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Neurological symptomatology is a crucial component of neurological expertise. The committee for fostering board-certified neurologists in the Japanese Society of Neurology (JSN) has hosted an educational activity for residents before the board examination, "The seminar for fostering board-certified neurologists" since 2004. In particular, the autumn seminar has been characterized by small group hands-on of neurological examinations and the evaluations of higher brain function. Besides this, hands-on seminar of neurological examinations by regional branches has been promoted by the JSN. In the Kanto Ko-shin-etsu branch, "The first hands-on seminar of neurological examinations" started in 2023 after a 3-year-suspension due to COVID-19. The most important educational activities in neuromuscular electrodiagnosis (EDx) is the "Neuromuscular diagnostics seminar" hosted since 2004 by the Japanese Society of Clinical Neurophysiology (JSCN). The majority of tutors and participants are neurologists. This seminar is also characterized by small-group, hands-on workshops. We have also run the overseas seminar, "Tokyo Super EMG hands-on," since 2013. These have undoubtedly contributed to enhancing the level of neuromuscular electrodiagnosis not only in Japan but also in other Asian countries. I have conducted studies on neurological symptomatology and neuromuscular electrodiagnosis, which are directly linked to enhancing clinical practice of neurologists through educational activities such as review articles or lectures. Due to the fact that symptomatology is crucial in neurological expertise, neurology is a basic specialty around the world except in Japan. In 2018, the JSN decided to aim to make neurology a basic specialty and continues to make efforts to attain this goal.Copyright © 2023 Japanese Society of Neurology and John Wiley & Sons Australia, Ltd.
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Background: Case study: Conclusion(s): The purpose of the study was twofold: (1) to present post-COVID-19 syndrome, which involves a variety of ongoing neurological, neuropsychiatric, neurocognitive, emotional and behavioral disorders resulting from SARS-CoV-2 infection followed by a severe course of COVID-19 treated in long term pharmacologically induced coma in a visual artist, which impacted on her artwork;(2) to present QEEG/ERP results and neuropsychological testing results in the evaluation of the effectiveness of a comprehensive neurotherapy program, with individualized EEG-Neurofeedback, and art-therapy in the reduction of post-COVID-19 syndrome in this artist. Ms. G., 42, a visual artist, portraitist, with good health, became ill in May 2022. Allegedly flu symptoms appeared first. After a few days, shortness of breath joined in. The PCR test for SARS-CoV-2 was positive. The patient was hospitalized, referred to the ICU, put on a respirator and treated over 11days of a pharmacologically induced coma. Two months after leaving hospital the patient developed post-COVID-19 syndrome. She was diagnosed by an interdisciplinary team: a neurologist, neuropsychiatrist and neuropsychologist. A PET scan of her brain revealed extensive changes involving a loss of metabolism in various brain areas. The presence of complex post-COVID, neurological, neuropsychiatric, neurocognitive, emotional and behavioral disorders was found and a neuropsychiatrist suggested a diagnosis of post-COVID schizophrenia. She was refered to the Reintegration and Training Center of the Polish Neuropsychological Society.We tested the working hypothesis as to the presence of schizophrenia and there was no reduction in the difference of ERPs waves under GO/NOGO task conditions, like in the reference group with schizophrenia (see also Pachalska, Kaczmarek and Kropotov 2021). The absence of a functional neuromarker for schizophrenia allowed us to exclude this diagnosis and to propose a new disease entity, that being post-COVID-19 syndrome. She received a comprehensive two-component program of neurotherapy: (1) program A consisting in goal-oriented neuropsychological rehabilitation, including art therapy (see also: Pachalska 2008;2022b), and (2) program B, based on the most commonly used form of EEG-Neurofeedback: frequency/ power EEG-Neurofeedback, using 2 bipolar surface electrodes, with the protocols written for her specific needs (see also Thompson & Thompson 2012;Kropotov 2016). The comprehensive neurotherapy program lasted 10 weeks, EEG Neurofeedback and art therapy classes were conducted 3 times a week for 45 minutes each. We found that after the completion of the comprehensive neurotherapy program there was a statistically significant reduction in high beta activity compared to the normative HBI database, which is associated with a reduction of anxiety. Also, we observed the improvement of neurocognitive functioning in neuropsychological testing (a significant reduction of anxiety and a noticeable improvement in neurocognitive functions). It should be stressed that the artist was happy that she had regained the ability to create, and even sells her artwork, although her style of painting had changed. Almost all the neurological, psychiatric, neurocognitive, emotional and behavioral disturbances, were reduced in their severity. The artist showed marked improvement and was able to return to painting. The artwork she produced after her illness is in high demand with art collectors. It can be also helpful in the reintegration of the Self System, and the improvement in her quality of life. Human Brain Index (HBI) methodology might be very useful in diagnosing and developing therapies for patients with post-COVID-19 syndrome.Copyright © 2023, MEDSPORTPRESS Publishing House. All rights reserved.
