Neuromyelitis optica spectrum disorder after BIBP COVID-19 vaccine: A case report

Background: With the COVID-19 vaccine now available, there have been occasional reports of post-vaccination neurological complications. Case presentation: In this report, we present a case of neuromyelitis optica spectrum disorder (NMOSD) that developed one month after the patient received the second dose of BIBP COVID-19 vaccine (SARS-CoV-2-Vaccine [Vero Cell] Inactivated). The patient presented with itching, numbness in the hand and right side of the face, as well as nausea, vomiting, and hiccups. Brain MRI revelead lesions in the area postrema, medulla, and bilateral hypothalamus, which are typical of NMOSD. Serum antibodies to anti-AQP4 and anti-MOG were negative. Conclusion(s): The pathogenesis of NMOSD development after vaccination is still unknown. NMOSD is generally aggressive and disabling, it is important for the neurologist to be attentive to the highly variable clinical presentation after COVID-19 vaccination for early diagnosis and effective treatment.Copyright © 2023

Impact of COVID-19 vaccination on menstruation pattern among female nursing and paramedical students in a peripheral medical college in Eastern India

Background: Many females worldwide have reported abnormalities in their menstrual patterns post-COVID-19 vaccination. The present study was conducted to determine the impact of the COVID-19 vaccination on menstrual patterns among female nursing and paramedical students at a peripheral medical college in eastern India. Material(s) and Method(s): The cross-sectional, online self-administered survey was conducted using Microsoft Forms after taking institutional ethical clearance and informed consent from the participants. Two hundred BSc nursing and paramedical students who had received two doses of COVID vaccination (Covaxin or Covishield) and were not suffering from any endocrinopathies, bleeding disorders, structural gynecological abnormalities, or taking any medication known to affect the hypothalamic-pituitary-gonadal axis were included in the study. The questionnaire included menstrual length cycle length and amount of bleeding and there were no direct identifiers. Result(s): The participants reported a significant increase in the amount of bleeding on the heaviest day (mean +/- standard deviation [SD] of the number of pads used was 3.52 +/- 1.15 during prevaccination months vs. 4.64 +/- 1.36 during postvaccination months;P < 0.001) following vaccination. A similar result of increased bleeding on the heaviest day of the period was obtained in both the Covaxin group (mean +/- SD: 3.08 +/- 1.16 vs. 4.88 +/- 1.53;P: 0.001) and the Covishield group (mean +/- SD: 3.59 +/- 1.13 vs. 4.6 +/- 1.34;P < 0.001). No difference in change in the menstrual pattern was observed between the two groups who had received two different types of vaccine (P: 0.527). Conclusion(s): The study showed a possible connection between the COVID-19 vaccination and the change in menstrual patterns.Copyright © 2023 Authors. All rights reserved.

Adipose tissue, systematic inflammation, and neurodegenerative diseases

Obesity is associated with several diseases, including mental health. Adipose tissue is distributed around the internal organs, acting in the regulation of metabolism by storing and releasing fatty acids and adipokine in the tissues. Excessive nutritional intake results in hypertrophy and proliferation of adipocytes, leading to local hypoxia in adipose tissue and changes in these adipokine releases. This leads to the recruitment of immune cells to adipose tissue and the release of pro-inflammatory cytokines. The presence of high levels of free fatty acids and inflammatory molecules interfere with intracellular insulin signaling, which can generate a neuroinflammatory process. In this review, we provide an up-to-date discussion of how excessive obesity can lead to possible cognitive dysfunction. We also address the idea that obesity-associated systemic inflammation leads to neuroinflammation in the brain, particularly the hypothalamus and hippocampus, and that this is partially responsible for these negative cognitive outcomes. In addition, we discuss some clinical models and animal studies for obesity and clarify the mechanism of action of anti-obesity drugs in the central nervous system.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

42nd Scientific Meeting of the German Society for Magnesium Research

The proceedings contain 23 papers. The topics discussed include: Mg and skeletal system: a link to osteoporosis and osteoarthritis;a putative impact of IL-6 on the expression of magnesiotropic genes through the activation of the JAK/STAT3 pathway;magnesium in pain therapy - historical notes and current aspects;Alzheimer's-associated variant rs708727 might be connected to dementia in Parkinson's disease;effect of magnesium citrate supplementation on the brain tissue of patients with Miyoshi dysferlinopathy measured by 31P magnetic resonance spectroscopy;clinical status of magnesium implants;Ionized magnesium: update 2022;magnesium in the treatment of selected types of muscular dystrophy;magnesium speciation analysis in blood serum;epigenetically-induced modulation of the HPA axis might improve resilience to chronic stress;magnesium status in patients with fibromyalgia syndrome;and post-covid-syndrome and transient microvascular pathology in pulse-wave-analysis - association with Mg/Ca ratio and magnesium therapy-options.

