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

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.

Special Isue: Virtual anatomy, histology and embryology in research and education. (Special Isue: Virtual anatomy, histology and embryology in research and education.)

This issue contains 13 articles on the use of virtual anatomy, histology and embryology in research and education;digital histological morphometry of the human pineal gland in a postmortem study, with endocrine and neurological clinical implications;an international collaborative approach to learning histology using a virtual microscope;delivery anatomy kits to help keep practical veterinary classes during the COVID-19 pandemic;how virtual animal anatomy facilitated a successful transition to online instruction and supported student learning during the coronavirus pandemic;using videos in active learning in veterinary anatomy;dissection videos as a virtual veterinary anatomy peer learning tool at the University of Tehran during the COVID-19 pandemic;a new virtual platform for teaching comparative animal neuroanatomy based on metameric slices of the central nervous system;application of student remote and distance research in neuroanatomy by mapping Dscaml1 expression with a LacZ gene trap in mouse brain;implementing a multi-colour genetic marker analysis technique for embryology education;impact of COVID-19 on student attainment and pedagogical needs when undertaking independent scientific research;extended reality veterinary medicine case studies for diagnostic veterinary imaging instruction and assessing student perceptions and examination performance and students' performance in teaching neuroanatomy using traditional and technology-based methods. 16 proceedings from the Trans-European Pedagogic Anatomy Research Group (TEPARG) Hybrid Meeting entitled "Hybrid Anatomy Education: Barriers and Enablers for Students and Educators" held in Barcelona, Spain, during 5 March 2022, are also included.

[Neurocovid-19: effects of COVID-19 on the brainNeurocovid-19: efeitos da COVID-19 no cérebro]. / Neurocovid-19: efectos del COVID-19 en el cerebro.

In the COVID-19 pandemic, direct and indirect effects on mental health have been reported, including neurological, neuropsychiatric, and neuropsychological symptoms with possible long-term effects. Also, it is suspected that in the coming years there could be a worldwide increase in the incidence of neurodegenerative disorders.The objective of this article is to review the most up-to-date information on brain damage associated with COVID-19, as well as the neuropsychiatric symptoms of the disease. The exact mechanisms of brain damage have not yet been clarified, and further longitudinal and international research-including studies that incorporate epidemiological, clinical, and diagnostic variables-is required to define these mechanisms and establish their impact on mental health, as well as their long-term consequences.

Durante a pandemia de COVID-19 foram relatados efeitos diretos e indiretos na saúde mental, incluindo sintomas neurológicos, neuropsiquiátricos e neuropsicológicos com possíveis efeitos no longo prazo, e suspeita-se que nos próximos anos poderá haver um aumento nas taxas de incidência de doenças neurodegenerativas em todo o mundo.O objetivo deste artigo é revisar as informações mais atualizadas sobre os danos cerebrais associados à COVID-19 e seus sintomas neuropsiquiátricos. Os mecanismos exatos desses danos ainda não foram esclarecidos, sendo necessário continuar com pesquisas longitudinais e internacionais ­ incluindo estudos que contenham variáveis ­ epidemiológicas, clínicas e diagnósticas ­ para defini-los e estabelecer sua repercussão na saúde mental, bem como suas consequências no longo prazo.

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.

Observational study of imaging findings in COVID -19 related rhino-orbito-cerebral mucormycosis - a tertiary care center study

Background: There has been a tremendous increase in number of cases of rhino-orbitocerebral involvement with mucor in the COVID era, as reported from India. It is well established that management of ROCM involves early clinical and radiological diagnosis, reversal of underlying risk factors, prompt antifungal therapy and surgical debridement when indicated. Materials &Methods: Multiplanar MR imaging and CT scan were performed for brain, orbit and paranasal sinuses. All the cases were assessed for involvement of the paranasal sinuses, nasal cavities, orbits and brain. Results: 25 cases with ROCM were identified over 8 months. The mean age of the cases was 56.1 years. 18 of the 25 cases had a positive RT-PCR test result at the time of diagnosis with ROCM. 20 cases had poorly controlled diabetes mellitus, 2 had a hematological malignancy, 2 had chronic kidney disease and 1 had ischemic heart disease. There was involvement of the paranasal sinuses, nasal cavities, orbits and brain inclusing necrosis in most of the cases. The number of cases identified during the interval is much higher than the numbers presenting in the prior 2 years during equivalent intervals than those reported in the literature in different settings in the pre-pandemic era. Conclusions: Rhino-orbito mucormycosis can have aggressive necrosis of the involved paranasal sinuses and orbits with or without cerebral extension. Hence, the correct diagnosis is imperative as prompt antifungal drugs and surgical debridement can significantly reduce mortality and morbidity.

