared with healthy controls (5.47±1.33) pg/ml. genotype results revealed that IL-10 gene distribution was GG homozygous (58.3%) higher in Covid-19 patients in compared to healthy controls (21.7)% and G allele was 124 for patient and 42 for healthy, so GG consider risk factor for coronavirus while AA genotype regard protective factor with frequency reach to 12% in patients and 48.3 % in healthy. The genotype distribution for critical/sever revealed the GG was 74.7% while in M/M was 31.1%. In conclusion: a significant association of GG genotype and allele G was observed with severity of COVID-19 infection.

Increasing the Level of Neopterin in patients infected with SARS-CoV-2 Indicates Fatal Mortality

Background: The severity of Coronavirus Disease-2019 (COVID-19) cases is associated with hyperinflammation. Patients with critical and severe COVID-19 have been observed to have high amounts of circulating cytokines. Neopterin, a crucial cytokine in the antiviral immune response that is released by macrophages upon stimulation with interferon-gamma, can be utilized to forecast the severity of illness in COVID-19 patients. Methods: The study included 185 patients with COVID-19. The patients with COVID-19 were divided into three groups according to disease severity as critical disease (n=51), severe disease (n=81), and moderate disease (n=53). All basic demographic and clinical data of the patients were recorded and blood samples were collected. Results: Neopterin levels were significantly higher in critical COVID-19 patients compared with severe and moderate COVID-19 patients (p < 0.0001). Further, neopterin showed significantly higher levels in the age group >50 years of patients with COVID-19 than in the age group <50 years. Neopterin levels were correlated with WBCs, Platelet, CRP, D-Dimer, Ferritin, Fibrinogen, IL-6, and Procalcitonin levels positively (ρ= 0.569, 0.474, 0.338, 0.696, 0.605, 0.77, 0.727, and 0.585;p < 0.01 respectively), and correlated with BMI, SpO2, and lymphocyte negatively (ρ= - 0.165;p < 0.05, p= - 0.754, - 0. 548;p < 0.01 respectively). A cutoff value of 23.62 nmol/L for neopterin predicted COVID-19 with a sensitivity of 95.7% and a specificity of 95.5% (AUC: 0.986;p < 0.0001). Conclusion: Neopterin may be a useful prognostic biomarker for assessing the severity of COVID-19.

Severity of illness and risk of mortality in Mayo Clinic's virtual hybrid advanced care at home program: a retrospective cohort study.

BACKGROUND: In July 2020, Mayo Clinic launched Advanced Care at Home (ACH), a high-acuity virtual hybrid hospital-at-home model (HaH) of care at Mayo Clinic Florida and Northwest Wisconsin, an urban destination medical center and a rural community practice respectively. This study aims to describe demographic characteristics of ACH patients as well as their acuity of illness using severity of illness (SOI) and risk of mortality (ROM), to illustrate the complexity of patients in the program, taking into account the different diagnostic related groups. METHODS: Mayo Clinic uses All Patient Refined-Diagnosis Related Groups (APR-DRG) to calculate SOI and ROM on hospitalized patients. APR-DRG data, including SOI and ROM, were gathered from individual chart reviews from July 6, 2020, to March 31, 2022. RESULTS:  Out of 923 patients discharged from ACH, the average APR-DRG SOI was 2.89 (SD 0.81) and ROM was 2.73. (SD 0.92). Mean age was 70.88 (SD 14.46) years, 54.6% were male patients and the average length of stay was 4.10 days. The most frequent diagnosis was COVID-19 infection with 162 patients (17.6%), followed by heart failure exacerbation (12.7%) and septicemia (10.9%). The 30-day readmission rate after discharge from ACH was 11.2% (n = 103) and the 30-day mortality rate was 1.8% (n = 17). There were no in-program patient deaths. CONCLUSIONS: SOI and ROM from patients at the ACH program have been shown to be in the range of "moderate/major" according to the APR-DRG classification. The ACH program is capable of accepting and managing highly complex patients that require advanced therapeutic means. Furthermore, the ACH program has an in-program mortality rate of 0 to date. Therefore, ACH is rising as a capable alternative to the brick-and-mortar hospital.