Apport de l'imagerie dans l'intoxication au methanol: a propos de 4 cas

Objectifs: - Analyser le profil clinico-radiologique des patients victimes d'intoxications methyliques - Souligner l'interet diagnostique de l'imagerie dans l'intoxication au methanol. Methodes: Il s'agit d'une etude retrospective qui a concerne quatre cas d'intoxications au methanol etudies sur dossiers medicaux, colliges au sein des services de reanimation, neurologie et ophtalmologie du CHU Mohammed VI d'Oujda, durant une periode de 2 ans s'etalant de septembre 2020 au mois de septembre 2022. L'analyse a concerne les caracteristiques liees a l'intoxication. Resultats: Nos 4 patients etaient de sexe masculin, dont l'age moyen etait de 57 ans avec des extremes de 36 et 71 ans. La duree entre consommation et apparition des symptomes etait de 1 jour. Le tableau clinique etait domine par les troubles de la conscience et la cecite. Le bilan biologique a objective une acidose metabolique. 3 de nos patients ont beneficie d'une IRM encephalique objectivant des anomalies de signal caracteristiques a savoir une necrose putaminale bilaterale, une atteinte de la substance blanche et des voies optiques. Tandis que le 4eme patient a beneficie d'une TDM cerebrale montrant une anomalie de densite de la substance blanche frontale bilaterale. 2 patients ont beneficie d'un traitement symptomatique. 3 patients ont garde une cecite bilaterale sequellaire, et l'autre est decede suite au Covid-19. Discussion(s): l'intoxication au methanol et rare et grave engageant le pronostic vital et fonctionnel. Le diagnostic est confirme par un taux sanguin eleve de methanol. L'imagerie joue un role primordial dans l'explication des atteintes, elle objective des anomalies de signal bilaterales et symetriques des noyaux gris centraux, une atteinte des voies optiques et de la substance blanche sous corticale, du cervelet et de l'hypothalamus. Elle impose une prise en charge rapide afin d'eviter les atteintes qui sont irreversibles.Copyright © 2023

Hyponatremia in Empty Sella Syndrome: Is it a Covid Sequelae?

The symptoms associated with empty sella syndrome (ESS) include headache, giddiness, vomiting, visual field deficits, and endocrine problems, as well as the radiological appearance of an enlarged sella turcica. This case report highlights a 45-year-old female who had a COVID-19 infection 2 months back and presented with chronic headache, giddiness, and lethargy having persistent hyponatremia later diagnosed as empty sella syndrome on brain magnetic resonance imaging. In this case, we tried to correlate all of these clinical and radiological features as COVID-19 sequelae due to post-Covid hypothalamic-pituitary axis dysfunction.Copyright © 2023 Authors. All rights reserved.

Massive polyuria associated with severe COVID-19-related pneumonia complicated by pulmonary embolism

Coronavirus disease 2019 (COVID-19) predominantly manifests with signs of respiratory system injury;however, multi-systemic manifestations may occur. Renal pathology develops in up to 80% of patients with COVID-19. The aim of the study was to describe the case of isolated massive polyuria of unknown etiology in the patient with severe COVID-19-related pneumonia complicated by pulmonary embolism (PE). A 54-year-old male with bilateral pneumonia, related to COVID-19, developed PE. The next day after successful thrombolysis with alteplase (90 mg) the diuresis of the patient began to increase and fluctuated between 5000 mL and 8000 mL. The diuresis returned to normal ranges two weeks after PE episode. The rise of the diuresis was not accompanied by electrolyte disorders and elevation of serum creatinine. Changes in the urine tests were minimal, only once the urine protein was detected (0.25 g/L). The highest urine excretion was observed in evening hours (16.00-24.00). Chest CT on the day 14 after the patient's admission revealed 90% of lung tissue injury, cranial CT showed no brain abnormalities, including hypothalamus and pituitary gland. The patient's condition met neither diagnostic criteria of acute kidney injury, nor acute interstitial nephritis, nor pituitary gland damage. The course of the polyuria in the presented case was benign (self-limiting, no blood electrolyte abnormalities, compensated by oral rehydration only). Polyuria in patients with COVID-19 may not be a life-threatening condition that does not require active treatment.Copyright © 2021 EDIZIONI MINERVA MEDICA.

