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1.
Journal of Neurology, Neurosurgery and Psychiatry ; 93(Supplement 1):A69, 2022.
Article in English | EMBASE | ID: covidwho-2064254

ABSTRACT

Video consultations have become a viable alternative for face-to-face consultations during Covid19 pandemic and are expected to be used increasingly in the future. To date, there is little evidence to support the acceptability of these services or to document the benefits and challenges when offering online clinics to HD patients. Method We report on an EHDN WG Genetic Counselling and Testing project of 41 healthcare professionals from 15 European countries. Participants filled in a purposely-designed survey to assess the acceptability, benefits and challenges of telemedicine with HD affected and at risk individuals. The survey was active from March 2020 until March 2021. Results Respondents were geneticists (34%), neurologists (34%), genetic counsellors (15%), and others (psychologists, psychiatrists and research practitioners) (17%). Before the Covid-19 pandemic, professionals saw 4.5 HD patients per week and most (85%) never used telemedicine. During the pandemic, professionals saw 2.4 patients per week in face-toface consultations and 3.4 patients in online consultations. 85% of professionals felt that HD clinics can be done safely and effectively online. Most respondents agreed several aspects of consultations can be done safely online: follow-up counselling (78%), genetic counselling for predictive testing (54%), psychological assessment (49%), psychiatric and behavioural assessment (44%). The main benefits of telemedicine perceived were and challenges were also listed and discussed at length. Conclusions and discussion Our data are encouraging in relation to the potential for virtual and hybrid consultations in HD care. We draw on both quantitative and qualitative data to discuss professionals' views on telemedicine as well as potential implications for future practice.

2.
Chest ; 162(4):A1102, 2022.
Article in English | EMBASE | ID: covidwho-2060769

ABSTRACT

SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: More reports are indicating a temporal association between Bell's palsy and the mRNA vaccine for coronavirus disease 2019 (COVID-19). Therefore, collecting vaccine history is becoming important in post-marketing surveillance to monitor the safety of vaccines in real-world settings. We report the case of concomitant occurrence of Bell's palsy and glossopharyngeal neuralgia leading to severe symptomatic hyponatremia in a previously healthy patient. CASE PRESENTATION: A 60 year-old-female without significant medical history presented to the hospital with odynophagia, and generalized weakness for two weeks. She decreased her oral intake due to stabbing pain in the back of her throat triggered by swallowing. She reported hyperacusis and frequent shooting pain in the left cheek managed with non-steroidal anti-inflammatory drugs. The symptoms occurred several days after the first dose of the mRNA vaccine for COVID-19. She denied previous COVID-19 infection and herpes zoster. Examination revealed dry mucosa, left facial muscle weakness, inability to raise the left eyebrow or lift the labial commissure, effacement of the nasolabial fold, and left-sided frontal wrinkles. Laboratory investigation revealed sodium of 110. Computerized Tomography of the brain revealed negative findings for intracranial abnormalities. Severe symptomatic hyponatremia was managed with hypertonic saline. The neurologist made the diagnosis of Bell's palsy and glossopharyngeal trigeminal neuralgia leading to poor oral intake. We initiated acyclovir, prednisone, and gabapentin. The patient recovered from hyponatremia and experienced improvement of neurological symptoms with initiated medications. DISCUSSION: High morbidity and mortality of patients with COVID-19 accelerated the development and production of the vaccines. During the pandemic, mRNA COVID-19 vaccines reduced asymptomatic and prevented severe symptomatic COVID-19 infection and its complications. Although the benefits and protective effects of the COVID-19 vaccines outweighed the risks associated with them, we have reports of associations between vaccines and certain disorders such as Bell's palsy. Glossopharyngeal neuralgia is defined as sudden severe brief pain in the distribution of the glossopharyngeal nerve. It can be described as transient stabbing pain experienced in the ear, tonsillar fossa, and base of the tongue. Unusual presentation is fear to eat as this can be a precipitating cause of the pain. It overlaps with trigeminal neuralgia and can create a diagnostic dilemma. CONCLUSIONS: In summary, it is unknown what causal relationship exists between the mRNA COVID-19 vaccine and neurological diseases such as Bell's palsy and glossopharyngeal neuralgia. Glossopharyngeal neuralgia is frequently overlooked as a diagnosis. This is a unique case of concomitant glossopharyngeal neuralgia and Bell's palsy that is coincidental with a history of COVID-19 vaccine. Reference #1: El Sahly HM, Baden LR, Essink B, et al. Efficacy of the mRNA-1273 SARS-CoV-2 Vaccine at Completion of Blinded Phase. New England Journal of Medicine. 2021;385(19):1774-1785. doi:10.1056/NEJMoa2113017 Reference #2: Singh PM, Kaur M, Trikha A. An uncommonly common: Is glossopharyngeal neuralgia. Ann Indian Acad Neurol. 2013;16(1):1-8. doi:10.4103/0972-2327.107662 Reference #3: Cellina M, D'Arrigo A, Floridi C, Oliva G, Carrafiello G. Left Bell's palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: A case report. Clin Imaging. 2022;82:1-4. doi:10.1016/j.clinimag.2021.10.010 DISCLOSURES: No relevant relationships by Nemanja Draguljevic No relevant relationships by Katherine Hodgin No relevant relationships by Kristina Menchaca No relevant relationships by Catherine Ostos Perez