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Treating neurological patients during the pandemic period has become extremely challenging. At the same time, responding properly to these challenges has been diverse around the world, with varying levels of readiness, discipline, and approach. Additionally, there are significant differences in healthcare resources and processes between nations, and even within a nation, and these have significantly influenced the treatment procedure throughout the pandemic. However, neurologists have been called to care for patients with neurological symptoms who have COVID-19, and to continue managing COVID-19-affected neurological comorbidities in patients as before. This study highlights how the treatment procedures for neurological diseases are rapidly changing due to the spread of the SARS-CoV-2 virus. It also focuses on the challenges healthcare professionals are facing while providing proper treatment to neurological patients during the pandemic situation. Lastly, it offers some useful recommendations regarding the effective management of neurological diseases during the COVID-19 pandemic period.
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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
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Introduction The COVID-19 pandemic affected medical students experience of clinical neurology. Outpatient clinics reverted to telephone or video consultations. We sought to assess the impact of this change via a survey of both students and consultant neurologists. Methods An online 14-part questionnaire using Likert scales and free text options was distributed to all Year 4 medical students and consultant neurologists via email. Results 366 students received the survey and 39 responded (an 11% response rate). 41 consultants received the survey and 9 responded (a 22% response rate). 83% of consultants felt the student's inter- action with the patient was affected by the telephone/video software. 29% of students strongly agreed and 36% agreed that technological barriers impacted their learning experience. The free text student feedback highlighted good practice. We developed best practice guidance which included use of video consultation software, student engagement and clinic debrief. This was distributed as digestible checklists for students and clinicians. The limitations of this survey are the small response rates of both consultant and student groups. Conclusion Remote consultations are likely to remain part of neurological practice. Ongoing evaluation of its effect on medical student education and specific guidance for educators is required.
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Objective(s): The objectives were to provide an overview of the current practices of Near East (NE) healthcare practitioners (HCPs) by probing their prescribing decisions, to report the COVID-19 impacts on neurologists' prescribing habits, and to explore the future relevance of current medication used in MS management among other newcomers Material(s) and Method(s): A cross-sectional study was carried out using an online survey from April 27, 2022, to July 5, 2022. The questionnaire was designed with the input of five neurologists representing five NE countries (Iran, Iraq, Lebanon, Jordan & Palestine). They identified several factors that play a crucial role in the optimal care of MS patients. The link was shared among neurologists using snowball sampling Result(s): The survey included 98 neurologists from the included NE countries, the majority of whom had more than 15 years of experience in the field, and 39% were seeing more than 40 MS patients a month. Effectiveness and safety balance was the most important factor considered when selecting the MS treatment. In the treatment of mild to moderate RRMS in men, Interferon beta 1a SC, Fingolimod, and Glatiramer acetate were the most commonly recommended treatments. Dimethyl fumarate substituted fingolimod in female patients. According to 80.7% of participants, interferon beta 1a SC was the safest treatment for mild to moderate RRMS. Interferon beta 1a SC was preferred over other treatments for patients with mild to moderate MS and planning for pregnancy (56.6%) or breastfeeding (60.2%). Fingolimod was not a choice for these patients. Neurologists seemed to discuss the top three treatments of Natalizumab, Ocrelizumab, and Cladribine with patients with highly active MS. Conclusion(s): Most neurologists in the NE region followed MENACTRIMS recommendations for prescribing treatment. The treatment choice also depended on the availability of DMTs in the region. Regarding the use of upcoming DMTs such as Ofatumumab, Siponimod, Ozanimod, and BTK inhibitors, there is a clear need for real-world data, long-term extension studies, and comparative studies to support their efficacy and safety profiles in treating patients with MSCopyright © 2022
