COVID-19 testing trends: pre-radiation and throughout cancer care

Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.

Neurologic Manifestations of COVID-19

Coronavirus disease (COVID-19) caused by a new coronavirus, SARS-CoV-2, has become a serious health problem throughout the world. Although COVID-19 primarily presents as an acute respiratory tract infection, many neurological findings have also been described in patients. Neurological findings are classified into three groups as central, peripheral nervous system and musculoskeletal system. The most common central nervous system symptom is headache. Encephalitis, encephalopathy, seizures, acute ischemic stroke are also seen. The most common symptoms in the peripheral nervous system are loss of smell and taste. Myalgia, myositis and rhabdomyolysis also can be seen in musculoskeletal system involvement. Awareness of the neurological symptoms by physicians will be beneficial in early diagnosis and treatment of the disease.

News and Current Events. COVID-19 Infection Related to Three-Times-Higher Risk of Neuropathy

The article reports on the findings of a study conducted by researchers at Washington University School of Medicine revealing that people who tested positive for COVID-19 are more at risk of neuropathy.

Association of the matrix metalloproteinases (MMPs) family gene polymorphisms and the risk of coronavirus disease 2019 (COVID-19); implications of contribution for development of neurological symptoms in the COVID-19 patients.

BACKGROUND: Seemingly, the Matrix metalloproteinases (MMPs) play a role in the etiopathogenesis of coronavirus disease 2019 (COVID-19). Here in this study, we determined the association of MMP9 rs3918242, MMP3 rs3025058, and MMP2 rs243865 polymorphisms with the risk of COVID-19, especially in those with neurological syndrome (NS). METHODS: We enrolled 500 patients with COVID-19 and 500 healthy individuals. To genotype the target SNPs, the Real-time allelic discrimination technique was used. To determine serum levels of MMPs, Enzyme-linked immunosorbent assay (ELISA) was exerted. RESULTS: The MMP9 gene rs3918242 and MMP3 gene rs3025058 SNP were significantly associated with increased COVID-19 risk and susceptibility to COVID-19 with NS. The serum level of MMP-9 and MMP-3 was significantly higher in COVID-19 cases compared with the healthy controls. Serum MMP-9 and MMP-3 levels were also higher in COVID-19 subjects with NS in comparison to the healthy controls. The polymorphisms in MMP genes were not associated with serum level of MMPs. CONCLUSION: MMP9 and MMP3 gene polymorphisms increases the susceptibility to COVID-19 as well as COVID-19 with neurologic syndrome, but they probably have no role in the regulation of serum MMP-9 and MMP-3 levels.

The many facets of CD26/dipeptidyl peptidase 4 and its inhibitors in disorders of the CNS - a critical overview.

Dipeptidyl peptidase 4 is a serine protease that cleaves X-proline or X-alanine in the penultimate position. Natural substrates of the enzyme are glucagon-like peptide-1, glucagon inhibiting peptide, glucagon, neuropeptide Y, secretin, substance P, pituitary adenylate cyclase-activating polypeptide, endorphins, endomorphins, brain natriuretic peptide, beta-melanocyte stimulating hormone and amyloid peptides as well as some cytokines and chemokines. The enzyme is involved in the maintenance of blood glucose homeostasis and regulation of the immune system. It is expressed in many organs including the brain. DPP4 activity may be effectively depressed by DPP4 inhibitors. Apart from enzyme activity, DPP4 acts as a cell surface (co)receptor, associates with adeosine deaminase, interacts with extracellular matrix, and controls cell migration and differentiation. This review aims at revealing the impact of DPP4 and DPP4 inhibitors for several brain diseases (virus infections affecting the brain, tumours of the CNS, neurological and psychiatric disorders). Special emphasis is given to a possible involvement of DPP4 expressed in the brain.While prominent contributions of extracerebral DPP4 are evident for a majority of diseases discussed herein; a possible role of "brain" DPP4 is restricted to brain cancers and Alzheimer disease. For a number of diseases (Covid-19 infection, type 2 diabetes, Alzheimer disease, vascular dementia, Parkinson disease, Huntington disease, multiple sclerosis, stroke, and epilepsy), use of DPP4 inhibitors has been shown to have a disease-mitigating effect. However, these beneficial effects should mostly be attributed to the depression of "peripheral" DPP4, since currently used DPP4 inhibitors are not able to pass through the intact blood-brain barrier.

