Clinical Characteristics of COVID-19 Reinfection: A Retrospective Study in China (preprint)

Purpose The number of patients with COVID-19 reinfection is gradually increasing.In this study, we aimed to investigate the clinical characteristics of individuals who experienced COVID-19 reinfection.Methods A retrospective data analysis was conducted involving patients diagnosed with COVID-19 between April 1, 2023, and June 20, 2023. The patients were categorized into two groups: the observation group, consisting of individuals with reinfection, and the control group, comprising those with primary infection.Results A Total 905(905/1025) patients were included in the study,with 407 in the observation group and 498 in the control group. The top three clinical symptoms in both groups were fever, cough with expectoration, and dizziness with fatigue (p < 0.001). The clinical classification of patients in the observation group primarily consisted of non-severe cases, (p<0.001). The proportion of hospitalized patients was lower in the observation group than in the control group (p < 0.001). The observation group exhibited a shorter clinical symptom recovery time than that of the control group (median, 5 d vs. 7 d,p < 0.001).Conclusion Patients experiencing COVID-19 reinfection were primarily classified as non-severe cases, with lower proportions of occurrence of severe and rare critical conditions. The severity was milder compared to that in patients with primary COVID-19 infections.

The association between loneliness and mental health disorders in older people after the COVID-19 pandemic (preprint)

Background Acknowledging the exacerbated impact of the COVID-19 pandemic on the mental health status of the general population, particularly the older population, this study aimed to explore the association between loneliness and mental health disorders in older people after the COVID-19 pandemic.Methods A cross-sectional survey using the SHARE database was conducted from June to August 2020 amid the COVID-19 pandemic.Results The sample comprised 847 participants, including 393 (46.4%) men, with an overall mean age of 74.6 years (sd = 6.7 years). Concerning mental health indicators, 441 (52.1%) reported feelings of nervousness, 384 (45.3%) experienced sadness or depression, 349 (41.2%) encountered sleeping difficulties, and 280 (33.1%) reported experiencing loneliness often or some of the time. The results revealed increased loneliness feelings for women who had worse health, increased fear of falling, dizziness, heightened fatigue, anxiety, depression, and concurrent health and sleep problems. Notably, age and medication had no impact on feeling lonely.Conclusions The pandemic has adversely affected the mental well-being of older population. These findings provide valuable insights for the development of targeted strategies to prevent mental health problems.

Neurosyphilis with Concomitant Cryptococcal Meningitis in a Patient with AIDS after COVID-19: a case report (preprint)

Background The common infections agents causing meningitis in patients with human immunodeficiency virus (HIV) include Cryptococcus neoformans and Treponema pallidum. Furthermore, there is an elevated risk of meningitis in patients with HIV concomitantly infected with SARS-CoV-2.Case presentation: A 38-year-old male presented with headache and dizziness. After hospitalization, polymerase chain reaction test for SARS-CoV-2 in nasopharyngeal swab was positive, and lumbar puncture revealed neurosyphilis with concomitant cryptococcal meningitis. He underwent Paxlovid, penicillin, antifungal and antiretroviral treatment. The patient had no other neurological symptoms and was stable during the 6-month follow-up period.Conclusions During the COVID-19 pandemic, patients with HIV, particularly those not underwent antiretroviral therapy, are at higher risk for severe infections, including central nervous system complications, due to their compromised immune systems.

Headache or Disturbed Smell and Taste During Acute COVID-19 as Predictors of Long COVID at One Year (preprint)

Purpose: Long coronavirus disease (COVID) poses a significant health concern for a substantial proportion of COVID-19 patients. Viral pathogenesis studies suggest the potential of central nervous system (CNS) affection in the acute phase of COVID-19 predicting long COVID. This study investigates whether acute COVID-19 symptoms, particularly headache and disturbed smell and taste, predict manifestations of long COVID. Methods: This prospective cohort study included COVID-19 patients hospitalized between March 2020, and May 2021. One year after discharge, patients responded to a symptom questionnaire. Logistic regression analysis was used to determine the odds ratio (OR) for these outcomes. Results: Of 288 eligible patients, 111 responded to the follow-up questionnaire. At 1 year follow-up, disturbed smell and taste during acute COVID-19 did not elevate the risk of long COVID. However, patients with acute headache demonstrated a tendency towards an elevated risk of CNS-related long COVID. Notably, this risk significantly increased in patients reporting dizziness (adjusted OR=4.20; 95% confidence interval (CI) 1.19 - 14.85). Neither disturbed smell and taste nor headache during acute COVID-19 indicated a statistically significant risk of worsening in fatigue, health, or total symptom score at 1-year follow-up. Conclusion: Headache, and not disturbed smell and taste, predicted CNS-related long COVID. Further research is warranted to clarify pathways connecting CNS-related symptoms during acute COVID-19 with long COVID, aiding the efforts of addressing the range of symptoms observed among long COVID patients and developing effective interventions.