Effects of Various Mrna-Lnp Vaccine Doses on Neuroinflammation in Balb/C Mice

It has been proven that mRNA vaccines are highly effective against the COVID-19 outbreak, and low prevalence of side effects has been shown. However, there are still many gaps in our understanding of the biology and biosafety of nucleic acids as components of lipid nanoparticles (LNPs) most often used as a system for inctracellular delivery of mRNA-based vaccines. It is known that LNPs cause severe injection site inflammation, have broad biodistribution profiles, and are found in multiple tissues of the body, including the brain, after administration. The role of new medications with such pharmacokinetics in inflammation developing in inaccessible organs is poorly understood. The study was aimed to assess the effects of various doses of mRNA-LNP expressing the reporter protein (0, 5, 10, and 20 microg of mRNA encoding the firefly luciferase) on the expression of neuroinflammation markers (Tnfalpha, Il1beta, Gfap, Aif1) in the prefrontal cortex and hypothalamus of laboratory animals 4, 8, and 30 h after the intramuscular injection of LNP nanoemulsion. It was shown that mRNA-LNP vaccines in a dose of 10-20 microg of mRNA could enhance Aif1 expression in the hypothalamus 8 h after vaccination, however, no such differences were observed after 30 h. It was found that the Gfap, l11beta, Tnfalpha expression levels in the hypothalamus observed at different times in the experimental groups were different. According to the results, mRNA-LNPs administered by the parenteral route can stimulate temporary activation of microglia in certain time intervals in the dose-dependent and site specific manner.Copyright © 2022 Pirogov Russian National Research Medical University. All rights reserved.

Yoga may Prevent Cytokine Storm in COVID-19

The pandemic outbreak of coronavirus disease (COVID-19) has emerged as the most threat-ening public health challenge. The clinical presentation ranges from asymptomatic and mild clinical symptoms to acute respiratory-distress syndrome (ARDS) and death. Apart from the respiratory system, other organ systems like cardiovascular, renal, and gastrointestinal systems are also involved. Cytokine storm is a condition of systemic inflammatory cytokine rampage through the bloodstream leading to life-threatening complications. There is an urgent need for the prevention of infection and effective man-agement. Yoga is a profound science with both immunity-boosting and immune-modulating capacity. We propose that yoga-based intervention may aid in improving health with its immunity-boosting potential and preventing the exuberant inflammatory cytokine storm, thus reducing the severity of the disease. It can also reduce stress, anxiety, and co-morbid depression by promoting neuroplasticity and prevents persistent activation of the hypothalamus pituitary adrenal axis and thus may reduce disease severity. It may also enhance the immunity of caretakers and make them more emotionally resilient. Thus, yoga can be useful for enhancing immunity, stress reduction and may prevent the exaggerated immune response to the cytokine storm.Copyright © 2021 Bentham Science Publishers.

COVID-19 and Male Reproduction: A Thorny Problem.

With the global epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the increasing number of infections, little is known about how SARS-CoV-2 affects the male reproductive system during infection or after recovery. Based on the existing research data, we reviewed the effects of SARS-CoV-2 on the male reproductive system and discussed its possible mechanism of action. SARS-CoV-2 enters host cells through the angiotensin-converting enzyme 2 (ACE2)/transmembrane serine protease 2 (TMPRSS2) pathway, and males are more susceptible than females. After infection, immunopathological damage is noticed in the testicles, and the semen index is significantly reduced. Second, abnormalities of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) levels were also observed, suggesting that there may be dysfunction of the hypothalamic-pituitary-gonadal (HPG) axis. Even after recovery, the effect of SARS-CoV-2 on the male reproductive system can last for at least a period. There are still many unresolved questions about the effect of SARS-CoV-2 infection on the male reproductive tract. Other receptors involved during the invasion of human cells by SARS-CoV-2 remain to be identified. Will the mutation of SARS-CoV-2 increase the diversity of receptors? How does SARS-CoV-2 affect the HPG axis? The long-term effects of SARS-CoV-2 on the male reproductive system remain to be evaluated. SARS-CoV-2 infection can affect male reproductive function. Standard treatment strategies should be developed in time to protect the fertility of infected patients. For recovered patients with fertility requirements, fertility assessments should be performed and professional fertility guidance should be provided at the same time.