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Introduction: It seems that Multiple sclerosis (MS) patients are at the higher risk for COVID-19 implications due to the use of immunomodulatory or immunosuppressive treatments. Obesity as a risk factor may lead to more adverse consequences. Relationship between obesity and COVID-19 risk and outcome in Iranian MS patients still remains unclear. We aimed to investigate the impact of BMI as a modifiable risk factors on the risk and outcomes of COVID-19 in Iranian patients with MS. Material(s) and Method(s): A cross-sectional study was conducted in the Sina hospital, Tehran, Iran. MS patients were asked to complete an online questionnaire in the google form format. Demographic information, clinical data consisting of MS disease-related factors, COVID-19-related factors, and anthropometric information were collected. In total, 492 patients were filled the questionnaire. BMI was categorized considering WHO's standard classification as underweight (BMI<18.5), normal weight (BMI>=18.5 and <25), overweight (BMI>=25 and <30), obesity type I (BMI>=30 and <35), and obesity type II (BMI>=35) (3). Result(s): The mean age was 36.7+/-8.2 and 395(80.3%) of them were women. 350(71.1%) of participants were suffered from RRMS. The most received MS drugs was Rituximab (36.0%). The mean BMI was 24.3+/-4.5 kg/m2. 234(47.6%) participants reported COVID-19 infection during the pandemic. 465(94.5%) of them were two doses vaccinated and 15(3%) of them were one-dose vaccinated. The odds ratio of COVID-19 infection was significantly 4.41 times more than the normal group in the type 2 obesity category (OR:5.41;95%CI:1.00-29.09) in the fully adjusted regression model. COVID-19 severity was significantly different in BMI groups (P:0.02), So that 11(8.6%) patients in normal weight group and 4(50%) of patients in type II obesity group were hospitalized due to COVID-19 infection. Respiratory symptoms (P:0.05) and gastrointestinal symptoms (P<0.01) were more prevalent among types I and II of obesity. On the other hand, no one in the obesity type I and II reported COVID-19 infection without any symptoms (P:0.04). Conclusion(s): The results of current study support that obesity could play a key role in susceptibility to COVID-19 infection and symptoms severity in MS patients. One of the issues that emerge from these findings is recommended that neurologists pay more attention on patients' BMI during this pandemic.Copyright © 2022
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Objective: to assess the awareness of Parkinson's disease (PD) diagnosis and treatment among medical professionals in Kazakhstan. Background(s): PD is one of the most common neurodegenerative disease (1). Data on PD prevalence and incidence is lacking in Kazakhstan (2,3). Method(s): The original Thai questionnaire (4,5) was adapted, translated into the Russian language and validated. Questionnaire includes 20 questions divided into 3 groups: diagnosis of PD, treatment of PD and progression. The survey questionnaire was uploaded and shared online;printed forms were distributed to the medical staff in Almaty city. Result(s): 187 forms were collected, 20 printed forms were excluded after revising because of incorrect and incomplete filling (Fig.1): 48 male and 119 female responders. Mean age of responders was 36.34+/-10.933 years. 47.3% (79) of them work in the government hospitals, 50 (29.9%) are in the outpatient clinics, 33 (19.8%) are in the private clinics. The average experienced years after graduation are 12.16+/-11.696. Some of the responders has no practice with PD patients, but some of them accept 70 PD patients per month, average meaning is 5.23+/-9.562 patients per month. Average duration of residency of neurologists is 18.52+/-9.135 months. Only 14.4% of responders refer patients with PD to movement disorders specialist. Most popular medicines for PD treatment are Levodopa (70.06%), Pramipexol (25.75%), Amantadine (22.16%), only 9.58% of responders use DBS and less than 3% use pallidotomy and thalamotomy. 17.37% of responders has patients with foreign country treatment (43.8% other form of levodopa, 25% of levodopa +entocapone). 30.5% responders answered without mistakes, and only 9.6% mentioned all correct symptoms (Fig.2). 4.79% of responders mentioned all correct non-motor symptoms of PD (Fig.3). 74.3% of responders has supposed that neuroimaging is mandatory for diagnosing PD, 79.1% mentioned the rest tremor as obligatory symptom of PD (Fig.4). 81.4% of medical staff know that levodopa is the most effective medicine for PD patients. 50.9% of responders considered that SARSCov- 2 vaccine is contraindicated for PD patients (Fig.5). 83.8% of medical staff mentioned that PD medicines could slow down the progression of PD (Fig.6). Conclusion(s): Awareness of medical professionals in Kazakhstan about PD are poor. Educational programs are needed to improve quality and awareness of medical staff about PD.
