The role of physical activity in modulating COVID-19 neuropsychological complications: a narrative review

Since 2020, the COVID-19 pandemic, triggered by SARS-CoV-2, represents the major global issue affecting the lifestyle of people around the world. Wuhan, China was the first city to detect the SARS-CoV-2 virus, but the virus soon spread around the world, forcing the World Health Organization to declare a global epidemic on March 11, 2020 (1). Previous pathological conditions or comorbidities such as old age are one of the main causes of premature death and increased morbidity and mortality due to COVID-19 (4). Inactivity due to hospitalization and bed rest and reduced physical activity due to constant quarantine and social distancing can reduce the ability of organ systems to resist viral infection and the risk of damage to the immune, respiratory, and Increase cardiovascular systems, musculoskeletal and nervous system (4). On the other hand, the health benefits of physical activity, from cardiovascular health to mental health, have been well established (5). Decreased physical activity and increased sedentary behaviors were reported during quarantine in several populations, including children and patients with a variety of medical conditions (6). In general, COVID-19 lifestyle changes have led to a decrease in physical activity and consequently more inactivity in different parts of the community, which can pose a risk to general or mental health, especially for certain populations. In this study, we have tried to review the neurological and psychological effects of COVID-19 and the resulting lifestyle changes, and specifically the role of exercise in relation to these effects. Central nervous system (CNS) and peripheral nervous system (PNS) manifestations can occur during and after COVID-19, but the underlying mechanisms, symptomatology, and frequency of these complications are not well understood (7). Limited postmortem studies have shown signs of hypoxic brain damage and inflammatory neurological changes in the brainstem, while neuropathological data from the PNS are almost non-existent. Due to the cause, direct invasion of acute respiratory syndrome of COVID-19 virus to nerve tissue has been suggested in several cases, but autoimmune damage and neurological complications related to intensive care management can also be effective. The contribution of these mechanisms to the overall burden of CNS and PNS complications of COVID-19 is unknown (7). Follow-ups in Germany and the United Kingdom have shown that neuropsychological symptoms after COVID-19 in 20 to 70% of patients, even in young adults, last for months after the onset of respiratory symptoms, suggesting brain involvement persists (9). COVID-19, which enters through angiotensin-converting enzyme receptors, can damage endothelial cells, leading to inflammation, thrombosis, and brain damage. In addition, systemic inflammation leads to a decrease in monoamines and neurotrophic factors and activation of microglia, which leads to an increase in glutamate and N-methyl-d-aspartate-3 and excitatory toxicity, and these factors cause the onset or exacerbation of existing neuropsychiatric symptoms. They are already (9). However, the extent of damage caused by the COVID-19 pandemic strain is still speculated;it has recently been suggested that irregular neuro-endocrine-immune interactions may be behind psychiatric manifestations observed in quarantined individuals (12, 13). Persistent and increased stressful events can direct immune, endocrine, and nervous system responses primarily through hypothalamic-pituitary-adrenal (HPA) mediated dysfunction (12), and changes in the levels of systemic inflammatory mediators or the brain predispose individuals to pathological psychological conditions. It acts like anxiety and depression. In addition, stress can be a potential trigger for neuroinflammation, a term used to indicate an imbalance or intensification of immune signals in the brain that can lead to several disorders such as aggression, psychosis, depression, and anxiety disorders (12). Covid 19 has also been shown to alter nerve growth factors that may affect the neurop

Progress in the research of COVID-19 effects on Alzheimer's disease

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). More than one-third of patients with COVID-19 experience neurological symptoms, including confusion, headaches, and decreased/disordered taste. Alzheimer's disease (AD) is a slowly progressive neurodegenerative disease and the most common type of dementia. Alzheimer's disease patients are at high risk and susceptible to infection with COVID-19, which may cause severe illness and even death. There appears to be an interaction between AD and COVID-19, and on the one hand, patients with COVID-19 seem to be more likely to develop AD. AD patients, on the other hand, may be more susceptible to severe COVID-19. Therefore, understanding the common link between COVID-19 and AD may help to develop treatment strategies. Risk factors common to AD and COVID-19 are aging, ApoE T4 allele, beta-amyloid (Abeta) deposition, angiotensin-converting enzyme (ACE), neuroinflammation, oxidative stress. Here, this article focuses on the relationship between COVID-19 and AD, explores common risk factors and potential pathogenesis, and provides help for early prevention, treatment and recovery.