Screening of Asian Natural Materials to Promote beta-Endorphin Synthesis

Since the recent coronavirus disease 2019 pandemic and the lifestyle changes it necessitated, the demand for mental health treatment has skyrocketed, with long wait lists for both psychological and psychiatric care. Over-the-counter supplements and home remedies are increasingly sought. In this study, we screened natural materials and blended supplements from Asia that may improve the mood and mental health of humans by testing cell viability and expression of the proopiomelanocortin gene as a marker of beta-endorphin production in rat hypothalamus neuron cells. Among 23 tested samples, 3 samples produced significantly higher cell viability in R-HTH-507 cells than the control treatment. In a real-time-polymerase chain reaction (RT-PCR) experiment, 7 samples showed significant beta-endorphin synthesis activity. This is the first report that the Asian natural materials Areca catechu, Moringa oleifera, Lignosis rhinocerus, and Aegle marmelos promote beta-endorphin synthesis;further investigation will identify the active ingredients in the blended samples. These results suggested that these Asian natural materials have great potential to expand the range of treatments for mental health. Copyright © The Author(s) 2023.

Study Of COVID-19 Effect On Thyroid Gland Functions In Sharkia Governorate

The coronavirus disease-19 (COVID-19) is an infectious disease caused by the enveloped RNA beta-severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2). The COVID-19 may have a variable presentation, from an asymptomatic disease to acute respiratory distress syndrome (ARDS) and multi-organ failure. Impairment of endocrine systems may also occur in COVID-19 patients and thyroid gland involvement was reported in a not negligible number of patients, as documented in several studies since the pandemic outbreak. Abnormal thyroid function tests (TSH and/or thyroid hormones) are frequently reported in COVID-19 patients with variable prevalence and mild to moderate severity in available studies. Keys for understanding this dilemmaare introduced in this overview. Copyright © 2022, Anka Publishers. All rights reserved.

The interplay between severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and the hypothalamic and endocrinal disorders: A Mini-review

The worldwide medical systems are still being severely impacted by the coronavirus disease-2019 (COVID-19) pandemic, which is responsible for catastrophic mortality and morbidity. It becomes more and more obvious that this unique respiratory virus's impacts go beyond the respiratory system as time goes on and our comprehension of it deepens. The transmembrane serine protease 2 (TMPRSS2) protein is necessary for the severe acute respiratory syndrome coronavirus 2, which is the cause of COVID-19, to gain cellular entry through the angiotensin-converting enzyme 2 (ACE2) receptor. Most endocrine glands exhibit high levels of expression for ACE2 and TMPRSS2. This pays the attention to the effect of COVID-19 on the endocrine system. Besides its capability to pass to the central nervous system especially the hypothalamus inducing a lot of functional disorders in COVID-19 individuals. Although effective vaccines became widely available, and mortality declined but attention is shifting more and more to the lengthy health impacts on COVID-19 survivors. To inform suitable research and effective management, this review provides an overview of the data examining the impacts of COVID-19 on the endocrine glands besides the hypothalamus. In addition, we reported if the endocrinal and thalamic disorders could affect the incidence and progress of COVID-19. Copyright© by the Egyptian Association of Immunologists.

Effects of Varying Glucose Concentrations on ACE2's Hypothalamic Expression and Its Potential Relation to COVID-19-Associated Neurological Dysfunction.

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted millions of lives, despite several vaccine interventions and strict precautionary measures. The main causative organism of this disease is the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) which infects the host via two key players: the angiotensin-converting enzyme 2 (ACE2) and the transmembrane protease, serine 2 (TMPRSS2). Some reports revealed that patients with glycemic dysregulation could have increased susceptibility to developing COVID-19 and its related neurological complications. However, no previous studies have looked at the involvement of these key molecules within the hypothalamus, which is the central regulator of glucose in the brain. By exposing embryonic mouse hypothalamic neurons to varying glucose concentrations, we aimed to investigate the expression of ACE2 and TMPRSS2 using quantitative real time polymerase chain reaction and western blotting. A significant and time-dependent increase and decrease was observed on the viability of hypothalamic neurons with increasing and decreasing glucose concentrations, respectively (p < 0.01 and p < 0.001, respectively). Under the same increasing and decreasing glucose conditions, the expression of hypothalamic ACE2 also revealed a significant and time-dependent increase (p < 0.01). These findings suggest that SARS-CoV-2 invades the hypothalamic circuitry. In addition, it highlights the importance of strict glycemic control for COVID-19 in diabetic patients.

Orexin/hypocretin system dysfunction in patients with Takotsubo syndrome: A novel pathophysiological explanation.