3.
Journal of Neuromuscular Diseases ; 9:S169-S170, 2022.
Article in English | EMBASE | ID: covidwho-2043391

ABSTRACT

Introduction: Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction that causes muscle weakness and fatigability. Majority of MG patients request a long-term immune suppression. Aim: To analyze frequency and severity of COVID- 19 infection in MG patients, as well as frequency of patients vaccinated against SARS-CoV-2. Patients and Methods: 125 MG patients from the central Belgrade municipalities were included - 60.0% females, age at MG onset 50.1 (19.7) years, age at testing 61.7 (16.8) years, AChR positive 78.4% and MuSK positive 8.6%. Results: One third of MG patients have had a COVID- 19 and they were younger compared to those who did not suffer from a COVID-19. Severe COVID- 19 was registered in 27.9% of MG patients, mostly in elder subjects with comorbidities such as cardiac diseases and history of malignancies. Two patients had a lethal outcome. MG worsening was noticed in 21.4% of patients after COVID-19 and 41.8% had COVID-19 sequalae. Majority of our MG patients were vaccinated against SARS-CoV-2 (68.8%). Vaccination was more common among MG patients with diabetes and in those with a milder form of MG. Main reasons not to accept a vaccine were: Do not wish to be vaccinated (12 patients), afraid of MG worsening (10), advise of a neurologist (8), and advise of a general practitioner (6). The most common types of vaccine were Sinopharm (42.2%) and Pfizer-BioNTech (25.6%). Adverse events were noticed in 36.0% of vaccinated patients, with mild infection (77.4%) and local reactions (12.9%) being the most common. MG worsening was noticed in 5 (5.8%) vaccinated patients. Conclusion: COVID-19 has placed a significant burden for MG patients, with severe COVID-19 forms and MG worsening being common. Percentage of vaccinated MG patients was higher than in general Serbian population.

4.
Telehealth and Medicine Today ; 6(2), 2021.
Article in English | ProQuest Central | ID: covidwho-2026471

ABSTRACT

Objective: During the coronavirus-2019 (COVID-19) times, we have all learned to appreciate the advantages of communicating with each other on the digital or virtual format. This included both social, commercial and professional settings. This was necessitated through the restrictions on direct physical contact mandated by the pandemic. Through innovations and adaptations, the practice of medicine has also changed with telemedicine, triggered by ‘necessity is the mother of invention’ concept being embraced by both patients and physicians. Neurology, traditionally seen as a complex speciality and the preserve of a couple of thousand practising neurologists in the country, has opened itself up to the telemedicine or tele-neurology format very easily in the anecdotal and a few pilot studies conducted globally and in India. Design: Despite the initial misgivings and anticipation of patient reluctance to adopt this technology, the real-world experience has been, to the contrary, where both young and old patients have readily embraced the new medium and cooperated with the neurologists to improve their care, which would otherwise have been severely restricted in the COVID-19 times. The neurologists have also adapted to the new way of working to deliver optimum diagnosis and care plans. Outcome measures: There have been technical glitches (in form of internet connectivity, smartphone hardware and software problems and lighting and camera angle and image stabilization issues to name a few), which have been reduced with practice and innovation. Feedback from neurologists, patients, and their carers via regular audits and questionnaires are being circulated, and practice parameters are being improved (IFNR survey- Ref 5). The contribution of national regulatory agencies, such as the Ministry of Health and Family Welfare (MoHFW), and stakeholders, such as the Telemedicine Society of India (TSI), has been phenomenal to facilitate the tele-neurology practice and make it safe for all stakeholders. Results: In a country of 1.37 billion population and only 2,500 accredited neurologists, there is a need for tele-neurology to be able to serve patients living in remote areas in mountains and coastal areas, and also in poorly connected areas on the plains. This becomes paramount for patients requiring specialised acute neurological care and to improve access, which now becomes a practical feasibility on the digital format to bring neurology to the doorsteps of the people. Follow-up care of patients, epidemiological studies of various neurological chronic illnesses and their audit will become realities cutting down on costs and time to access quality neurological care using the digital format for 21st-century India. Conclusions: Tele-neurology is no longer a vision, but a reality precipitated by the pandemic, the needs and aspirations of the Indian population, and the technological infrastructure India has achieved in the last 20 years.