Physical Therapy Management of a Patient with Bilateral Knee Pain and Long COVID: A Case Report

Background: The purpose of this case study is to describe how post-exertional symptom exacerbation (PESE), a hallmark of long COVID, may affect the clinical course of physical therapy. Physical therapists can provide patient education and activity guidance to individuals with long COVID to improve clinical outcomes. Case Description: The patient was a 39-year-old female with a 20-year history of bilateral knee pain. Following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the patient developed PESE and increased bilateral knee joint effusion and pain, affecting her ability to perform cognitive tasks and walk, respectively. Outcomes: Following 8 weeks of intervention, the patient's Lower Extremity Functional Scale score improved from 35/80 to 59/80 and numeric pain rating scale decreased from 7/10 to 4/10 at maximum, but she experienced an apparent PESE relapse. Discussion: Post-exertional symptom exacerbation can affect multiple body systems, which may affect a patient's ability to participate in physical therapy. Clinical Relevance: Physical therapy management of individuals with long COVID must include monitoring during and after exertion for signs and symptoms of PESE.

The impact of Covid-19 restrictions in Ireland on symptom severity in mild to moderate Parkinson's disease

Introduction: The COVID pandemic and public health restrictions significantly impacted those living with neurological conditions such as Parkinson's Disease due to the curtailment of therapies. Patients attending a single centre movement disorders clinic reported reduced physical activity and quality of life during the pandemic. This study aimed to assess the impact of pandemic restrictions on Parkinson's Disease symptom severity in people with mild to moderate Parkinson's Disease. Method: A cross-sectional study design with a convenience sample of 20 people living with mild to moderate Parkinson's Disease was adopted. A telephone survey questionnaire was completed to measure changes in symptom severity on the 14 most common Parkinson's Disease symptoms. Data were analysed using descriptive statistics. Results: Nineteen participants completed the survey. Participants frequently reported a decline in nine symptoms of Parkinson's Disease;bradykinesia, rigidity, walking, sleep, mood, memory, quality of life and fatigue. Nil changes in freezing were reported. No change was reported in the nonmotor symptoms of constipation, speech and pain in 75, 65 and 95% of participants, respectively. Conclusion: Findings of this study acknowledge the negative impact of restrictions on the motor and nonmotor symptoms of Parkinson's Disease. Flexibility to access and delivery of service should be considered to mitigate any future potential restrictions.

Health Wire

This section offers news briefs pertaining to health as of January 1, 2023. Research suggests that regular home monitoring can help keep blood pressure at a lower level. A study found that drinking java made with ground coffee may help lower the risk of dying over 12 years than drinking no coffee. Older adults who did yoga or a short course of cognitive behavioral therapy reported less anxiety and insomnia.