Neurological manifestations in patients with COVID-19

Introduction: COVID-19 pandemic represents a challenge for healthcare systems, due to the impact on different systems, such as respiratory, cardiovascular and nervous systems. Background: to describe the neurological manifestations in patients with COVID-19. Methods: a search for information was carried out in the PubMed/Medline, SciELO, EBSCO, Lilacs and Scopus databases. A search strategy was applied by combining terms and using Boolean operators. Thirty references were chosen. Results: olfactory nerves and invasion of peripheral nerve terminals are suggested as routes of entry;the presence of severe neural symptoms associated with lesions of other organs and cytokine storm is also described. Headache was the most common neurological manifestation in patients with COVID-19, and rhabdomyolysis, acute hemorrhagic necrotizing encephalopathy, Guillain Barre syndrome, meningitis and encephalitis are rare neurological entities. In Guillain Barre syndrome, the literature suggests both a post infectious and para-infectious pattern. Conclusions: COVID-19 is associated with different neurological manifestations, including headache, dizziness, vertigo, vomiting, and alterations of consciousness, stroke and others not so frequent. These symptoms as a whole should be evaluated by healthcare personnel, with a view to their rapid detection and management, in order to guarantee the disappearance of sequelae that reduce the quality of life of patients, as well as to reduce the associated mortality records.

A hospital based observational study of clinical spectrum and outcome of mucormycosis during the COVID pandemic

Background : Mucormycosis is a life threatening fungal disease caused by the filamentous fungi mucormycetes. Though a known entity for decades, it began to manifest in an unprecedented manner in the COVID scenario specially with the second wave in India. The objectives were to describe the demographic characteristics, clinical presentations, risk factors, therapy and in-hospital mortality of patients with Mucormycosis. Material and Methods : We conducted a retrospective observational study for a period of six months from March 2021 to August 2021. The data was collected for cases of mucormycosis from multiple centres all over West Bengal and analysed. All consecutive individuals with confirmed mucormycosis were enrolled in this study. The data documenting demographic particulars, presentation, predisposing factors and comorbiditieswere recorded in a pre validated case report form Details of investigation recording site and extent of disease, therapeutic intervention and outcome was mentioned . Statistical analysis was done using SPSS 21.0 for MS-Windows. Results : The total number of cases from March to August 2021 was 263 . There were 171 males and 92 females and the mean age of occurrence was 50.8+or-0.4 years .In West Bengal clusters of cases were being reported most commonly from the districts of North 24 Parganas, Kolkata, Jalpaiguri, Darjeeling and Hooghly. Some cases admitted here hailed from outside states like Bihar, Jharkhand, Odisha and Assam. The majority of the cases 74.22% (196)were COVID Associated Mucormycosis (CAM) while only 25.78% were non COVID associated. Diabetes mellitus was associated in 78.7% and history of prolonged steroid therapy in 57.4% of cases. We encountered rhino orbital mucormycosis in 99.24% of cases and cerebral involvement in 47.3%. They were treated with Amphotericin B deoxycholate along with endoscopic debridement. The most common side effects of Amphotericin B Deoxycholate were hypokalemia (93%), hypomagnesemia (32%) and AKI (74%) of the cases . The number of patients discharged was 16.7% and 10 left against medical advice (LAMA) . In hospital deaths were recorded to be 26.7%. Cause of death was commonly -AKI, septic shock and multiorgan failure . Conclusion : Prevention is better than cure of this devastating disease which is difficult todiagnose and treat . Awareness about mucormycosis and careful clinical evaluation of post-COVID patients is mandatory in this era in order to rapidly diagnose and treat mucormycosis.