5.
Journal of Chinese Medicine ; - (128):2, 2022.
Article in English | EMBASE | ID: covidwho-2006868
6.
Atemwegs- und Lungenkrankheiten ; 48(7):276-285, 2022.
Article in German | EMBASE | ID: covidwho-1997975

ABSTRACT

Especially at the beginning of a pandemic, the risks of infection for health professionals but also for other professions are increased. As a result, more than 220,000 insurance claims due to COVID19 have been reported to the statutory accident insurance institutions (DGUV) since the end of December 2021. COVID19 can be recognized as either an accident at work or an occupational disease. To do this, certain conditions relating to diagnosis and occupational exposure must be met. The recognition rate for occupational diseases is approximately twice as high as for accidents at work (60.0 vs. 30.2%). The most commonly affected by occupational SARSCoV2 infections are nurses in the hospital and in inpatient geriatric care. In 2021, educators were also frequently affected. The assessment of the causal relationship usually does not cause any major problems, as the occupations with an increased risk of infection are already well described in epidemiological studies. So far, there is little experience with the assessment of longterm consequences of COVID19. There are two reasons for this. „Rehabilitation before retirement“also applies to the DGUV. Several specific rehabilitation services have been developed for patients with postCOVID symptoms, the effectiveness of which needs to be evaluated. As a further reason for the lack of experience in the assessment, it must be taken into account that naturally the spontaneous course of the longterm consequences of COVID19 cannot yet be known. An assessment is probably best carried out by the discipline in whose area the most pronounced symptoms fall, i.e. in the case of shortness of breath by pulmonologists, in the case of cardiac arrhythmias by cardiologists or in fatigue and concentration disorders by neurologists. If necessary, the assessment should be carried out with the support of the other disciplines. The good news, the likelihood of severe, longterm courses of COVID19 has been significantly reduced by vaccination.

7.
Journal of General Internal Medicine ; 37:S368-S369, 2022.
Article in English | EMBASE | ID: covidwho-1995646

ABSTRACT

CASE: Patient is a 60-year-old woman who works at a local hospital in billing department. She has a history of rheumatic fever, non ST elevation MI, osteoarthritis, Crohn's disease. Her husband was diagnosed with COVID-19 infection in November 2020. A Week later, patient developed myalgias, diarrhea and subsequent testing confirmed COVID-19 infection. Overall, her symptoms were mild and required no treatment or hospitalization. Six weeks following the infection she woke up one morning with diplopia and a large left pupil. She tried to manage this by covering one eye initially, but later visited with a neurologist, ophthalmologist, neuro-ophthalmologist. She was found to have fixed, dilated left pupil and horizontal diplopia with some diagonal component. There were no other neurological signs or meningismus. Laboratory tests showed hemoglobin of 12.5, White cell count 5.7, platelets 405. Electrolytes, kidney function, liver function tests were normal. ACH receptor antibodies were negative. Imaging studies included a negative CTA head, negative brain MRI, face, orbits and optic nerves. She was diagnosed with left third cranial nerve palsy possibly as a complication of COVID-19 infection. She was prescribed oral prednisone 60 mg with a slow taper. Her pupil size and vision gradually improved over the ensuing weeks and the recovery of the third cranial nerve was nearly complete. IMPACT/DISCUSSION: The third cranial nerve supplies the levator muscle of the eyelid, medial rectus, superior rectus, inferior rectus, and inferior oblique;constricts the pupil through its parasympathetic fibers. Patients with oculomotor cranial nerve palsy develop diplopia and droopy eyelid. Etiology for third cranial nerve palsy include many pathologies such as a structural lesion, infectious or inflammatory conditions, cerebrovascular disease and trauma. Our patient developed acute 3rd cranial nerve palsy 6 weeks following the COVID-19 infection. The workup was negative for any structural lesions, CVA or other known causes. This raised the possibility that her symptoms are possibly complications of COVID-19 infection. Neurological complications of COVID-19 infection have been well documented. These include encephalopathy, stroke, dysgeusia and anosmia. There were two case reports of oculomotor nerve palsy that occurred during the acute phase of COVID-19 infection. These were thought to be from direct invasion of the virus. Our patient however, had developed symptoms 6 weeks following the infection raising the possibility of immune mediated complication. She made near complete recovery with oral glucocorticoid treatment. However, it is not known whether the improvement is the result of the treatment. CONCLUSION: 1. Oculomotor cranial nerve palsy is potentially associated with COVID-19 infection. 2. Oculomotor cranial nerve palsy could present several weeks after the acute COVID-19 infection. 3. In patients presenting with 3rd cranial nerve palsy, it is important to obtain the history of past COVID-19 infection.