A review of pleiotropic potential of erythropoietin as an adjunctive therapy for COVID-19

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory disease with a high prevalence. According to the research and statistical data, in January 2021, there have been 92,262,621 confirmed cases of COVID-19 and more than two million deaths. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the main cause of this disease. In addition to the respiratory system, the disease affects the gastrointestinal tract, central-peripheral nervous system, circulatory system, and kidneys. Therefore, any therapeutic action to reduce COVID-19-related symptoms and complications is essential. In this study, we conducted a systematic review of the published literature and preprints on the efficacy of erythropoietin (EPO) and recombinant human EPO as a safe stimulant and tissue protector in the treatment of COVID-19. We also briefly described the structure of coronavirus, its pathogenesis, and the structure of EPO and recombinant human EPO. All relevant articles published in the Science Direct, PubMed, and Google Scholar databases were searched. According to the results, EPO is a cytoprotective cytokine induced by hypoxia. The pleiotropic effects of EPO are associated with its erythrocyte-forming, anti-apoptotic, anti-inflammatory activities. It also exerts protective effects on the heart, lungs, kidneys, arteries, and central and peripheral nervous systems. It has been demonstrated that EPO can increase hemoglobin levels, thereby increasing oxygen delivery to the tissues. Therefore, recombinant human EPO therapy can be used for counteracting the adverse effects of COVID-19 including hypoxic myocarditis, acute renal failure, pulmonary edema, and brain-spinal cord ischemic injury. Overall, the use of EPO and recombinant human EPO therapy increases blood coagulation, tumor growth, thromboembolism, and purification of red blood cells, which must be accompanied by anticoagulants such as heparin.

Rhino-orbital-cerebral mucormycosis as a complication of coronavirus disease 2019.

Coronavirus disease 2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus 2. This disease as well as its various treatments like steroids, antivirals, and antibacterials can alter the immune state of the affected individuals and result in secondary infections such as mucormycosis. Mucormycosis is a well-known opportunistic fungal infection that affects immunocompromised subjects, particularly those with diabetes mellitus, prolonged antibiotic or steroid use, and patients with organ trans-plantation, neutropenia, and hematological malignancies. Rhino-orbital-cerebral mucormycosis is an aggressive disease owing to its ability to invade the blood vessels by fungal hyphae, leading to necrosis of the involved structures. Large cases were reported from India, indicating that this clinical entity shows a geographical variation. The affected patients are suffering on a clinical spectrum depending on the stage of the disease. Radiological assessment, including computerized tomography and magnetic resonance imaging, is necessary to evaluate the stage of the disease and choose the appropriate surgical treatment. A multidisciplinary approach is required to treat rhino-orbital-cerebral mucor-mycosis and includes local or intravenous antifungal drugs, debridement of the dead tissues, and appropriate management of any predisposing conditions. The disease has a very poor prognosis with a death rate of 50%. This review aimed to sum-marize the demographic and clinical risk factors, investigations, treatments, and outcomes of coronavirus disease 2019 patients with rhino-orbital-cerebral mucormycosis.

Obesity and the brain. Winter Conference 2021, 7-8 December 2021

This journal issue includes 48 articles that discuss development and validation of a novel quality assessment tool to measure the quality of nutrition information online;longitudinal association between takeaway food environment and secondary school adolescents BMI and body fat percentage;dietary practices, beliefs, and behaviours among adults with inflammatory bowel disease;postpartum depression in Irish mothers and associations with infant feeding practices;the impact of dietary saturated fat replacement with unsaturated fat on the plasma lipidome and cardiometabolic disease risk;ole of brain serotonin in age-related decline in physical activity in mice;ey stakeholder perceptions of food allergies within the airline industry;sleep quality of higher education students during COVID-19 and its association with diet quality and lifestyle behaviours.