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Background: There was no evidence about how COVID-19 can affect the neuroimmunological situation in patients who use immunosuppressive or immunomodulatory medications at the beginning of the COVID-19 pandemic in June 2020. Many concerns have arisen among clinicians regarding the management of Multiple Sclerosis (MS) secondary to different limitations applied during this period including the closure of clinics, quarantine, and difficulty for face-to-face communication. Considering this, the potential use of social media in patient-physician communication has been addressed in this study. Material(s) and Method(s): In a cross-sectional study, potential effect of available social media technologies on the communication between patients with MS and MS fellowships at the time of the COVID-19 outbreak in Iran in 2020 has been evaluated. Two questionnaires were designed, one for patients and another for MS fellowships. Data were gathered and results were analyzed by SPSS 23.0 software. Result(s): Of 1700 patients, 408 answered the questionnaire wholly. Most of them used mobile for their medical connection (77.4%). Patients with Relapsing-Remitting had more connections with their doctors (p=0.045). Although MS patients preferred to visit their doctors in person and have face-to-face contact, COVID-19 infectious MS fellowships used social media technologies to solve most patients' problems, answer their questions, and help them stop worrying, and only visited emergency patients in MS clinics by following disease control strategy. Conclusion(s): Social media could help patients and neurologists to solve most problems without in-person visits during the COVID-19 pandemic.Copyright © 2022
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Studies about headaches associated with acute ischemic stroke in patients suffering from migraine were limited, and therefore we present a clinical case of central post-stroke pain (CPSP) in a 47-year-old woman with migraine and lacunar infarcts in the medulla oblongata and also possible mechanisms of CPSP in patients with migraine. Magnetic resonance imaging of the brain revealed lacunar infarction in the medulla oblongata on the right (vertebral artery basin) and a single focus of gliosis in the parietal lobe on the right. Magnetic resonance angiography of cerebral vessels showed the fetal type of structure of both posterior cerebral arteries. This clinical case is a complex clinical situation of a combination of secondary headaches (post-stroke) in a patient with a primary headache (migraine), which was successfully treated by the combined administration of first-line drugs for the treatment of neuropathic pain in a patient with lacunar infarcts in the medulla oblongata. The treatment of CPSP is a difficult task due to the insufficiently unexplored mechanisms of development, the most effective approaches are those aimed at reducing the increased excitability of neurons.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.
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Background: Disease-modifying drugs (DMDs) are an inseparable part of multiple sclerosis (MS) management, which have dramatically changed the prognosis and course of the disease. A change during DMD therapy, which includes switching or stopping (temporary or permanent) medication, can manipulate the goals and has various causes such as side effects, ineffectiveness of treatment, patient's preference, presence of concurrent diseases and pregnancy. Therefore, we aimed to investigate the patterns and causes of DMD change in patients with MS (PwMS) in Tehran, Iran. The understanding will help us identify opportunities to improve adherence and ultimately patient outcomes and health system efficiency through effective education, and recognition of more tolerable or simpler regimens. The aim of this study is to identify rate and pattern of DMDs among PwMS in Tehran. Material(s) and Method(s): The study population of this cross-sectional was all PwMS in Tehran province who had changed their DMD for any reason in the last 5 years until June 2, 2022. The basic information was extracted through nationwide MS registry of Iran (NMSRI), Tehran, where all MS data including diagnosis had been confirmed by trained neurologists based on the 2017 revisions of the McDonald criteria. Moreover, supplementary unregistered data were gathered through telephone follow-ups carried out by 6 trained physicians with precise quality checks. The questionnaires covered 5 aspects of MS including demographics, disease history, diagnosis, progress and treatment. DMDs were classified into 10 general classes. All participants were asked to attribute the change to distinct categories following a written pre-existing consent. IBM SPSS (version 23) was used for statistical analysis. All the steps taken were in complete adherence with the tenets of the declaration of Helsinki. Result(s): Among 1999 enrolled patients with a mean age of 36.9+/-9.4 and total disease duration of 7.06+/-5.8 years, 1315 experienced change (Group 1) during study period, while 684 did not (Group 2). There was no difference in terms of demographic characteristics between the two groups. On the other hand, Group 1 had longer disease durations and more comorbidities (P <0.001). Getting infected with COVID-19 more than 4 times was observed to be significantly higher in Group 1 (P =0.032). Unlike Patients with PPMS and RRMS, SPMS patients showed higher EDSS scores when experiencing no DMD change. The most widely used DMDs were interferons, while ocrelizumab was the least used drug. Corona virus had the most effect on the change of ocrelizumab. Conclusion(s): DMD change generally occurs independent of socioeconomic level. Since most of the patients (65.8%) experienced DMD change, which serves as the biggest cost component in PwMS, the economic aspects of MS management in this field should be considered in the future.Copyright © 2022