Takotsubo syndrome (TTS) is an acute heart failure syndrome. Emotional or physical stressors are believed to precipitate TTS, while the pathophysiological mechanism is not yet completely understood. During the coronavirus disease (COVID-19) pandemic, an increased incidence of TTS has been reported in some countries; however, the precise pathophysiological mechanism for developing TTS with acute COVID-19 infection is unknown. Nevertheless, observing the symptoms of COVID-19 might lead to new perspectives in understanding TTS pathophysiology, as some of the symptoms of the COVID-19 infection could be assessed in the context of an orexin/hypocretin-system dysfunction. Orexin/hypocretin is a cardiorespiratory neuromodulator that acts on two orexin receptors widely distributed in the brain and peripheral tissues. In COVID-19 patients, autoantibodies against one of these orexin receptors have been reported. Orexin-system dysfunction affects a variety of systems in an organism. Here, we review the influence of orexin-system dysfunction on the cardiovascular system to propose its connection with TTS. We propose that orexin-system dysfunction is a potential novel explanation for the pathophysiology of TTS due to direct or indirect dynamics of orexin signaling, which could influence cardiac contractility. This is in line with the conceptualization of TTS as a cardiovascular syndrome rather than merely a cardiac abnormality or cardiomyopathy. To the best of our knowledge, this is the first publication to present a plausible connection between TTS and orexin-system dysfunction. We hope that this novel hypothesis will inspire comprehensive studies regarding orexin's role in TTS pathophysiology. Furthermore, confirmation of this plausible pathophysiological mechanism could contribute to the development of orexin-based therapeutics in the treatment and prevention of TTS.

Neuroimmunoendocrinology of SARS-CoV 2 Infection.

This review is aimed at illustrating and discussing the neuroimmune endocrinological aspects of the SARS-CoV-2 infection in light of the studies on this topic that have so far appeared in the literature. The most characteristic findings and pending controversies were derived by PubMed and Scopus databases. We included original and observational studies, reviews, meta-analysis, and case reports. The entry of the coronavirus into susceptible cells is allowed by the interaction with an ecto-enzyme located on human cells, the angiotensin-converting enzyme 2 (ACE2). SARS-CoV-2 also targets the central nervous system (CNS), including hypothalamic-pituitary structures, as their tissues express ACE2, and ACE2 mRNA expression in hypothalamus and pituitary gland cells has been confirmed in an autoptic study on patients who died of COVID 19. SARS-CoV-2 infection may cause central endocrine disorders in acute phase and in post-COVID period, particularly due to the effects of this virus at CNS level involving the hypothalamic-pituitary axis. The aggression to the hypothalamus-pituitary region may also elicit an autoimmune process involving this axis, responsible consequently for functional disorders of the satellite glands. Adrenal, thyroid and gonadal dysfunctions, as well as pituitary alterations involving GH and prolactin secretions, have so far been reported. However, the extent to which COVID-19 contributes to short- and long-term effects of infection to the endocrine system is currently being discussed and deserves further detailed research.

Unusual Presentation of COVID-19 Headache and Its Possible Pathomechanism.

Headache was the most common neurological symptom during the H1N1 pandemic in 2009 and the most recrudescing symptom of human coronavirus (hCoV) in 2016. Even in this prevailing global coronavirus disease 2019 (COVID-19) pandemic, the main neurological symptom is found to be a headache. Headache phenotypes identified with COVID-19 are largely migraine, tension-type headache, or cough headache located in the frontotemporal or occipital region with wavering intensity and essentially of acute onset. We present two cases of unusual headache phenotypes with COVID-19 infection and attempt to shed light on their pathomechanism. Trigeminal autonomic cephalgia may be a possibility in our case, triggered by the virus itself, either directly or through an indirect path elaborated well in the pathomechanism segment. Severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) binds to angiotensin-converting enzyme 2 (ACE2) located in the peripheral nerve and intracranial vascular endothelium, sensitizing the trigeminovascular system by further interacting with higher cortical pain centers via the thalamic and hypothalamic nuclei, producing pain. CSF analysis along with opening pressure measurement in Case 2 may portray a comprehensive understanding of our patient's headache. Coupling with the dorsal pons and trigeminal nucleus caudalis (TNC), the hypothalamus could be the supreme generator for an attack. Hypothalamic perturbance could be a possible phenomenon for abnormal headache experiences and requires further validation. The possible COVID-19 pain pathway pathomechanism engaging interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF) alpha aided with a cortical spreading depression disturbing the hypothalamus is also described in this study. Undoubtedly, this pandemic could prove to be a guiding tool for mankind, for a comprehensive understanding of the enigmatic concepts of headaches.