A case of fatal acute necrotising encephalopathy associated with probable SARS-CoV-2

Introduction. Clinical studies during the epidemic of a new coronavirus infection caused by the SARS-CoV-2 virus confirm not only neurotropic damage to the central nervous system, but also complex immune-mediated neurological complications of COVID 19, one of which is acute necrotizing encephalopathy. Purpose of the study. Presentation of a clinical case of acute fatal necrotizing encephalopathy resulting from a severe respiratory infection probably caused by the SARS-CoV-2 virus. Research methods. Retrospective analysis of the medical history, interpretation of clinical and laboratory data, neuroimaging studies and autopsy results in a 22-year-old patient with a fatal neurological complication of a respiratory infection that occurs with bilateral polysegmental interstitial pneumonia. Conclusions. Characteristic ground-glass lung changes suggested a new coronavirus infection caused by the SARS-CoV-2 virus, despite a negative PCR result for virus RNA in a nasopharyngeal and cerebrospinal fluid swab. The rapid increase in focal and cerebral neurological symptoms, diffuse changes and edema of the brain substance according to CT scan and subsequently according to the results of autopsy, signs of systemic inflammation and changes in the coagulating blood system confirmed the changes characteristic of the "cytokine storm" and DIC syndrome developing against the background of systemic endothelitis in COVID 19.

XXI ExpoPPGIm Annual Meeting of the Graduate Program in Immunology, Online, 1-3 September 2021

These proceedings contains 30 articles that covered various topics related to immunology and related fields. The conference papers presented focused on investigating the role of genetics, microbiome, and immunological pathways in disease pathogenesis and treatment. Studies presented at the conference explored the genetic factors associated with obesity in Brazilian children, the role of flavonoids in reprogramming microglia towards a neuroprotective inflammatory profile, the gut microbiome in asthmatic individuals, and the involvement of the MTOR gene and its variants in the severity of COVID-19. Other studies evaluated the immunodiagnostic potential of a protein exclusive to Corynebacterium pseudotuberculosis, genetic markers associated with alcohol dependence and asthma, and the effects of nicotine on glial cells in Parkinson's disease. The conference also presented research on the molecular mechanisms associated with the anti-glioma and immunomodulatory effects of flavonoids, the influence of Trypanosoma cruzi co-infection on the immune response and clinical outcome of patients with cutaneous leishmaniasis, and the association of metalloproteinase gene variants with periodontitis. Furthermore, the papers presented discussed the production of Zika virus singular peptide for the development of serological immunassays, and the role of genetic polymorphisms in the IL1B and IL6 genes in periodontitis. Lastly, the conference included research on the immunological response of broiler chickens fed with diet supplemented with zinc, and the modulatory effects of Agatis flavone on the glial response in an ex vivo model of brain trauma.

SARS-Cov-2 Damage on the Nervous System and Mental Health.

The World Health Organization declared the pandemic situation caused by SARSCoV- 2 (Severe Acute Respiratory Syndrome Coronavirus-2) in March 2020, but the detailed pathophysiological mechanisms of Coronavirus disease 2019 (COVID-19) are not yet completely understood. Therefore, to date, few therapeutic options are available for patients with mildmoderate or serious disease. In addition to systemic and respiratory symptoms, several reports have documented various neurological symptoms and impairments of mental health. The current review aims to provide the available evidence about the effects of SARS-CoV-2 infection on mental health. The present data suggest that SARS-CoV-2 produces a wide range of impairments and disorders of the brain. However, a limited number of studies investigated the neuroinvasive potential of SARS-CoV-2. Although the main features and outcomes of COVID-19 are linked to severe acute respiratory illness, the possible damages on the brain should be considered, too.

High neutrophil/lymphocyte ratios in symptomatic pediatric COVID-19 patients

Objective: To investigate the symptoms and laboratory results of children hospitalised with the diagnosis of COVID-19, aiming to reveal the characteristics of symptomatic cases. Study Design: A descriptive cross-sectional study. Place and Duration of Study: Department of Pediatrics, Kastamonu Training and Research Hospital, Kastamonu, Turkey from March to December 2020. Methodology: Seventy-nine children, hospitalised with the diagnosis of COVID-19, were included in the study and were divided into two groups as symptomatic and asymptomatic. The demographic data, laboratory results and clinics of the patients of the two groups were compared.