8.
European Journal of Neurology ; 29:777, 2022.
Article in English | EMBASE | ID: covidwho-1978464

ABSTRACT

Background and aims: COVID-19 infections are reported in numerous case-reports as a trigger for development of Parkinson's disease (PD). We report 4 patients with symptoms of PD developed or exagerated after SARSCoV2 infection. Methods: Patients were retrospectively recruited in an outpatient clinic of Department of Neurology, Faculty of Health Science, Medical University of Warsaw. Patients were independently assessed by 2 neurologists experienced in movement disorders. Results: We identified 4 patients with rapid onset of PD symptoms following COVID-19. All patients were female. Symptoms of COVID-19 included headache in 4/4 cases and anosmia in 3/4 cases. PCR test confirmed SARS-CoV2 infection in all cases. The age of onset was between 28 and 62 years old. The rest tremor was present in all patients, ridgidity in 3/4 patients. Non-motor symptoms included RBD in 2/4 patients. Two patients were treated with levodopa with good response. MRI findings were nonsignificant. The SPECT-DatScan was performed in one patient and was typical for parkinsonian disorders. The positive family history was present in two patients. Conclusion: We conclude that COVID-19 may trigger development of parkinsonian motor symptoms or exaggerate the slight disease progression. The cause is unknown. Involvement of olfactory bulb could trigger neuroinflammation in line with Braak's hypothesis. COVID-19 may also induce parkinsonism in patients with genetic predisposition.

9.
European Journal of Neurology ; 29:267-268, 2022.
Article in English | EMBASE | ID: covidwho-1978453

ABSTRACT

Background and aims: Epilepsy burden in sub-Saharan Africa (SSA) has increased dramatically in the last 20 years. People with epilepsy (PWE) are estimated to be over 20 millions, with about 1 neurologist every 3-5 millions inhabitants, meaning more than 90% of epileptic patients are managed by health workers (HW) with insufficient education in Epilepsy, and 75% of them have no access to treatments. Moreover COVID-19 pandemic is affecting epilepsy management in SSA through care disruption. Teleneurology has the potential to improve this situation, although poor education of HW is associated with its underutilization. We measured the changes of teleneurology requests from primary cares in SSA after an education program on epilepsy. Methods: Global Health Telemedicine (GHT) offers remote advices and education to HW of the Disease Relief through Excellent and Advanced Means (DREAM) program active in 10 SSA countries. GHT-DREAM recently started an epilepsy program in Malawi and Central African Republic (CAR) with education and training courses delivered both locally and remotely. Results: In Malawi and CAR DREAM follows 18,770 patients, 569 (3,0%) suffering from epilepsy. The total number of teleneurology requests increased from 91 in 2019 to 141 in 2020 to 802 in 2021;>90% were for PWE. Conclusion: Education and training in epilepsy increased the number of tele-requests by improving knowledge and communication between SSA HW and European neurologists. Partnerships can bring neurologists where there are none, contributing to limit COVID-19 care disruption thus reducing the treatment gap in SSA. Our results move towards the Intersectoral Global Action Plan 2022-2031 in SSA. (Figure Presented).

10.
Neurol Sci ; 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1971734

ABSTRACT

INTRODUCTION: The concept of "autoimmune epilepsy" (AE) has been emphasized more frequently through the recent increase in recognition of various autoantibodies specific to neuronal proteins. AIMS: To evaluate the attitudes of neurologists in regard to AE, to review the differential diagnosis, treatment options, and to reveal the effect of COVID-19 on this matter. METHODS: A detailed questionnaire prepared for AE was sent to neurologists via social media and WhatsApp after the approval of the Ethics Committee. The responses of 245 respondents working in different settings were analyzed, and the group with 15 years or less experience in neurology was statistically compared to the group with more than 15 years of experience. RESULTS: Awareness and knowledge levels on AE seemed high in all groups, while 11% had never thought about AE during the differential diagnosis in real life. Before starting treatment, 20% thought that the autoantibody result should definitely support it, and 77.6% reported that they did not recognize AE well. Participants stated that satisfactory guidelines for diagnosis and treatment (88.2%) and widespread laboratory support (83.7%) were lacking. Neurologists with less experience and those working outside of training hospitals get more often consultation from an experienced clinician while diagnosing and conduct more detailed investigations at the diagnosis stage (p = 0.0025, p = 0.0001). CONCLUSION: This first survey study conducted in a large group of neurologists on the attitudes for the concept of AE suggested that postgraduate education, and diagnostic and treatment guidelines should be organized and antibody screening tests need to be better disseminated.