Covid-19 Vaccines and Menstrual Disorders: Reports from Sardinian Regional Centre of Pharmacovigilance: An International Journal of Medical Toxicology and Drug Experience

Introduction: The anti-Covid vaccines approved in Italy are: Comirnaty, Spikevax, Vaxzevria, Janssen, Nuvaxovid. As of March 26th, 2022, 134,361 adverse events following immunization have been collected in the National Pharmacovigilance Database, 69% of them concern women [1]. Regarding the Sardinian region, as of May 12th, 2022, there are 3043 total reports, 63.4% involve women. In July 2021, the French Drug Agency issued an alert about reports concerning menstrual alterations [2]. PRAC, since new studies have been published, recently decided to further investigate [3]. A cohort study conducted in the US comparing cycle length in a vaccinated cohort vs. an unvaccinated cohort, showed a statistically significant difference [4]. A British case-control study found that 20% of the population included reported menstrual changes, with a higher incidence in individuals with a history of Covid infection [5]. A Norwegian study showed similar results [6]. Objective: To describe the adverse events regarding menstrual disorders in the Sardinian population vaccinated against Covid-19. Methods: We analyzed reports of suspected adverse reactions in the National Pharmacovigilance Database regarding the region of Sardinia, from December 27th, 2020 to April 30th, 2022, we extracted those concerning menstrual cycle alterations after Covid-19 vaccine administration. Results: A total of 78 reports referring to all three scheduled administrations were collected. The majority concerned Comirnaty, with 56 reports: 51 were non-serious, concerning abnormal menstrual cycles in lenght and flow, amenorrhea, dysmenorrhea;five cases were considered serious, but there were other adverse events associated (hypersensitivity reactions, autoimmune disorders, myocarditis in one case). Six reports were related to Vaxevria, with similar manifestations as for Comirnaty;in one case the patient was treated with Tamoxifen. Sixteen cases were reported for Spikevax, with one reporting an episode of bleeding in a three-year menopausal patient. In one case, the patient (IUD carrier) reported menstrual disturbances following all three vaccine administrations (two Comirnaty, one Spikevax). Conclusion: The different distribution of reports among the vaccines can be explained by the increased administration of Comirnaty in the general population and the phasing out of Vaxzevria. Menstrual disorders are common and can be related to several conditions, although a link with Covid vaccines is plausible, as highlighted by recent studies [4-6] and as already observed for other vaccines. In particular, the strong immune system response created by mRNA vaccines may affect the hypothalamic-pituitary-ovarian axis, which regulate the menstrual cycle.

Menstrual Cycle Changes after COVID-19 Infection: Does Coronavirus-induced Stress Lead to Hormonal Change?

Background: Pieces of clinical evidence suggest that coronavirus disease-2019 (COVID-19) viral infection results in hormonal imbalance leading to changes in menstrual cycles of women. This study has been conducted with the aim to determine the effect of COVID-19 infection and its vaccine on menstrual cycle patterns. Materials and methods: This was a cross-sectional study to observe any changes in menstrual cycle after COVID-19 infection or after its vaccination. A Web Link collector generated the survey‘s universal resource locator (URL) and was sent via social media messages to females in the general population as well as healthcare workers. Results: Menstrual cycles remained unaltered in 154/228 (67.5%) of women post-COVID-19 infection irrespective of its severity. Out of 228, one-third of women, i.e., 74/228 (33%), reported changes in their menstrual patterns, with respect to either cycle length, duration of flow, number of pads used, pain during menses, or premenstrual symptoms (PMSs). Menstrual blood loss was decreased by 14% (32/228) and 18%;42 women complained of increased flow during menses. Twenty percent of women who had severe infections had menorrhagia. Out of the 590 women who completed the questionnaire, 436 (73.8%) were vaccinated against COVID-19 and 154 (26%) were unvaccinated. After vaccination, 290/436 around one-third of women (66.5%) had normal menstrual cycle, 21 women (4.8%) had decreased menstrual blood flow, and 18 women (4.1%) reported increased menstrual flow. Conclusion: COVID-19 infection affected the menstrual cycle of only one-third of women and this effect was temporary. This effect might be due to stress and anxiety affecting the hypothalamic-pituitary axis (HPA). More studies are needed to support this effect.