Brain damage in COVID-19. Case reports and summary of data in literature

SARS-CoV-2 (severe acute respiratory syndrome), rapidly escalated to a pandemic and has a significant impact on the quality of human life and activity, affecting millions of people. The presentation resumes data regarding the neurological impairment of patients affected by COVID-19;although the data was observational and limited, this examination would help us to broaden our understanding on the association between COVID-19 and the stroke. In order to support such observations I will present two cases of patients diagnosed with COVID-19 that have shown neurological damage, but with different altogether outcomes. The first case analysed, the age and comorbidities of the patient determined an unfavourable evolution, partly also due to tardiness in getting admitted. The apparition of the stroke after the serological negative bias SARS-CoV-2 denotes the complications recently emerged after the severe infection with COV-2, therefore while the viral infection remitted, the physical and pathological tumult determined the emergence of complications with unfavourable evolution. Although similar in certain ways to the first case, the second patient that also presented multiple unfavourable factors, such as old age, severe comorbidities and beyond that - multiple hospital admissions, recent neurosurgical intervention- clinical, immune-serum and biological evolutions have been favourable. Cerebrovascular events are somewhat common findings in COVID-19 infected patients and they could bare a multifactorial etiology. In order to better understand the impact of cerebrovascular events in COVID-19 infection, more precise and prospective data are needed.

Effects of COVID-19 pandemic on economy, healthcare and society

Introduction:- The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is now causing a pandemic with a rapid spread and is expected to become a global public health problem by 2020. Coronavirus illness-2019 is a potentially lethal disease caused by this novel member of the coronavirus family (COVID-19). Despite the continued efforts of researchers to develop effective COVID-19 vaccines and medicines, no progress has been made. COVID-19 (Coronavirus) has hampered global economic progress and caused significant disruption. Thousands of people have been afflicted by the sickness, with many becoming sick or dying as a result of its spread. Fever, chills, cough, bone pain, and difficulty breathing are the most typical signs of this infection, which can lead to pneumonia. Vaccines for this novel virus, which infects people for the first time, are not currently available. As a result, great precautions are taken, such as following a strict hygiene routine, social isolation, and wearing masks, among other things. COVID-19 has had a significant impact on our day-to-day lives, as well as our business, globalisation, and travel. Because the virus spreads quickly from one person to the next, detecting it early is critical to limiting its spread. The majority of countries have narrowed their product offerings.

Patients with hypercoagulability and cerebral infarction caused by COVID-19

Corona Virus Disease 19 (COVID-19) plague is a deadly disease that gets the world's attention, also in Indonesia. The death cases report shows a high number with a sum of more than 95.723 in August 2021 and predicted the case will increase. The virus can cause cerebral edema which penetrates the brain through the olfactory epithelium and induces Cytokine Storm Syndrome (CSS) which can cause interference with the Blood-Brain Barrier (BBB) resulting in hypoxia and coagulopathy. This study used a case study approach with detail testing towards one event. In this case, cerebral infarction caused by COVID-19 was proven by laboratory results with symptoms of inflammation, CSF, sepsis, and coagulopathy. These symptoms can lead to cerebral infarction and hypercoagulability. Treatment interventions are carried out to reduce inflammation and cerebral edema and prevent secondary infection. COVID-19, in this case, is considered to have a deleterious effect on cerebral infarction patients. Proper treatments are needed to give better results.

Effects of the COVID-19 pandemic on brain and behavior. (COVID-19 dedicated issue.)

The Covid-19 viral infection, which was first detected in Wuhan, China at the end of 2019, spread rapidly around the world and turned into a major pandemic. At the time this article was written, Covid-19 has infected more than 250 million people worldwide, causing close to 5 million deaths. In addition to the fact that Covid-19 is a lytic infection, its easy spread through the respiratory tract required a social isolation that people were not accustomed in the pandemic period. Social isolation and economic losses caused significant social and psychological problems in society. On the other hand, Covid-19 also has direct effects on the central nervous system (CNS), and these effects may be responsible for some serious early or late neuropsychic disorders. In addition, acute symptoms of infection involved in respiratory system failure and cytokine storm, and vaccination activities were discussed detailed. Although neurological problems such as seizure, encephalitis, anosmia, dysgeusia, stroke and delirium are discussed to a certain extent, current data on psychological and/or psychiatric problems due to pandemic itself or the virus are remaining limited. In this review article, it is aimed to evaluate the effects of Covid-19 on brain and mental health in the light of current data. In addition, the literature on neuropsychiatric side effects of vaccines approved for emergency use was also reviewed.