Suppression of stress by aroma: alterations in the expression of brain factors

Stress such as uncertainty about the future, including the problem of new coronavirus infection, is a very serious problem not only for physical health but also for mental health. It is certain that stress is one of the risk factors for developing mental disorders. We have found stress-responsive biomarker (stress marker) candidates through studies on the process from stress to disease onset. Recently, we have been trying to prove the stress-suppressing effect of aroma with brain factors. We analyzed how aroma affects behavioral changes due to stress and the expression of stress marker candidates in the brain. In this article, the data on aroma that we have accumulated so far will be introduced. Specifically, we will describe changes happened in experimental animals when they smelled coffee beans, lavender, cypress, a-pinene, and thyme linalool. When considering the biological effects of aroma, it is inevitable that not only the olfactory pathway but also odor molecules act through the bloodstream by nasal and transdermal absorption. The brain transferability of odor molecules may be a bottleneck in analyzing the biological effects of volatile components. Thus, we would like to discuss on this issue.

Can dentists prevent black fungus in post-COVID-19 patients?

In the southeast India, post-COVID-19 black fungus is increasingly being reported in medically compromised individuals. Diabetes and systemic steroids in COVID-19 patients constitute the double-edged sword that results in post-COVID-19 fungal infections. Black fungus is a part of normal flora that thrives in an immunocompromised state, resulting in rhino-orbital-cerebral mucormycosis. Majority of patients, suffering from black fungus, have uncontrolled diabetes and have undergone steroid therapy. Intra-oral signs are the earliest warning signs in black fungus and dentists should be on the lookout for these, so as to prevent the development of deadly infection. Comprehensive intra-oral signs are enlisted in this review for dentists that include tooth mobility and periodontal clinical attachment loss amongst others. Evidence-based preventive approaches are highlighted in this review to reduce morbidity and mortality, associated with black fungus. Regular dental check-ups are vital to prevent and diagnose early the secondary fungal infections in post-COVID-19 patients, reducing morbidity significantly.

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.

Social isolation and post-COVID neuropsychological damage

Social isolation (SI) exerts a harmful effect on brain plasticity even in healthy animals and humans. We reported some new connections between aggressive behavior and SI, and new mechanisms of SI damaging effect on experimental rodents in previous studies. SARS-CoV-2 exhibits neurotropism through its affinity for the ACE2 receptor in endothelial cells found in the brain. The neurotropism in the disease caused by the new coronavirus accords with a wide spectrum of neurological, psychiatric and psychological symptoms. It had been reported that up to almost 43% of SARS survivors developed long-lasting psychiatric morbidity that persisted at 4 years follow up with main diagnoses in diminishing order of representation: posttraumatic stress disorders, depression, panic disorder, and obsessive-compulsive disorder. Full assessment of the long-term risk of neurological and psychological complications will be greatly needed once the coronavirus pandemic is over. Based on current data and the reported experience with SARS-CoV we hypothesize that the neurobehavioral sequelae of the disease caused by SARS-CoV-2 will necessitate close interaction between emergency medicine and psychological support. The role of social support for the restoration of post-Covid neuropsychological damage is essential because the human being is not only a biological object but also a social subject who needs support from other humans.

The effects of exercise on cognitive dysfunction in patients with Coronavirus and sports recommendations for their recovery

