Hypoxic Encephalopathy in COVID-19

Aims This study aimed to investigate the prevalence of hypoxic encephalopathy in patients with COVID-19 and its relationship with in-hospital mortality. Instruments & Methods A multicenter prospective study was conducted on 1277 patients with SARS-CoV-2 infection. All patients were evaluated based on age, severity of disease course, presence or absence of typical symptoms of COVID-19, presence of exacerbating chronic conditions, and presence of developed acute neurological complications. Patients with signs of encephalopathy were identified among patients with acute neurological complications, and a differential diagnosis was carried out to identify hypoxic encephalopathy. The data relating to severe patients with hypoxic COVID-19-associated encephalopathy was studied thoroughly for the chronology of the onset of symptoms, detection of the SARS-CoV-2, the similarity of test results, and diagnostic clinical examinations. Findings Hypoxic encephalopathy was identified as the most severe complication among patients with neurological disorders. Most often, older patients had a severe course of the disease. 20% of patients had obtained disorders of the nervous system. 92% of them were diagnosed with hypoxic encephalopathy, which led to death in 95% of cases. Conclusion SARS-CoV-2 hypoxic encephalopathy may lead to a poor prognosis for the course of the disease in the vast majority of patients with neurological complications. It means that this serious complication should be investigated more carefully for possible prevention, early diagnosis, effective treatment, and long-term rehabilitation for patients with COVID-19. Copyright © 2022, the Authors ;Publishing Rights, ASPI.

Neurological manifestations and pathogenic mechanisms of COVID-19.

Coronavirus disease (COVID-19) arising from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection has caused a worldwide pandemic, mainly owing to its highly virulent nature stemming from a very strong and highly efficacious binding to the angiotensin converting enzyme-2 (ACE2) receptor. As the pandemic developed, increasing numbers of COVID-19 patients with neurological manifestations were reported, strongly suggesting a causal relationship. Indeed, direct invasion of SARS-CoV-2 viral particles into the brain can occur through the cribriform plate via olfactory nerves, passage through a damaged blood-brain-barrier, or via haematogenic infiltration of infected leukocytes. Neurological complications range from potentially fatal encephalopathy and stroke, to the onset of headaches and dizziness, which despite their apparent innocuous presentation may still imply a more sinister pathology. Here, we summarize the most recent knowledge on the neurological presentations typically being associated with COVID-19, whilst providing potential pathophysiological mechanisms. The latter are centered upon hypoxic brain injury, generation of a cytokine storm with attendant immune-mediated damage, and a prothrombotic state. A better understanding of both the neuroinvasive properties of SARS-CoV-2 and the neurological complications of COVID-19 will be important to improve patient outcomes.

Genophenotypic Factors and Pharmacogenomics in Adverse Drug Reactions.

Adverse drug reactions (ADRs) rank as one of the top 10 leading causes of death and illness in developed countries. ADRs show differential features depending upon genotype, age, sex, race, pathology, drug category, route of administration, and drug-drug interactions. Pharmacogenomics (PGx) provides the physician effective clues for optimizing drug efficacy and safety in major problems of health such as cardiovascular disease and associated disorders, cancer and brain disorders. Important aspects to be considered are also the impact of immunopharmacogenomics in cutaneous ADRs as well as the influence of genomic factors associated with COVID-19 and vaccination strategies. Major limitations for the routine use of PGx procedures for ADRs prevention are the lack of education and training in physicians and pharmacists, poor characterization of drug-related PGx, unspecific biomarkers of drug efficacy and toxicity, cost-effectiveness, administrative problems in health organizations, and insufficient regulation for the generalized use of PGx in the clinical setting. The implementation of PGx requires: (i) education of physicians and all other parties involved in the use and benefits of PGx; (ii) prospective studies to demonstrate the benefits of PGx genotyping; (iii) standardization of PGx procedures and development of clinical guidelines; (iv) NGS and microarrays to cover genes with high PGx potential; and (v) new regulations for PGx-related drug development and PGx drug labelling.