Neurological manifestations and etiological risk factors in patients hospitalized with COVID-19 in Turkey

Coronavirus disease 2019 (COVID-19) can affect the neurological as well as the respiratory system. Neurological manifestations may involve the central or peripheral nervous systems, or musculoskeletal system. Findings can range from mild presentations, such as headache and anosmia, to severe complications, such as stroke and seizure. To evaluate the neurological findings and to determine etiological risk factors for mortality in patients hospitalized for COVID-19. Medical records of patients with COVID-19 who were hospitalized and sought neurological consultation between March 2020 and March 2021 at a reference pandemic hospital in Turkey were reviewed retrospectively in a cross-sectional study design. We included data from 150 (94 male) patients. Their mean age .. standard deviation was 68.56 .. 16.02 (range 21-97) years. The patients were categorized into 2 groups according to any acute neurological event or progression of neurological disease. Ischemic cerebrovascular events, seizures, and encephalopathy were the most common acute neurological events, while deterioration in consciousness, epileptic seizures, and Parkinson disease were observed in those with progression of neurological disease. Abnormal neurological findings were found at a mean of 7.8 .. 9.7 days following COVID-19 diagnosis and 50 (a third of) patients died. A logistic regression model found that advanced age, increased Modified Charlson Comorbidity Index (MCCI) score, and prolonged duration of hospitalization were factors significantly associated with increased mortality;however, sex and day of abnormal neurological findings after COVID-19 diagnosis were not. Common conditions accompanying neurological events were hypertension, coronary artery disease-heart failure, and diabetes mellitus. COVID-19 may present with neurological symptoms in our Turkish patients and comorbidities are often present.

Computer aided diagnosis based on artificial intelligence in providing support for health services in rural areas

The health service system in Indonesia is still a homework that needs to be addressed by the government. Both in terms of equity, regulation, and integration between offline and online systems. As for what is happening now, there are at least some obstacles that need to be addressed and addressed as soon as possible. On the other hand, health development should be seen as an investment to improve the quality of human resources and support economic development, and have an essential role in poverty reduction efforts. Today's primary health development problems include the high disparity in health status between socioeconomic levels, regions, and urban and rural areas. In general, the health status of people with high socioeconomic levels in western Indonesia and urban areas tends to be better. On the other hand, the health status of people with low socioeconomic status in eastern Indonesia and rural areas is still lagging. The quality, equity, and affordability of health services are also still low. The quality of service is an obstacle because medical personnel is minimal and equipment is inadequate. In terms of numbers, the ratio of health workers to the population to be served is still low. The affordability of services is closely related to the number and distribution of health facilities. In terms of the limitations of medical equipment, this is due to the high price of the medical equipment. Besides, special training is also needed in medical equipment, which training takes quite a long time, and the material is quite complex. With these conditions, it is necessary to optimize technology to develop medical equipment, especially diagnostic support equipment that is cheap, easy to use, and has high accuracy. Our research aims to address optimizing image processing technology and artificial intelligence in developing technology to support health services in rural areas. We tried to implement several cases of health services that often occur in rural areas, namely early detection of cataracts, optimizing the use of ultrasound machines, optimizing the use of low- quality MRI machines in the diagnosis of Alzheimer's, using microscopic images to identify leukocytes and using X-ray images to support the diagnosis. COVID19. Of the several modules that we have developed for health care support technology, the results show promising prospects with a good level of accuracy, ease to use, and use modalities that already exist in the lowest health service units to reduce prices. It is hoped that this image processing and artificial intelligence-based health service support module can be used in rural areas to overcome disparities in health services in Indonesia.

Neuropsychological disorders after COVID-19. Urgent need for research and clinical practice.