IMPACT OF PANDEMIC ON COVID-19 QUALITY OF LIFE AND EFFECTING FACTORS AMONG ADULTS WITH LONG COVID: FAMILY HEALTH CENTERS BASED STUDY (preprint)

Aim: The aim of the study was to evaluate impact of pandemic on COVD-19 quality of life and effecting factors among adults wıth long COVID. Methods: The study included 440 individuals applying at family health centers for any reason. Participants were asked to complete a survey after their written consent was received. The survey consisted of two parts: the first related to socio-demographic information; the second including “COVID-19 Quality of Life Scale” and the “Perception Health Scale” . Mean, median, Kruskal Wallis and Mann-Whitney U tests and Sperman Correlation analysis were used in analysis. Results: Of the participants, 40.9% were male, 59.1% were female as well as 33.2% had at least one long COVID symptoms, 44.5% were reported that symptoms continued for 1-3 months. In addition, the median age was 41 years, the body mass index was 24.6 kg/m2. The median time since first infected was 7 month. The median COV19-QoL and Perception of Health Scale scores were 3.0 and 40.0 respectively. Among the prolonged COVID symptoms, fatigue/tiredness was shown with 53.2%. Other common symptoms were muscle pain (27.1%), headache/dizziness (24.1%), difficulty thinking or concentrating (20.9%), difficulty in breathing and heart palpitation (20.0%). The COV19-QoL median score significantly differed by education level, existing chronic conditions, COVID-19 treatment type, number of experienced long COVID symptoms and continuation of the symptoms p<0.05. There was significant correlation between COV19-QoL and age, time since first infected and perceived health score (p<0.05) . Conclusion: Aging, low education, existing chronic conditions, hospitalization, number of long symptoms, continuation of symptoms, and perception of health were risky factors for impact of the pandemic on COVID-19 quality of life. Specific rehabilitation services and programmes seems to be urgent need in overcoming this issue and to improve health. Key words: Long COVID, COVID-19, quality of life, adults, family health

IMPACT OF COVID-19 PANDEMIC ON QUALITY OF LIFE AND EFFECTING FACTORS AMONG ADULTS WITH LONG COVID: FAMILY HEALTH CENTERS BASED STUDY (preprint)

Background: Long COVID are the uninterpretable symptoms of COVID-19. However, quality of life and other factors among COVID-19 survivors remain less clear. Objectives: The aim of the study was to evaluate impact of COVID-19 pandemic on quality of life and effecting factors among adults with long COVID. Design and Setting: This cross-sectional study included 440 individuals applying at family health centers for any reason. Methods: The survey consisted of two parts: the first related to socio-demographic information; the second including “COVID-19 Quality of Life Scale”and the “Perception Health Scale”. Results: Of the participants, 40.9% were male, 59.1% were female as well as 33.2% had at least one long COVID symptoms. The median COV19-QoLand Perception of Health Scale scores were 3.0 and 40.0 respectively. Among the prolonged COVID symptoms, fatigue/tiredness was shown with 53.2%. Other common symptoms were muscle pain (27.1%), headache/dizziness (24.1%), difficulty thinking or concentrating (20.9%), difficulty in breathing and heart palpitation (20.0%). The COV19-QoL median score significantly differed by education level, existing chronic conditions, COVID-19 treatment type, number of experienced long COVID symptoms and continuation of the symptoms p<0.05. There was significant correlation between COV19-QoL and age, time since first infected and perceived health score (p<0.05). Conclusion: Aging, low education, existing chronic conditions, hospitalization, number of long symptoms, continuation of symptoms, and perception of health were risky factors for impact of the pandemic on quality of life. Specific rehabilitation services and programmes seems to be urgent need in overcoming this issue and to improve health. Key Words (MeSH Terms): Long COVID; COVID-19; quality of life; adults; family health

Extended Duration and Intense Manifestations of COVID-19-Linked Cytotoxic Lesions of the Corpus Callosum: Case Reports and Literature Review (preprint)