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Background: While the COVID-19 pandemic affected more than thirty million people world-wide, still the true link between COVID-19 and the incidence of stroke remains to be eluci-dated. Method(s): Herein, we briefly discuss virology of COVID-19 and approaches for diagnosis and treatment of COVID-19 patients, as well as the mechanisms that link stroke and COVID-19. Result(s): Many pathophysiologic and immunologic mechanisms have been implicated in stroke occurring among patients with COVID-19. COVID-19 pandemic has, in different ways, negative im-pacts on the care of stroke patients world-wide, and still, neurologists have to face many challenges to improve the care of stroke patients during such crisis. Conclusion(s): Although the control of the COVID-19 is of crucial importance, at the same time, the management of stroke must not be neglected. Therefore, preserving care for critical conditions such as stroke, and providing strategies to ensure this continues, have a priority even during the cri-sis. Till vaccine is available for COVID-19, strategies for rapid diagnosis and those for treating patients with that disease are evolving. Further studies are warranted.Copyright © 2021 Bentham Science Publishers.
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A 20-year-old patient was presented with subacute onset of headache, nausea and vomiting. Testing of nasal/oropharyngeal swabs indicated the presence of SARS-CoV-2 RNA, and later the antibodies to this virus were found. The treatment in the hospital for Coronavirus 19 Disease (COVID-19) provided only temporary relief, and the patient then was referred to the Regional Stroke Center (RSC) to exclude a subarachnoid hemorrhage. RSC neurologists drew attention to multiple skin nevi in the patient. Brain MRI demonstrated abnormal T1 hyperintensity in the brain leptomeninges, with leptomeningeal contrast enhancement as well as hyperintensity in amygdala regions on T1 weighted images, bilaterally. The anomaly of the Dandy-Walker malformation complex was also revealed. Cerebrospinal fluid (CSF) analysis showed elevated protein (0.52 g/L), low lymphocytosis (lymphocytes, 6 in mm3), and decreased glucose (1.8 mmol/L). Neurocutaneous melanocytosis (NCM) was diagnosed, which neurological manifestation was probably triggered by COVID-19. The patient's vision gradually progressively worsened. In 2.5 months after the clinical manifestation of NCM, fundoscopy revealed optic discs atrophy (despite the absence of previous edema), and repeated CSF analysis showed atypical cells with characteristics corresponding to melanoma. Malignant transformation of cerebral melanocytosis was suspected, and the patient was referred to an oncological dispensary for further therapy. In the presented literature review, special attention is paid to the issues of neuroimaging, cytological and immunocytochemical diagnostics of NCM.Copyright © Russian Neurological Journal. All rights reserved.
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A 20-year-old patient was presented with subacute onset of headache, nausea and vomiting. Testing of nasal/oropharyngeal swabs indicated the presence of SARS-CoV-2 RNA, and later the antibodies to this virus were found. The treatment in the hospital for Coronavirus 19 Disease (COVID-19) provided only temporary relief, and the patient then was referred to the Regional Stroke Center (RSC) to exclude a subarachnoid hemorrhage. RSC neurologists drew attention to multiple skin nevi in the patient. Brain MRI demonstrated abnormal T1 hyperintensity in the brain leptomeninges, with leptomeningeal contrast enhancement as well as hyperintensity in amygdala regions on T1 weighted images, bilaterally. The anomaly of the Dandy-Walker malformation complex was also revealed. Cerebrospinal fluid (CSF) analysis showed elevated protein (0.52 g/L), low lymphocytosis (lymphocytes, 6 in mm3), and decreased glucose (1.8 mmol/L). Neurocutaneous melanocytosis (NCM) was diagnosed, which neurological manifestation was probably triggered by COVID-19. The patient's vision gradually progressively worsened. In 2.5 months after the clinical manifestation of NCM, fundoscopy revealed optic discs atrophy (despite the absence of previous edema), and repeated CSF analysis showed atypical cells with characteristics corresponding to melanoma. Malignant transformation of cerebral melanocytosis was suspected, and the patient was referred to an oncological dispensary for further therapy. In the presented literature review, special attention is paid to the issues of neuroimaging, cytological and immunocytochemical diagnostics of NCM.Copyright © Russian Neurological Journal. All rights reserved.