11.
Nevrologiya, Neiropsikhiatriya, Psikhosomatika ; 14(3):4-11, 2022.
Article in English | EMBASE | ID: covidwho-1957600

ABSTRACT

Currently, patients who attribute their complaints and disorders to the past COVID-19 are turning to a neurologist for a consultation. One should consider dangerous complications of COVID-19 such as stroke, including cerebral venous thrombosis, autoimmune encephalitis and myelitis, posterior reversible encephalopathy syndrome, Guillain-Barre' syndrome. Disorders of consciousness, disorders of smell and taste, headache and dizziness are significantly more often present in the acute period of COVID-19. Long-term persistence of complaints and disorders after COVID-19 is regarded as post-COVID syndrome (PCS). Neurological complaints and disorders in a patient who has had COVID-19 are often caused by the development or exacerbation of a comorbid disease, including primary headache, musculoskeletal pain in the neck and back, various vestibular disorders, Alzheimer's disease, anxiety and depressive disorders. Unfortunately, in real clinical practice, these diseases are often not diagnosed, patients are observed with a diagnosis of PCS, and it is not taken into account that the basis for diagnosing PCS is the exclusion of other diseases that can explain complaints and disorders in a patient who has suffered from COVID-19.

12.
Neuro-Oncology ; 24:i165, 2022.
Article in English | EMBASE | ID: covidwho-1956579

ABSTRACT

INTRODUCTION: A multidisciplinary team (MDT) approach is essential for quality cancer care. Since 2019, we have conducted regular MDT meetings to discuss pediatric patients with central nervous system (CNS) tumors at the Philippine General Hospital. Because of COVID-19, an abrupt transition from in-person to virtual meetings became necessary. METHODS: We reviewed the proceedings of MDT meetings for pediatric CNS tumors from March 2020-December 2021. We identified the strategies and adaptations of our pediatric neuro-oncology group, and outlined recommendations for other institutions in low- and middle-income countries. RESULTS: Our pediatric neuro-oncology group conducted 18 virtual MDT meetings during the study period. Meetings were scheduled every last Tuesday of the month, with pediatric oncologists, neurologists, neurosurgeons, radiation oncologists, radiologists, and neuropathologists regularly attending. We invited other specialists as needed. In total, we had 135 case discussions for 79 unique patients, or about 8 patients per meeting. These included both inpatients (74%) and outpatients (26%). Ten patients received prior treatment elsewhere. At the time of the meeting, 86% were postoperative, 8% were preoperative, and 6% did not require surgery. Most (60%) had malignant CNS tumors and 15% had disseminated/leptomeningeal disease. Histopathologic diagnosis was obtained for 62 patients (79%). Concerns addressed were: formulating a treatment plan (88%), surveillance strategy (10%), and diagnostic workup (5%). DISCUSSION: Several factors contributed to the ease of online transition: (1) motivated care providers including a patient navigator, (2) fixed schedule, (3) institutional Zoom account for securing data privacy, and (4) availability of picture archiving and communication system (PACS) for neuroimaging. Challenges included: (1) delays due to internet connectivity, (2) Zoom fatigue and online distractions, and (3) risk for miscommunication or misunderstanding. Commitment of the entire neuro-oncology team is essential to ensure the delivery of best possible care for pediatric patients with CNS tumors.