Human brain organoids to explore SARS-CoV-2-induced effects on the central nervous system.

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). In less than three years, an estimated 600 million infections with SARS-CoV-2 occurred worldwide, resulting in a pandemic with tremendous impact especially on economic and health sectors. Initially considered a respiratory disease, COVID-19, along with its long-term sequelae (long-COVID) rather is a systemic disease. Neurological symptoms like dementia or encephalopathy were reported early during the pandemic as concomitants of the acute phase and as characteristics of long-COVID. An excessive inflammatory immune response is hypothesized to play a major role in this context. However, direct infection of neural cells may also contribute to the neurological aspects of (long)-COVID-19. To mainly explore such direct effects of SARS-CoV-2 on the central nervous system, human brain organoids provide a useful platform. Infecting these three-dimensional tissue cultures allows the study of viral neurotropism as well as of virus-induced effects on single cells or even the complex cellular network within the organoid. In this review, we summarize the experimental studies that used SARS-CoV-2-infected human brain organoids to unravel the complex nature of (long)-COVID-19-related neurological manifestations.

Cardiac Autonomic Function in Long COVID-19 Using Heart Rate Variability: An Observational Cross-Sectional Study.

BACKGROUND: Heart rate variability is a non-invasive, measurable, and established autonomic nervous system test. Long-term COVID-19 sequelae are unclear; however, acute symptoms have been studied. OBJECTIVES: To determine autonomic cardiac differences between long COVID-19 patients and healthy controls and evaluate associations among symptoms, comorbidities, and laboratory findings. METHODS: This single-center study included long COVID-19 patients and healthy controls. The heart rate variability (HRV), a quantitative marker of autonomic activity, was monitored for 24 h using an ambulatory electrocardiogram system. HRV indices were compared between case and control groups. Symptom frequency and inflammatory markers were evaluated. A significant statistical level of 5% (p-value 0.05) was adopted. RESULTS: A total of 47 long COVID-19 patients were compared to 42 healthy controls. Patients averaged 43.8 (SD14.8) years old, and 60.3% were female. In total, 52.5% of patients had moderate illness. Post-exercise dyspnea was most common (71.6%), and 53.2% lacked comorbidities. CNP, D-dimer, and CRP levels were elevated (p-values of 0.0098, 0.0023, and 0.0015, respectively). The control group had greater SDNN24 and SDANNI (OR = 0.98 (0.97 to 0.99; p = 0.01)). Increased low-frequency (LF) indices in COVID-19 patients (OR = 1.002 (1.0001 to 1.004; p = 0.030)) and high-frequency (HF) indices in the control group (OR = 0.987 (0.98 to 0.995; p = 0.001)) were also associated. CONCLUSIONS: Patients with long COVID-19 had lower HF values than healthy individuals. These variations are associated with increased parasympathetic activity, which may be related to long COVID-19 symptoms and inflammatory laboratory findings.

COVID-19 and the central nervous system: What is the interplay?

Since the outbreak of COVID-19 in 2019-2020, the highly contiguous disease caused by coronavirus 2 (SARS-CoV-2) spread worldwide in a short life span causing a disastrous effect and nearly 5.8 million deaths until February 2022. This global health crisis caused concerns about the disease's aetiology, epidemiology, and management. Understanding the virus's long-and short-term consequences on diverse human body organs and systems was one of the scientist's concerns despite the virus' respiratory system principal effect. Thus, after reporting neurological symptoms in approximately one-third of hospitalised patients with COVID-19, demonstrating how COVID-19 infects the central nervous system (CNS), causing neurodegenerative diseases in various patients and how the virus affects CNS function became quintessential. There are various mechanisms for COVID-19 pathophysiology, some implicating the potential virus invasion of the blood-brain barrier (BBB). Trans-synaptic and hematogenous routes are the main routes for the virus to pass through the barrier. Binding to the BBB endothelial cells is causing significant alterations in the permeability and integrity properties of the barrier, which cause an elevation of the incidence rate of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and Amyotrophic Lateral Sclerosis among COVI-19 patients. COVID-19 patients developed neurological manifestations ranging from mild symptoms to severe diseases such as headache and loss of smell, encephalitis and CNS-mediated respiratory distress. However, encephalitis is not a common complication, and it has a significant mortality rate in severely ill patients due to the hyperactivation of the host immune response. Although more investigations are needed, severe COVID-19 patients are considered at a high risk of neurodegenerative disorder as a long-term consequence of SARS-CoV-2 infection. © 2022, Neurotak Publishing. All rights reserved.