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A 20-year-old patient was presented with subacute onset of headache, nausea and vomiting. Testing of nasal/oropharyngeal swabs indicated the presence of SARS-CoV-2 RNA, and later the antibodies to this virus were found. The treatment in the hospital for Coronavirus 19 Disease (COVID-19) provided only temporary relief, and the patient then was referred to the Regional Stroke Center (RSC) to exclude a subarachnoid hemorrhage. RSC neurologists drew attention to multiple skin nevi in the patient. Brain MRI demonstrated abnormal T1 hyperintensity in the brain leptomeninges, with leptomeningeal contrast enhancement as well as hyperintensity in amygdala regions on T1 weighted images, bilaterally. The anomaly of the Dandy-Walker malformation complex was also revealed. Cerebrospinal fluid (CSF) analysis showed elevated protein (0.52 g/L), low lymphocytosis (lymphocytes, 6 in mm3), and decreased glucose (1.8 mmol/L). Neurocutaneous melanocytosis (NCM) was diagnosed, which neurological manifestation was probably triggered by COVID-19. The patient's vision gradually progressively worsened. In 2.5 months after the clinical manifestation of NCM, fundoscopy revealed optic discs atrophy (despite the absence of previous edema), and repeated CSF analysis showed atypical cells with characteristics corresponding to melanoma. Malignant transformation of cerebral melanocytosis was suspected, and the patient was referred to an oncological dispensary for further therapy. In the presented literature review, special attention is paid to the issues of neuroimaging, cytological and immunocytochemical diagnostics of NCM.Copyright © Russian Neurological Journal. All rights reserved.
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Background: The large proportion of coronavirus disease 2019 (COVID-19) patients has been associated with a large number of neu-ropsychiatric manifestations. Despite the high prevalence of COVID-19, few studies have examined such manifestations, especially in children and adolescents. Objective(s): This study investigated neuropsychiatric manifestations in hospitalized children and adolescents admitted for COVID-19 infection in Iran. Method(s): This prospective observational study included admitted children and adolescents (4-18 years old) diagnosed with COVID-19 infection, pediatric neurologists, child and adolescent psychiatrists, and infectious disease specialists, and assessed 375 infected patients during August and December 2021. Result(s): Of the 375 patients, 176 (47%) were female, with a mean age of 9.0 +/- 3.39 years. Psychiatric and neurological manifestations were reported in 58 (15.5%) and 58 (15.5%) patients, respectively. The most prevalent psychiatric disorders were separation anxiety disorder (SAD) (5.1%), major depressive disorder (MDD) (3.5%), generalized anxiety disorder (GAD) (2.7%), insomnia (2.4%), and op-positional defiant disorder (ODD) (2.4%). Regarding neurological complications, seizures were the most prevalent (13.1%), followed by encephalitis (1.9%), transverse myelitis (0.3%), acute ischemic stroke (0.3%), and Guillain-Barre syndrome (0.3%). There was no significant relationship between the duration of COVID-19 infection (P = 0.54) and ICU admission (P = 0.44) with the emergence of psychiatric symptoms. Conclusion(s): The most prevalent neurologic and psychiatric complications among children and adolescents with COVID-19 infection were seizures and the symptoms of anxiety/mood disorders, respectively.Copyright © 2023, Author(s).
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ChAdOx1 nCoV-19 (AZD1222) is a replication-deficient chimpanzee adenovirus vectored vaccine developed by Oxford and AstraZeneca for a disease we all know as Coronavirus, or COVID-19. Ongoing clinical studies reveal that the ChAdOx1 nCoV-19 vaccine has a tolerable safety profile and is effective against symptomatic COVID-19. This vaccine may prove crucial in boosting herd immunity, averting life threatening illness, and relieving the current pandemic. In this mini review, we performed a thorough literature search through PubMed and Google Scholar and reported various case reports associated with complications of the adenovirus-vectored COVID-19 vaccine. Various adverse effects of the ChAdOx1 nCoV-19 vaccine were reported around the globe, which were often serious but rare and developed into life-threatening pathologies such as GBS, thrombocytopenia, demyelinating neuropathies, progressive dementia, cerebral infarction, IgA vasculitis, hemophagocytic lymphohistiocytosis, herpes zoster, cutaneous reactions, and vein thrombosis. These worldwide reported complications, which are usually rare and severe, will aid clinicians in understanding and managing unforeseen situations. There is a need for more research to find out more about these complications and their etiopathogenesis. However, the benefits of these vaccinations for stopping the spread of the outbreak and lowering the fatality rate outweigh the potential risk of the uncommon complications.Copyright © The Author(s) 2023.