13.
European Journal of Clinical Pharmacology ; 78:S130, 2022.
Article in English | EMBASE | ID: covidwho-1955961

ABSTRACT

Introduction: Zolpidem and zopiclone are widely used for sleep disorders, yet their abuse and dependence potential has been underestimated. The electronic prescription of zolpidem/zopiclone became mandatory on 17.07.2019 in Greece. Objectives: To investigate descriptive characteristics of zolpidem/ zopiclone prescriptions and the impact of the mandatory electronic prescription mandate. Methods: Anonymized prescriptions of zopiclone (ATC: N05CF01) and/or zolpidem (ATC: NC05CF02) that were executed in pharmacies between 01.10.2018 and 01.10.2021 were obtained from the Greek nationwide prescription database. The database covers almost the entire Greek population and it is administrated by IDIKA of the Greek Ministry of Health. We investigated descriptive characteristics of prescriptions, and calculated themonthly number of prescriptions taking into consideration dates with potential impact, i.e., the date of the mandatory electronic prescription mandate (on 17.07.2019) and the date of the first case of COVID-19 in Greece (on 26.02.2020). Results and Conclusion: During the investigated period of three years, there were 1229842 executed prescriptions of zolpidem (89.4%), zopiclone (10.4%) or both (0.3%), considering 156554 unique patients. The patients weremainly elderly (73.1%were ≥ 65 years old) andwomen (64.5%). The majority of the prescription physicians (69.9%) were general practitioners or internists, followed by 17% psychiatrists or neurologists, 5.3% cardiologists, 4.5% physicians in specialty training, 1% nephrologists and 2.4% of physicians with another specialty. After the mandatory electronic prescription mandate and before COVID- 19 in Greece, i.e., between 08.2019 to 03.2020, there was a notable increase of prescriptions in comparison to the previous period from 10.2018 to 07.2019 (median 37267 vs median 34106;Mann-Whitney U=9, p-value=0.009). After COVID-19, the median monthly number of prescriptions was 36363, yet there were variations ranging from 16963 to 39956. In conclusion, the mandatory electronic prescription system could increase the surveillance of drugs with abuse potential such as zolpidem and zopiclone. Nevertheless, the large number of prescriptions in elderly patients and prescribed by primary care physicians is worrisome and warrants further investigation.

14.
European Stroke Journal ; 7(1 SUPPL):493, 2022.
Article in English | EMBASE | ID: covidwho-1928121

ABSTRACT

Introduction: SARS-CoV-2 pandemic has highlighted the importance of using Telehealth technologies to offer medical care to patients. Teleneurology can provide access to specialists with quality and safety, in addition to presenting great potential in reducing care gaps, especially in the Brazilian public system. Objective: Demonstrate the profile and impact of the population assisted by Teleneurology during the SARS-CoV-2 pandemic in 2020 and 2021, in addition to the outcomes at the end of this strategy in a city located in the northeast Brazil's territory. Methodology: Retrospective and cross-sectional analysis of medical records of patients treated by the team of neurologists at Hospital Alemão Oswaldo Cruz, through the Regula Mais Brasil Collaborative project in 2020 and 2021, using telehealth strategies. Results: 657 teleconsultations (video or phone) were carried out, all from users of the public health system, and referred for neurological assessment from primary care. The median age was 45,03 ± 15,9 years and 79,3% were women. According to the international code of diseases (ICD-10), the main diagnoses referred to were Headache (51.6%), followed by Epilepsy (16.6%) and Stroke (ischemic and hemorrhagic) at 2.8%. After the first teleconsultation, 56.2% were followed by teleconsultation and 27.4% returned to primary care. Conclusion: Using teleneurology as strategy helped to reduce the gaps in healthcare due to the closing of Primary Care Centers during the coronavirus pandemic, avoided unnecessary displacements, especially of patients with several comorbidities, in addition to ensuring the safety of users, since they were cared for in their respective homes.

15.
European Stroke Journal ; 7(1 SUPPL):354-355, 2022.
Article in English | EMBASE | ID: covidwho-1928063

ABSTRACT

Cerebral microbleeds (CMB) emerged as a possible complication of COVID-19. We aimed to assess CMB presence, distribution, and potential underlying pathophysiological mechanisms in hospitalised COVID-19 patients. In a cohort of 112 COVID-19 patients with neurological symptoms admitted to the Geneva University Hospital between March 2020 and May 2021, we assessed CMB distribution, and associations with clinical/ radiological variables. Neuroimaging was performed on a 1.5 T MRI with susceptibility-weighted images, 3D time-of-flight angiography, and 3D-contrast-enhanced fat-saturated T1 black blood VISTA sequences. Two neurologists rated CMB using the Microbleed Anatomic Rating Scale and white matter hyperintensities using the Age-Related White Matter Changes score. 53 patients (47.0%) had CMB;in 45.3% of cases, CMB were found in lobar regions with a predilection for temporal (58.3%) and frontal (29.2%) lobes. Deep CMB were present in 18.9%, with corpus callosum CMB found in 15.0%, in 35.9% CMB distribution was mixed. CMB presence was not related to intubation, pulmonary involvement, nor to radiologic signs of endothelitis. Patients with CMB were more likely to have a higher burden of white matter hyperintensities (OR 1.13, p=0.005, 95% CI: 1.03- 1.24), to have hypertension as a comorbidity (OR= 2.34, p= 0.04, 95% CI: 1.04 - 5.30) and to suffer from an acute stroke during hospitalisation (OR: 3.50 p= 0.012, 95% CI:1.31-9.18). In our sample, COVID-19 patients with neurological symptoms had a high burden of CMB. Their distribution suggests that they may be related to cardiovascular risk factors and cerebral amyloid angiopathy. CMB were also associated with an increased risk of acute stroke.