Effect of the Covid-19 Pandemic on Neuroinflammatory Diseases

In December of 2019, SARS-CoV-2 surfaced and the global COVID-19 pandemic began. The pandemic has had far-reaching effects, socially, economically, and especially for healthcare, presenting challenges to patients with neuroinflammatory disorders. Apart from the well-known respiratory, pulmonary, and cardiovascular symptoms that COVID-19 is responsible for, studies continue to show its role in generating neuroinflammation and the different neurological effects that can arise. This review summarizes the relationship between the COVID-19 pandemic and neuroinflammatory diseases, with an emphasis on the effects on patients with neuroinflammatory disorders. Copyright © 2022, Biolife s.a.s.. All rights reserved.

Experiences of Children and Young People Respondents to My Neuro Survey

My Neuro Survey represents the fourth iteration of our biennial national neurological patient experience survey. For the first time, the 2021/22 survey included a version specifically for children and young people affected by neurological conditions and those who support them. The survey ran online and in select clinics between October 2021 and February 2022. Questions covered key topics including the impact of Covid-19, diagnosis, access to treatment and care, mental health and wellbeing, transition and education. Six hundred and twenty-nine people shared their experiences through the children and young people's survey. Eighty-seven percent of respondents were parents, 11% were children and young people themselves while 2% reported as other. The most reported neurological conditions were epilepsy, Tourette Syndrome, hydrocephalus and autism. Key topics and findings from the experiences of children and young people and those who support them are touched on below. 56% (n = 317) of respondents said their condition made their mental wellbeing much worse. 63% (n = 349) of respondents reported that their mental health has worsened during the pandemic. Sixty-six percent of respondents reported their mental wellbeing needs were being met to a small extent (31%, n = 159) or most often, not at all (35%, n = 179). 85% (n = 250) applicable respondents reported that they had not been offered a named worker to support the transition process between pediatric and adult services but would find this helpful. Twenty-percent (n = 89) of applicable respondents reported not being given an explanation at diagnosis or when they were first told about their condition. The experiences of children and young peoples survey respondents helped to inform a series of national policy reports with targeted recommendations, 'Together for the 1 in 6', and a campaign calling on Governments across the UK to '#BackThe1in6' and set up a Neuro Taskforce. Our presentation would explore key findings in detail and highlight opportunities to improve patient experience.

Multisystem inflammatory syndrome associated with COVID-19 in children: Risk factors of severe life-threatening course of the disease

Background/Purpose: Multisystem inflammatory syndrome in children (MIS-C), associated with COVID-19 infection is a life-threatening condition, required intensive care. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. Method(s): The retrospective study included 166 children (99 male, 67 female), aged from 4 months to 17 years (median 8.2 years), who met the WHO criteria for MIS-C. The criterion of severity was the fact of the ICU admission. The analysis of the obtained data was performed using the STATISTICA software package, version 10.0 (StatSoft Inc., USA). Result(s): To assess the factors associated with the severe course of MIS-C, patients were divided into two groups: those who were hospitalized in the ICU (n = 84;50.6%), and those who did not (n = 82;49.4%). Patients with a more severe course of MIS-C were significantly older. They had a high frequency of signs such as rash, edema, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial damage were much more common in patients hospitalized in the ICU. Among the laboratory changes there were significant differences in the levels of hemoglobin, leukocytes and platelets, CRP, creatinine, troponin and D-dimer. The presence of macrophage activation syndrome was higher in patients, admitted in the ICU. Children, required intensive care required high dose corticosteroids and IVIG more often (table 1). FIGURE: 1) The first symptoms of progeria in infancy: scleroderma-like changes in the skin of the lower extremities and stiffness of knee joints at the age of 2 months. 2) Girl at the age of 3 years 5 months. Almost total alopecia with the absence of eyebrows and eyelashes. Pronounced venous pattern in the forehead, nasal bridge and nasolabial triangle. Conclusion(s): MIS-C is potentially a severe life-threatening condition, in which more than half (50.6%) of patients needed the ICU admission. The main factors determining the severity of MIS-C were: cardiovascular, resiratory and central nervous system disorders. It has been found that factors such as hepatomegaly, splenomegaly, D-dimer >2568 ng/ml, troponin >10 pg/ml, make it possible to identify a group of patients with high risk of severe MIS-C who may potentially need hospitalization in the ICU.