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Background: The impact of Covid-19 pandemic makes the hospital innovate using technology services, one of which was telepharmacy. Telepharmacy has the potential to improve Covid-19 outpatient through the use of telecommunications with self-home care patient. In July 2021, 120 patients received telepharmacy services with teleconsultation with pulmonologist, pediatrist, internist, otorhinolaryngologist, neurologist, psychiatrist and general practioners. In August 2021, telepharmacy patients were reduced to 39 patients, and in September 2021, telepharmacy patients were reduced to 11 patients. Objective(s): Evaluating outpatients with telepharmacy services by measuring satisfaction patients. Method(s): This program integrated with interprofessional doctor, pharmacy, nurse, driver and customer care unit. The satisfaction of patient depends on the multiprofessional services. This research to evaluate the satisfaction Covid-19 outpatients with received telepharmacy services. Desain study were descriptive, non-experimental and study cross-sectional. Data collected 3 months dan the samples were 170 patients with patient surveys to evaluate patient satisfaction. Result(s): 170 patients received telepharmacy ranged in age from 5-70 years, consisting of 93 women (54.7%) and 77 men (45.3%) with 76,5% satisfaction with telepharmacy services. Patients reported telepharmacy services from pulmonologist by 61.7%, internist 8.2%, otorhinolaryngologist 1.2%, pediatrist 23.5%, neurologist 0.5%, psychiatrist 0.5% and general practitioner from medical check-up by 4.1%. Conclusion(s): The satisfaction of self-home care telepharmacy patients overall reached 76.5%, and the patient felt dissatisfied were 23.5%. The decrease of patients in August and September 2021 because the telepharmacy services has not been maximized services and needs improvement. The hospital can improve the quality of telepharmacy services to increase patient satisfaction and visit telepharmacy patients. Copyright © RJPT All right reserved.
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Background: The COVID-19 pandemic led to changes in healthcare delivery for people living with multiple sclerosis (MSers), largely due to the rapid increase in the use of telemedicine. The learnings from this change may influence the future of MS care, providing an opportunity for MSers to shape the framework of clinical care. Goals: The goals of this research were to 1) gain lived experience insights to understand the impact of the pandemic on MSers' access to, and delivery of, clinical care about 18 months into the pandemic, and 2) understand MSers' experiences of telemedicine, including the adoption, feasibility, benefits, drawbacks, and preferences relative to their previous experience with in-person appointments. Method(s): An online volunteer survey (in English), available 27 August 2021 to 22 September 2021, was emailed or accessed through social media for adults (>=18) who self-reported an MS diagnosis. Result(s): 2,214 respondents answered at least the first question and 1,469 completed it. Most respondents lived in the UK (65%), were white (89%), female (77%), with diagnosis of relapsingremitting MS (66%). Despite the pandemic, 42% of respondents were dissatisfied with the level of contact with their MS neurologist. Attending in-person appointments with MS clinical team was challenging for 51%, primarily due to symptoms/disability. Over the past year, 74% of respondents had a telemedicine (telephone or video) appointment and 51% had in-person appointments. More than half (60%) considered telemedicine to be the same or better than in-person appointments, especially if via video. Various types of appointments were identified as 'acceptable' or 'unacceptable' for telemedicine. Although there were varying degrees of confidence with technology and use of telemedicine for remote care, the majority indicated recognition of the role of telemedicine in the future of MS clinical care and believe technology improves their lives. Conclusion(s): Best practice for implementing video appointments by MS healthcare teams should include recognition of the patient perspectives and managing their expectations around the limitations. Considerations should include MSers' different confidence levels in engaging in telemedicine, understanding of appointment types better suited for in-person vs video, and heterogeneity of MS, including greater symptom burden for MSers with progressive MS, potentially impacting their ability to travel to in-person appointments.