Genotyping of Corona virus infections in Baghdad city

Background: The discovery of genotypes linked to geographic and temporal infectious clusters suggests that genotyping analysis can be used to track and monitor the transmission of corona virus. Objective: To explore the clinical value of causative agent for corona virus infection (CoVI) by using different genes (SARS-HCoV2 ORFlab JINZA1 and JINZA2 gene and HCoV NL63, HCoV OC43 and HCoV 229E in the diagnosis of causative agent for corona virus disease and severity of infection to know speed transmission this pandemic and control of disease. Patients and methods: Different types from human samples included nasal swabs, throat swabs and blood samples(plasma) from patients with CoVI and pneumonia. To diagnosis SARS-HCoV2 ORFlab JINZA1 and JINZA2 gene, and HCoV NL63 gene, HCoV OC43 gene and HCoV 229E gene. The positive ratio of SARS-HCoV2 ORFlab gene in the diagnosis of COVID-19 pneumonia confirmed by conventional PCR then gene sequencing by sanger method by using PCR product were sent for Sanger sequencing using ABI3730XL, automated DNA sequences, by Macrogen Corporation Korea. The results were received by email then analyzed using geneious software. Results: Assay for CoV the results shown P = 0.001 Highly sign. (P<0.01) within NL63 gene from nasal and throat swab positive n = 2 (10.53%) while negative n =17 (89.47 %) and P = 0.00 Highly sign. (P<0.01) within CT for NL63 gene positive n = 2 (4 %) while negative n = 48 (96 %). In addition to CoV result by PCR were P = 0.033 Sign. (P<0.05), positive n =17 (34%) and negative n =33 (66 %) from total n =50, and P = 0.019 Sign. (P<0.05) within SARSHCOV2 ORFlab gene from nasal swab by PCR positive n =4(21.05%), negative n = 15(78.95%) from total n =19 and P = 0.648 Non sign. (P>0.05) 229E gene from nasal and throat swab positive n =11(57.9%), negative n =8 (42.1%) from total n=19 (100%). While undetectable from OC43HCOV gene by real time PCR and by conventional PCR that indicated all results were negative for blood samples and from nasal and throat swab: Conclusion: Genotyping very important to know type of gene caused corona virus infection by using PCR real time PCR and conventional PCR indicated the study on the present other types of corona virus were HCOV 229E and NL63 HCOV and PCR product confirmed by Sanger sequencing using ABI3730XL, automated DNA sequences, the results concluded discovery two new isolates called SARSHCOV2ORF1ab JINZA1 gene and SARSHCOV2ORF1ab JINZA2 gene in Baghdad/Iraq patients and submitted in National Center for Biotechnology Information. SARSHCOV2ORF1ab JINZA1 OK486620 gene and JINZA2 OK586822 gene. The names of both genes according to name of PhD student Jnan Jafar Baksh, Supervisal Prof. Dr. Nazar Shiyaa Mohammed and Assist prof. Dr. Ahmed Saadi Hassan. BLAST results indicated because transmission by travel between Iraq and USA. Both of two patient's loss of their life due to severity of infection for JINZA1 and JINZA2 and were critical class for this pandemic.Recommendation: 1) Chosen specific primers for specific gene to avoid coinfection with other viruses and using confirmed tests include real time PCR or conventional PCR and gene sequencing for genotyping for corona virus to know speed viral transmission and control of disease: 2) Nasal swab and throat swab for detection from corona virus mostly greatest than blood samples because viral load higher and development molecular techniques and instruments for detection from virus when very low viral load.

Association of serum level of stem cell factor receptor (c-Kit) with the severity of COVID-19 infection in a sample of Iraqi patients with Asthma

Background: SARS-CoV-2, an enveloped, positive-sense single-stranded RNA virus, was the cause of the pandemic COVID-19. It enters the host cells via the angiotensin-converting enzyme 2 (ACE2) receptor and causes diffuse alveolar damage, pulmonary capillary congestion, and a cytokine storm, which leads to respiratory failure and the deadly acute respiratory distress syndrome (ARDS). Asthma affects a sizable majority of COVID-19 patients. The effects of asthma on COVID-19 progression are still unknown, but a moderating effect is conceivable because respiratory viruses are known to be a significant cause of asthma attacks, and another factor, possibly SCF (stem cell factor and its receptor), is a pleiotropic cytokine that affects immune response activation and survival at various stages of bone marrow development. Therefore, the study's case control objective was to assess the blood levels of c-KIT and the gene expression of stem cell factors in various age groups (asthmatics, people infected with Covid-19, and asthmatics and infected patients compared to healthy subjects). Methods: A case-control investigation was carried out on This study included one handicapped patient who visited Al-Kadhimya Hospital, Medical City, and private clinics in Baghdad, Iraq. The study also included 50 control subjects (without asthma or covid 19). For all groups indicated, the serum level of C-Kit was calculated using ELISA methods. SCF's gene expression was evaluated using the Ct value and folding (2-ΔΔCt) and standardized to the level of a housekeeping gene (GAPDH). Results: The expression of c-KIT and SCF significantly increased in the aforementioned groups (p < 0.001 and p <0.05, respectively). Conclusion: Serum concentrations of SCF and its soluble receptor c-kit appear to be prospective diagnostic targets for asthma and Covid-19 severity, indicating a function for these molecules in asthmatic inflammation as well as a potential treatment target for Covid-19 pathogenesis.