Chunk Learning Media for Cognitive Load Optimization on Science Learning

The sudden shift in the education world due to the pandemic of Covid-19 bring both challenge and opportunity at the same time. Since decades ago, the understanding of the importance to manage cognitive load for effective learning had been applied in multiple methods. Having said that, only a few addresses the opportunity to combine it with the latest trend attractive for today's young learners to minimize more extraneous cognitive load. This research discusses the matter by proposing the adoption of the combination of chunk learning, animation, and super short video in social media platforms to convey learning materials on nervous system science, which has been stamped as a hard subject for high school students. The adaptation of super short video animation on nervous system science successfully helps students cope with the daunting pile of materials align with the cognitive load theory. © 2022 IEEE.

Active pharmacovigilance in patients immunized with the CoronaVac vaccine in the port of Cartagena group.

Introduction: The crisis caused during the COVID-19 pandemic led scientists around the world to think about the creation of different vaccines against SARS-CoV-2. One of them was the inactivated virus vaccine CoronaVac, which was approved by Colombia's Ministry of Health. However, there are few pharmacovigilance studies conducted by occupational medicine to know the adverse events caused by vaccines. Objective(s): To estimate the safety of the CoronaVac vaccine. Methodology: Descriptive, retrospective and quantitative study, in which a population group of 508 workers from the port of Cartagena group was chosen, who were selected under inclusion criteria, during the second period of 2021 and the first of 2022. Result(s): 3.54 % of workers reported adverse events within the study population. Men had the most reports with 72.2% and women 27.8%. The most affected population group in terms of age was those aged 30 to 35 years, with a report of 44.4%. Likewise, the systems where there was a higher percentage of reports were the musculoskeletal, respiratory, and nervous system for first, second and third doses respectively;with symptoms such as headache, malaise, fever, muscle and joint pain, followed by pain in the injection area. Conclusion(s): In this study it was possible to identify the adverse events reported by the study population. However, none of the events presented had a serious or negative influence on the health and integrity of the workers during the study period. In this way, the safety of the vaccine was estimated. It should be noted that the CoronaVac vaccine did not prevent the spread or possible reinfection of the virus. Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.

Neurological Manifestations In COVID-19 Patients: An Imaging Review

Background: The COVID-19 pandemic that started in late 2019, has posed a great health challenge to India rapidly elevating our country to the second most affected nation after the United States. While the respiratory manifestations of COVID-19 are widely-known, there is paucity of information on its neurological manifestations in Indian literature. The imaging features of the diverse neurological presentations such as stroke, encephalitis, demyelination, hemorrhages and vascular involvement are reviewed in this article. Objective of the review is to discuss the spectrum of neuroimaging features in COVID-19. Method(s): Multiple publications from systematic and cohort studies on neuroimaging are reviewed in this article. Due permission was obtained from the publishers to reproduce the illustrations because of lack of adequate neuroimaging data in our country. Result(s): Ischemic infarcts, micro-hemorrhages, parenchymal hematomas and white matter changes, both diffuse and focal were the most common manifestations. Acute necrotizing hemorrhagic encephalitis, features resembling posterior reversible encephalopathy syndrome (PRES) and acute demyelinating encephalomyelitis (ADEM), arterial dissections, dural sinus and deep venous thrombosis were reported. Olfactory bulb and white matter signal ratios were elevated in anosmic patients. Micro-structural changes such as remyelination and neurogenesis indicated processes of repair. Conclusion(s): Ischemic and hemorrhagic lesions are the most common neuroimaging abnormalities in COVID-19 patients, though 40% of the studies are normal. Awareness of the imaging features is essential for management of these patients in the current pandemic. Severity of illness and risk of spread of infection are major constraints for neuroimaging. Copyright © 2022 International Medical Sciences Academy. All rights reserved.