16.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925585

ABSTRACT

Objective: To create a novel module based online curriculum for neurologists, trainees, and students who do not have a Twitter account to learn how to use #NeuroTwitter professionally. Background: The use of social media has become more widespread within the neurology community since the COVID-19 pandemic onset. Many individuals are hesitant to join Twitter in a professional setting due to lack of informational resources on how to create a Twitter account and specifically orient towards activities in neurology. Design/Methods: The study was approved by the Weill Cornell IRB. Three 30-minute modules were created focusing on an introduction to Twitter and the basics of #NeuroTwitter, learning from peers, and academic scholarship. All modules are performed virtually. Eligibility criteria included current status as a United States based neurology attending physician, trainee or medical student applying to neurology without a professional Twitter account. After signing consent, participants completed a baseline survey, followed by 3 modules, and a post module survey. Participants will be prospectively followed for 4 months to assess use of Twitter after module completion. Results: Enrollment began September 27th, 2021 with a target enrollment of 50 participants. After 2 weeks of open enrollment we have screened 33 participants with 24 enrolling into the study. Nine participants failed screening due to either living outside the United States (n=6) or having a prior professional Twitter account (n=3). The average age of enrolled participants was 36 years (range 28 to 72), with 17 women (71%) and 7 (29%) men. Enrollment included 9 attendings (37%), 7 residents (29%), 4 fellows (17%), and 4 medical students (17%). Conclusions: There is an unmet need for resources to educate neurologists about utilizing Twitter in a professional context. Our study hopes to identify specific barriers and concerns to tailor future resources to match those needs.

17.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925584

ABSTRACT

Objective: To describe the growth of #HowToNeuroTwitter, a collaborative social media initiative orienting neurology residency applicants to Twitter as an educational and networking platform. Background: During the initial 6 months of the COVID-19 pandemic and the virtual residency interview season in 2020, a group of medical students, neurology residents, and fellows came together to create a #HowToNeuroTwitter guide and the #NeuroTwitterNetwork. With a continued virtual recruitment in 2021, the guide was expanded to provide more comprehensive and inclusive resources for all types of neurology applicants. Design/Methods: A group of 48 medical students, residents, fellows, and attendings created and promoted the updated guide between May 2021 - August 2021. Twitter was the primary method of promotion and recruitment. Based on feedback from the initial guide, we created new resources to include DO, IMG, and fellowship applicants in addition to residency resources. This was accomplished with the creation of topical subsections. Results: The comprehensive #HowToNeuroTwitter (bit.ly/NeuroTwitterNetwork2) guide was released on August 22nd, 2021 on Twitter, with a tweet that generated 91,082 impressions, 2,739 engagements, 1,137 link clicks to the guide, 180 likes, and 151 retweets as of October 4th, 2021. The guide was broken down into 12 sections including applying to residency, residency program twitter accounts, #MedEd resources, organizations to follow, the #NeuroTwitterNetwork database, child neurology resources, and more. Thirty organizations were catalogued, including subspecialty specific accounts, research journals, and national organizations. There were 111 adult neurology and 18 child neurology residency Twitter accounts included. Conclusions: The #HowToNeuroTwitter Guide 2.0 increased access to high yield information for medical students and residents applying to neurology by developing a centralized resource for trainees at all levels along with a diverse database of neurologists on Twitter.