Study of Adhesion Molecules' (ICAM-1 and VCAM-1) Effects on Immunothrombosis in Severe and Critical COVID-19 Infections in Comparison with Mild Cases

Background: The study aimed to evaluate the association among the adhesion molecules (ICAM1 and VCAM-1) with immunothrombosis in severe and critical COVID-19 patients in comparison with mild cases. Materials and Methods: A cross sectional study was conducted. From 1 October 2021 to 30 May 2022, a total of 82 COVID-19 patients were recruited at the hospital in Imam AL-Hussein Medical City/Kerbala, consisting of 44 males and 38 females, and their ages ranged from 25 to 85 years old. All participants were hospitalized after testing positive for the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). 27 of those were diagnosed with mild COVID-19 and 27 with severe cases, while 28 patients had critical diseases. Results: In mild cases, ICAM-1 adhesion molecule level increased approximately more than four folds over the normal range, and dramatically elevated with COVID-19 progression (p= < 0.001). VCAM-1 level also significantly elevated (p = 0.002), but his elevation was slower than ICAM-1 elevation. Conclusion: There is a more significant correlation among immunothrombosis, cellular adhesion molecules (ICAM-1, VCAM-1) elevation and COVID-19 severity.

Outcomes of budesonide multimatrix prescriptions in the COVID-19 pandemic

Background: Budesonide multimatrix is prescribed to treat forms of inflammatory bowel disease (IBD) during periods of relapse, and it is licensed to treat mild-to-moderate ulcerative colitis (UC). However, during the COVID-19 pandemic, there was a rise in the use of budesonide multimatrix to treat all forms of IBD after fears that systemic corticosteroid use, such as prednisolone, could increase the risk of COVID-19 severity. Methods: This audit included records of all patients who were prescribed the budesonide multimatrix Cortiment (9 mg once a day) over a year in NHS Lothian. Patients were grouped by disease activity at the point of prescription (Partial Mayo Score (PMS) less than 5 showed milder disease and above 5 showed more severe disease) and disease phenotype. The primary endpoint was response at 8 weeks from start of treatment, grouped into full response, partial response, no response and escalation. Results: The full response rate to budesonide multimatrix was 52% among all patients, but 80% in those with PMS ≤4 and only 15% in those with a PMS ≥5. By phenotype, response rates were 41% in Crohn's disease, 50% in IBD unclassified, 56% in proctitis, 56% in left-sided colitis and 51% in pancolitis. Conclusions: Budesonide multimatrix is effective to treat mild disease but is not effective in patients who are having a moderate-to-severe flare of IBD. This medication was 80% effective if the PMS was below 5, suggesting that it is very effective in mild disease.

Diabetes mellitus and severity by COVID-19 in hospitalized Brazilians / Diabetes mellitus e gravidade por COVID-19 em brasileiros hospitalizados

RESUMO Objetivo estimar a prevalência de gravidade de casos hospitalizados de COVID-19 e sua associação com o diabetes mellitus. Métodos estudo transversal, que utilizou base de dados secundários do Sistema de Informação de Vigilância Epidemiológica da Gripe, totalizando 405.294 casos confirmados. Para verificar a associação do diabetes e a gravidade em pacientes com COVID-19 hospitalizados, foram usados modelos de regressão de Poisson com estimador de variância robusta. Inicialmente, verificou-se a associação da doença com o desfecho; em seguida, foram realizados diversos ajustes para os potenciais confundidores. Resultados a prevalência de diabetes nos 405.294 casos hospitalizados e positivos foi de 25,7% (Intervalo de Confiança: 25,5% - 25,8%). Após ajustes, observou-se que a diabetes aumentou a gravidade da COVID-19 em 19% (Intervalo de Confiança: 1,17 - 2,21). Conclusão identificou-se associação importante do diabetes mellitus com casos graves de infecção pela COVID-19. Contribuições para a prática: a evidência gerada pelo estudo guia a estratificação de risco de pacientes e direciona o manejo clínico.

ABSTRACT Objective to estimate the prevalence of severity of hospitalized cases of COVID-19 and its association with diabetes mellitus. Methods a cross-sectional study, which used secondary data from the Influenza Epidemiological Surveillance Information System, totaling 405,294 confirmed cases. To verify the association of diabetes and severity in hospitalized patients with COVID-19, Poisson regression models with robust variance estimator were used. Initially, the association of disease with outcome was verified; next, several adjustments for potential confounders were performed. Results the prevalence of diabetes in the 405,294 hospitalized and positive cases was 25.7% (Confidence Interval: 25.5% - 25.8%). After adjustments, diabetes was found to increase the severity of COVID-19 by 19% (Confidence Interval: 1.17 - 2.21). Conclusion a significant association of diabetes mellitus with severe cases of COVID-19 infection has been identified. Contributions to practice: the evidence generated by the study guides the risk stratification of patients and directs clinical management.