While clinical instances of cytotoxic lesions of the corpus callosum (CLOCCs) are well-documented, international reports specific to COVID-19-related cases remain limited. This paper presents the case of a 40-year-old female patient admitted due to "sudden dizziness and poor limb coordination for 7 weeks following fever." She tested positive for COVID-19 and experienced symptoms like dizziness, temporary confusion, nausea, vomiting, cerebellar speech issues, and ataxia after fever onset. Later, she developed pyramidal tract symptoms and behavioral abnormalities. Head MRI revealed abnormal high signal in the splenium of the corpus callosum and abnormal signals in the left cerebellar peduncle on DWI. With no significant medical history and exclusion of other causes during treatment (including steroid therapy and two doses of intravenous immunoglobulin), a follow-up MRI after one month showed the lesions had disappeared. However, clinical recovery was slow, with residual symptoms persisting for almost a year, including involuntary tremors in the upper limbs and head. Phenytoin, gabapentin, and pregabalin showed limited effectiveness in treatment, but Arotinolol and donepezil led to slight improvement in involuntary tremors. This case suggests that COVID-19-associated CLOCCs might have a protracted course and severe symptoms, demanding differentiation from ischemic cerebrovascular diseases, particularly in early stages.

Prevalence of orthostatic intolerance in Long Covid clinic patients - A multicentre observational study (preprint)

PurposeOrthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (PoTS) and orthostatic hypotension (OH), are often reported in long covid, but published studies are small with inconsistent results. We sought to estimate the prevalence of objective OI in patients attending long covid clinics and healthy volunteers and associations with symptoms and comorbidities. MethodsParticipants were recruited from 8 UK long covid clinics, and healthy volunteers from general population. All undertook standardised National Aeronautics and Space Administration Lean Test (NLT). Participants history of typical OI symptoms (e.g. dizziness, palpitations) prior to and during the NLT were recorded. Results277 long covid patients and 50 frequency-matched healthy volunteers were tested. Healthy volunteers had no history of OI symptoms or PoTS, 10% had asymptomatic OH. 130 (47%) long covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT. 41 (15%) had an abnormal NLT, 20 (7%) met criteria for PoTS and 21 (8%) had OH. Of patients with an abnormal NLT, 45% had no prior symptoms of OI. Relaxing the diagnostic thresholds for PoTS from two consecutive to one reading, resulted in 11% of long covid participants meeting criteria for PoTS, but not in healthy volunteers. ConclusionMore than half of long covid patients experienced OI symptoms during NLT and more than one in ten patients met the criteria for either PoTS or OH, half of whom did not report previous typical OI symptoms. We recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced. Trial registration numbers NCT05057260, ISRCTN15022307

SARS-CoV-2 induces acute neurological signs while Calcitonin Gene-Related Peptide (CGRP) signaling blockade reduces interleukin 6 (IL-6) release and weight loss in mouse models (preprint)

COVID-19 can result in neurological symptoms such as fever, headache, dizziness, and nausea. We evaluated whether the Calcitonin Gene-Related Peptide (CGRP) receptor antagonist, olcegepant, used in migraine treatment could mitigate acute neuroinflammatory and neurological responses to SARS-COV-2 infection. We infected wildtype C57BL/6J and 129/SvEv mice, and a 129 CGRP-null mouse line with a mouse-adapted SARS-CoV-2 virus, and evaluated the effect of CGRP receptor antagonism on the outcome of that infection. We determined that CGRP receptor antagonism provided protection from permanent weight loss in older (>12 m) C57BL/6J and 129 SvEv mice. We also observed acute fever and motion-induced dizziness in all older mice, regardless of treatment. However, in both wildtype mouse lines, CGRP antagonism reduced acute interleukin 6 (IL-6) levels by half, with virtually no IL-6 release in mice lacking CGRP. These findings suggest that blockage of CGRP signaling protects against acute IL-6 release and subsequent inflammatory events after SARS-CoV-2 infection.