18.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925578

ABSTRACT

Objective: To demonstrate the effectiveness and usability of a novel tele-neurology service in Nairobi. Background: There is severe shortage of neurology healthcare workers in low-/lower-middle income countries (LLMICs), especially in Africa. Tele-neurology consultations (TNC), necessitated widely due to the COVID-19 pandemic, have been demonstrated to be effective in bridging neurology service gaps, but there is little evidence of TNC effectiveness in LLMICs. Design/Methods: We conducted a prospective cross-sectional study, enrolling neurology patients referred to our tertiary referral neurology outpatients center over 12 months from October 2020. We measured satisfaction and acceptability using Likert scales, and compared TNC to face-to-face (F2F) consultations. TNC were delivered as per 2020 British and American guidelines. Descriptive data are presented as median (inter-quartile range) and statistical comparisons made using paired student t-test. Results: From 219 enrolled patients, 66.7% (146/219) responded [74% (108/146) had both F2F and TNC]: age 40.9 (30.6-55.2) years;63.0% (92/146) female;2.7% (4/146) from neighboring countries;follow-up period with neurologist (DSS) 6.8 (1.5-29.8) months;and most common presentations were headache [30.8% (45/146)], seizure [26.0% (38/146)] and neurodegenerative [15.1% (22/146)] disorders. For TNC, >90%: (i) found it just as comfortable as F2F (p=0.35) and not in violation of their privacy;(ii) saved time [3.0 (2.0-4.0) hours], travel [11.0 (7.2-21.1) km] and cost [$10 (5-20)];(iii) felt satisfied with the care and that their neurological concerns were adequately addressed;and (iv) would use TNC again. Conversely, 15.1% (22/146) did not agree with TNC being as effective as F2F, including the neurologist identifying all their health problems satisfactorily (p=0.03). In total, our TNC service saved our patients $6,125, 1,143 hours, and 25,506km of travel, equating to 3.5 tons (21 trees) of carbon dioxide emissions. Conclusions: Our study demonstrates that our regionally unique TNC service is an acceptable, efficient, effective, and environmentally-friendly care delivery model in our resource-poor setting.

19.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925498

ABSTRACT

Objective: To evaluate patient and physician perceptions of aspects of telehealth including ease of use, convenience, effectiveness for communication, and overall quality of care. Background: At the start of the COVID19 pandemic, telehealth was rapidly integrated into outpatient neurology at Yale School of Medicine, allowing continued delivery of non-acute, outpatient care while minimizing the risk of potential disease spread. From March 2020 through March 2021, almost half of outpatient appointments were telehealth visits. Design/Methods: Anonymous surveys were administered to patients and physicians in six neurology subspecialty clinics from October to December 2020. Items were scored on a 5-point Likert scale (1=strongly disagree;5 =strongly agree), with an option for additional comments. Results: 120 consecutive patients responded to the survey (20 each in 6 different subspecialty clinics). Most patients strongly agreed that the technology was user-friendly and high quality (70.0%), telehealth is more convenient than face-to-face appointments (76.7%), and facilitates adequate communication of concerns (70.0%) and appropriate care (73.3%). Fewer than half of patients (45.8%) felt that telehealth provides the same overall quality of care due to lack of physical examination and personal rapport with their neurologist, among other reasons. There were no statistically significant differences in patient responses from each subspecialty clinic. 29/44 (65.9%) of physicians responded to the survey. Physicians had more negative overall perceptions about the ease of use/quality of technology (mean Likert score 3.52 vs 4.47, p<0.001), communication of concerns (mean 3.69 vs 4.58, p<0.001), and quality of care (mean 3.14 vs 3.92, p=0.002). Conclusions: Telehealth in outpatient neurology is perceived as convenient and effective by patients, and less so by physicians. A majority of physicians and patients perceive that telehealth facilitates a lower overall quality of care compared to in-person visits. Further studies may help identify situations where telehealth is most useful in neurological care.

20.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925476

ABSTRACT

Objective: Compare the global uptake of a neurology clinical reasoning conference between live sessions and asynchronous learning through different online platforms. Background: Online learning has emerged as an important component of medical education during the COVID-19 pandemic, allowing for both live and asynchronous learning. Podcasts have become a popular education resource, increasing the reach of educators. Design/Methods: In collaboration with The Clinical Problem Solvers (CPS) online medical education group, we developed a neurology virtual morning report (NVMR) in which cases are presented and discussed by trainees with a neurologist facilitator. These sessions are held live weekly on Zoom, then posted for asynchronous learning on the CPS website and YouTube. Some sessions are released as podcast episodes. We gathered data from August 25, 2020 to October 2, 2021 on: live conference attendance, views on the CPS website and Youtube, and podcast downloads to evaluate global uptake across platforms. Results: The first 50 NVMR had an average live attendance of 47 participants per session. All 50 episodes were posted on the CPS website (10,059 views;average 201.2 views/episode), 20 episodes were posted on YouTube (4,198 views;average 285.1 views/episode), and 8 episodes were released as podcasts (6954 downloads on Spotify;average 887.5 downloads/episode). Asynchronous viewing through all platforms (podcasts, website, and Youtube) increased the reach of NVMR 9.16 fold over live attendance. Podcasts represented the greatest increase in reach in comparison to live NVMR. Conclusions: Asynchronous learning, especially through podcasts, expands the global reach of live virtual conferences for neurology clinical reasoning education. As online education increases in neurology, options for asynchronous learning could improve global accessibility of educational content.

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