Background & Aims: Beginning in 2020, a deadly disease called COVID-19 spread throughout the world, plunging all countries into a viral infection. Viral infections are naturally associated with upper respiratory tract infections, which are commonly reported with fever, headache, and cough. COVID-19 virus can infect a person's respiratory system and lungs, eventually leading to death. The virus can first activate and infect macrophages. Macrophages then transfer COVID 19 to T cells and make them weak. In addition, by weakening T cells, T cell subsets are activated to increase cytokines to enhance the immune response. T cells, CD4 + T cells and CD8 + T cells play an important antiviral role in the body. It is noteworthy that CD4 + T cells in the body produce T cell-dependent (B) cells to increase virus-specific antibodies. On the other hand, CD8 + T cells are a toxic cell and can kill virus-infected cells. Most published studies have focused on the effect of aerobic exercise on immune system function. Recent studies have shown that tai chi and yoga exercises can also be beneficial for immune system function. Exercise has long been known as an important modulator of inflammatory processes. Exercise can apparently have both tonic and suppressive effects on the immune system. The effect of exercise on innate and acquired safety parameters depends on the intensity, load and duration of exercise. As the severity increases, immune function and ultimately the risk of infection increase. These risks depend on immune system regulators (genetics, nutritional status, psychological stress, circadian rhythms), environmental stressors (extreme temperatures, airway irritants) that increase inflammation. In response to exercise, immune cells grow, proliferate, and produce molecules such as cytokines and cytotoxic granules. Prolonged exercise, at least in healthy individuals, appears to reduce basal inflammatory status by reducing the circulation of inflammatory cytokines. Regular periods of short-term training (i.e., up to 45 minutes) with moderate intensity boost the immune system (increase T cells) while frequent periods of long-term high-intensity training (> 2 hours) can suppress the immune system. Acute exercise, even in healthy individuals, leads to a strong inflammatory response that is mediated by leukocyte mobilization (even for short periods of 6 minutes) and increases potent inflammatory mediators such as TNF-a, IL-1. The effect of increasing aerobic capacity on improving lung function and preventing lung injury can be summarized in four mechanisms. The first mechanism of aerobic exercise can prevent the suppression of the immune system by affecting the immune system and increase anti-inflammatory factors. The second mechanism contains the role of aerobic capacity in restoring the elasticity of lung tissue to normal and increasing the strength and endurance of the respiratory muscles, which helps increase ventilation, and reduce lung damage. The third mechanism includes the role of aerobic capacity as an antioxidant to limit the production of free radicals and oxidative damage. The fourth mechanism involves the role of aerobic capacity in reducing cough and clearing the airways by improving pulmonary safety and autonomic modulation.

The role of inpatient treatment with melatonin in patients with COVID-19 infection

Introduction: Melatonin is a hormone synthesized by the pineal gland with proven antioxidant, anti-inflammatory and immunomodulatory effects that may be helpful in reducing the severity of COVID-19 infection.

Three cases of encephalopathy / disseminated encephalomyelitis in SARS-CoV-2 infection

As many other viral pandemics, the current SARS-CoV-2 is also characterized by nervous system involvement, mainly in elderly patients with comorbidities. Recent scientific reports indicate that involvement of the nervous system is manifested by a variety of clinical symptoms related to the severity and extent of brain damage. Encephalopathy, encephalitis and polyneuritis are among the complications reported in patients with SARSCoV- 2. These complications have been morphologically proven. As an immune-privileged structure, neural tissue is particularly vulnerable to autoimmune attacks. Therefore, various neurological diseases such as MS, Guillain-Barre syndrome, as well as autoimmune encephalitis and psychosis have also been reported in patients with SARS-CoV-2 infection. Herein, we present three cases of patients who died after infection with the SARS-CoV-2 virus. We emphasize on the pathomorphological changes found in a detailed study of the brain and cervical spine. The analysis of the inflammatory findings, mainly manifested by perivenous lymphocytic infiltrates, serodiapedesis and erythrocyte depots around the vessels, showed a presence of initial demyelination (in two of the cases). The blood supply of most venous vessels with different size and a pronounced "sludge" phenomenon were the most impressive findings, as in some sections these changes were demonstrated by a presence of thrombosis. Inflammatory manifestations were also observed in the brainstem near to the stem nuclei. The SARS-CoV-2 virus induces a variety of immune system responses. In some patients there is a negligible or no reaction, while in others there is a "cytokine storm" with a system damage of multiple organs - often including the brain.

Special issue on microbiome. (Special issue on microbiome.)

This special issue includes 13 articles focusing on innate lymphoid cells and gastrointestinal disease;microbiota-gut-brain axis in autism spectrum disorder;characteristic dysbiosis in gout and the impact of a uric acid-lowering treatment, febuxostat on the gut microbiota;gut microbiota, inflammation, and molecular signatures of host response to infection;the rice histone methylation regulates hub species of the root microbiota;a powerful adaptive microbiome-based association test for microbial association signals with diverse sparsity levels;an efficient metatranscriptomic approach for capturing RNA virome and its application to SARS-CoV-2;easy to create repeatable and editable Venn diagrams and Venn networks online.

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.