Purpose: Numerous studies suggest that infection with coronavirus SARS-CoV-2, which causes acute respiratory distress syndrome and COVID-19 illness, can lead to changes in the central nervous system (CNS). Consequently, some individuals with SARS-CoV-2 infection may also present the symptoms of neuropsychological disorders. The goals of this literature review is the synthesis of various perspectives and up-to-date scientific knowledge as well as the formulation of initial recommendations for clinical practice. Views: According to current state of knowledge, numerous SARS-CoV-2 infection-specific and nonspecific risk factors exist for brain damage, which might lead to neuropsychological impairments in individuals who have recovered from COVID-19. The emerging evidence suggests significant behavioral and cognitive deficits in COVID-19 survivors, which are present in the early phase after recovery and persist for several months. Neuropsychological disturbances can potentially include a wide spectrum of disorders, yet deficits of attention, memory, executive functions, language and visuospatial orientation are among most commonly identified. The relationship between cognitive impairment, emotional disturbances and severity of COVID-19 symptoms needs to be submitted to further research. Conclusions: The scientific knowledge resulting from neuropsychological empirical studies during the COVID-19 pandemic allows for a postulate of an urgent evidence-based systematic neuropsychological research to be conducted among COVID-19 survivors. More than anything, the recovered individuals must be provided with adequate neuropsychological help in the form of neuropsychological diagnosis, monitoring and rehabilitation.

NMDA and AMPA Receptor Autoantibodies in Brain Disorders: From Molecular Mechanisms to Clinical Features.

The role of autoimmunity in central nervous system (CNS) disorders is rapidly expanding. In the last twenty years, different types of autoantibodies targeting subunits of ionotropic glutamate receptors have been found in a variety of patients affected by brain disorders. Several of these antibodies are directed against NMDA receptors (NMDAR), mostly in autoimmune encephalitis, whereas a growing field of research has identified antibodies against AMPA receptor (AMPAR) subunits in patients with different types of epilepsy or frontotemporal dementia. Several in vitro and in vivo studies performed in the last decade have dramatically improved our understanding of the molecular and functional effects induced by both NMDAR and AMPAR autoantibodies at the excitatory glutamatergic synapse and, consequently, their possible role in the onset of clinical symptoms. In particular, the method by which autoantibodies can modulate the localization at synapses of specific target subunits leading to functional impairments and behavioral alterations has been well addressed in animal studies. Overall, these preclinical studies have opened new avenues for the development of novel pharmacological treatments specifically targeting the synaptic activation of ionotropic glutamate receptors.

Coronaviruses: a challenge of today and a call for extended human postmortem brain analyses.

While there is abounding literature on virus-induced pathology in general and coronavirus in particular, recent evidence accumulates showing distinct and deleterious brain affection. As the respiratory tract connects to the brain without protection of the blood-brain barrier, SARS-CoV-2 might in the early invasive phase attack the cardiorespiratory centres located in the medulla/pons areas, giving rise to disturbances of respiration and cardiac problems. Furthermore, brainstem regions are at risk to lose their functional integrity. Therefore, long-term neurological as well as psychiatric symptomatology and eventual respective disorders cannot be excluded as evidenced from influenza-A triggered post-encephalitic Parkinsonism and HIV-1 triggered AIDS-dementia complex. From the available evidences for coronavirus-induced brain pathology, this review concludes a number of unmet needs for further research strategies like human postmortem brain analyses. SARS-CoV-2 mirroring experimental animal brain studies, characterization of time-dependent and region-dependent spreading behaviours of coronaviruses, enlightening of pathological mechanisms after coronavirus infection using long-term animal models and clinical observations of patients having had COVID-19 infection are calling to develop both protective strategies and drug discoveries to avoid early and late coronavirus-induced functional brain disturbances, symptoms and eventually disorders. To fight SARS-CoV-2, it is an urgent need to enforce clinical, molecular biological, neurochemical and genetic research including brain-related studies on a worldwide harmonized basis.

Coronaviruses and Central Nervous System Manifestations.

SARS-CoV-2 is a highly pathogenic coronavirus that has caused an ongoing worldwide pandemic. Emerging in Wuhan, China in December 2019, the virus has spread rapidly around the world. Corona virus disease 2019 (COVID-19), which is caused by SARS-CoV-2, has resulted in significant morbidity and mortality. The most prominent symptoms of SARS-CoV-2 infection are respiratory. However, accumulating evidence highlights involvement of the central nervous system (CNS). This includes headache, anosmia, meningoencephalitis, acute ischemic stroke, and several presumably post/para-infectious syndromes and altered mental status not explained by respiratory etiologies. Interestingly, previous studies in animal models emphasized the neurotropism of coronaviruses; thus, these CNS manifestations of COVID-19 are not surprising. This minireview scans the literature regarding the involvement of the CNS in coronavirus infections in general, and in regard to the recent SARS-CoV-2, specifically.