An Unusual Case Presentation of MOG-Positive Acute Disseminated Encephalomyelitis (ADEM) in a Preschool Child

Introduction: An unusual case presentation of MOG-positive Acute Disseminated Encephalomyelitis (ADEM) in a preschool child following meta-pneumo viral infection responded to the combination of immune modulatory treatment with a favourable outcome. Material: Three-year-old female child presented with acute encephalopathy, high fever, vomiting, starring episodes, floppiness, and left abducent nerve palsy with rapid deteriorating GCS necessitating intubation and ventilation. Two weeks earlier, she was treated for suspected CNS infection with 10 days of antibiotics in the PICU with a positive meta-pneumo-virus. On admission, she had a GCS score of 6 with left-sided increased tone, bilateral hyperreflexia, and bilateral extensor response and on Day 14 demonstrated hyperkinetic movements of the upper and lower limbs. Method(s): Serum MOG antibody positive, CSF MOG low positive, metabolic investigations, Mycoplasma, EBV, Influenza, corona PCR, SARS-COV-2 Antibody, viral CSF panel unremarkable. MRI brain demonstrated T2 hyperintense signal in bilateral medial thalami and brain stem with a normal spine. Progressive changes were shown on repeated MRI Brains on day 4 and day 14 suggestive of multifocal changes involving deep cortical and subcortical white matter bilaterally with a new short segment of the spinal lesion at the T8 level. Repeated EEG and ambulatory EEG showed a diffusely slow background with intermittent slow runs of slow waves suggestive of generalized cerebral dysfunction. Result(s): After receiving the combination of high pulse steroids with a taper over 10 weeks, IVIG and 10 cycles of plasmapheresis she demonstrated gradual and remarkable clinical improvement over 10-12 weeks with a minimal focal neurological deficit. Conclusion(s): Initial differentiating CNS infection, metabolic disease and ADEM may be clinically challenging. Her clinical presentation, investigations and imaging were in keeping with the diagnosis of MOG-positive ADEM. Previous CNS infection may be related. MOG-positive ADEM treated with the early combination of immunomodulation may lead to positive clinical outcomes.

Case Study of Transitioning a Clinical Trial from a Clinical Research Facility (CRF) to the Neurology Clinical Service Outpatient Department

Objectives: It was recognised that a later phase extension study was less intense and a potential to transition to the clinical service with support from a coordinator, Epilepsy CNS (Clinical Nurse Specialist) and Neurology fellow. This case study will explore the planning, implementation methods, challenges and successes from the medical, nursing and family perspectives. Method(s): Initial strategic planning will be demonstrated and include a pathway taken to implement the transition. The requirements of the study were assessed, and a model was established of how the study will run in the clinical service. The CNS role was expanded to include research. Teaching and support were provided by the CRF team outlining individual roles and responsibilities. In order to understand the family, medical and nursing experience of research transition, a questionnaire has been completed at the end of study. Result(s): Challenges included new team to research, CNS time, medication accountability management, visit coordination, Covid-19 pandemic impacts on patient visits, and medical responsibilities combining clinical and research care. Collaborative solutions were found overcome these challenges. Positive outcomes: Epilepsy CNS available to families, new CNS skills, and stronger links established between research and clinical. Questionnaires have been analysed to gather data on patient experience, and common themes have been highlighted for considerations to take forward to future trial transitions. Conclusion(s): Overall, it has been a smooth successful transition. This has shifted the culture mindset that research and clinical care running separately. The drug is now approved for use as recommendation on NICE guidelines. The case study is a prime example of research and the clinical service working in unison. Portraying the research journey from early phase to NHS usage.