Post-COVID chronic neuropsychiatric symptoms persisting beyond one year from infection- a case-control study and network analysis (preprint)

Background Limited data about chronic post-COVID neuropsychiatric complaints exist in the literature. Aim: Our study aims to delineate the phenotypes of chronic neuropsychiatric symptoms among adult subjects recovering from their first COVID that occurred more than one year ago. We also aim to explore the clinical and socioeconomic risk factors of having a high loading of chronic neuropsychiatric symptoms. Methods We recruited a post-COVID group who suffered from their first pre-Omicron COVID more than a year ago, and a control group who had never had COVID. The subjects completed app-based questionnaires on demographic, socioeconomic and health status, a COVID symptoms checklist, mental and sleep health measures, and neurocognitive tests. Results The post-COVID group has a statistically significantly higher level of fatigue compared to the control group (p<0.001). Among the post-COVID group, the lack of any COVID vaccination before the first COVID and a higher level of material deprivation before the COVID pandemic predicts a higher load of chronic post-COVID neuropsychiatric symptoms. Partial correlation network analysis suggests that the chronic post-COVID neuropsychiatric symptoms can be clustered into two major (cognitive complaints -fatigue and anxiety-depression) and one minor (headache-dizziness) cluster. A higher level of material deprivation predicts a higher number of symptoms in both major clusters, but the lack of any COVID vaccination before the first COVID only predicts a higher number of symptoms in the cognitive complaints-fatigue cluster. Conclusions Our result suggests heterogeneity among chronic post-COVID neuropsychiatric symptoms, which are associated with the complex interplay of biological and socioeconomic factors.

HEART rate variability biofeedback breathing programme for LOng Covid dysautonomia (HEARTLOC): results of a feasibility study (preprint)

Introduction Post-covid-19 syndrome, or Long covid (LC) refers to symptoms persisting 12 weeks after Covid-19 infection. LC comprises a wide range of dysautonomia symptoms, including fatigue, breathlessness, palpitations, dizziness, pain and brain fog. This study tested the feasibility and estimated the efficacy, of a Heart Rate Variability Biofeedback (HRV-B) technique via a standardised slow diaphragmatic breathing programme in individuals with LC. Methods and Analysis LC patients underwent a 4-week HRV-B intervention for 10 minutes twice daily for a total of 4 weeks using the Polar H10 ECG (Electrocardiogram) chest strap and Elite HRV phone application. Outcome measures C19-YRSm (Yorkshire Rehabilitation Scale modified), EQ5D- 5L (EuroQol 5 Dimensions), Composite Autonomic Symptom Score (COMPASS-31), WHO Disability Assessment Schedule (WHODAS), and Root Mean Square of Successive Differences between heartbeats (RMSSD) using a Fitbit device were completed before and after the intervention. The study was pre-registered at clinicaltrials.gov NCT05228665. Results 13 participants (54% female, 46% male) completed the study with high levels of data completeness and adherence. There was a statistically significant improvement in C19YRS-m (p=0.001), EQ5D Global Health Score (p=0.009), COMPASS-31 (p=0.007), RMSSD (p=0.047) and EHODAS (p=0.02). Qualitative feedback suggested participants were able to use it independently, were satisfied with the intervention, and reported beneficial effects from the intervention. Conclusion This is the first study in the literature to report that HRV-B is a feasible intervention for LC and seems to be potentially improving symptoms of LC and dysautonomia.

Prevalence of Long COVID19 among paediatric age group in Duhok Kurdistan region, Iraq (preprint)

Background A range of persistent symptoms that can develop in some people after they have recovered from acute COVID-19, is known as Long COVI-19. It can affect people of all ages and severity of initial illness, including those who had mild or asymptomatic infections. . Dealing with Long COVID-19 can be challenging, and the best course of action will depend on the specific symptoms and individual needs of the patient. This study aims to detect the prevalence of long covid-19 among the children who tested positive for IgG test. If IgG antibodies are detected in a person's blood sample, it suggests that they have been infected with SARS-CoV-2 at some point in the past and their immune system has responded by producing antibodies against the virus. Material and Methodology From (October 22nd till December 4th 2022) the data of this study had been collected through a face-to-face interview with withdrawing blood samples for serum Immunoglobin-G test in laboratory of (General zakho Teaching Hospital in Zakho) and (Hevi Pediatric Teaching Hospital in Duhok) . A total number of 330 children aged between 5-12 ages participated in this study. Moreover, If IgG antibodies are detected in a person's blood sample, it suggests that they have been infected with SARS-CoV-2 at some point in the past and their immune system has responded by producing antibodies against the virus. Results ( Fatigue 12/ 85.7% ) , ( cough 10/ 71.4% ) , ( post exertional malaise 5/ 35.7%) were the most detected symptoms among the 14 positive patients. Followed by ( headache, dizziness , hair loss , loss of appetite, loss/change in smell and taste , difficulty in sleep , mood change, abdominal pain, change in bowel habits, chest pain) to lesser extent. Conclusion long-term sequelae of Covid-19 now is becoming a challenge that needs more continued research and collaboration among healthcare providers, researchers, and patients are essential. Long COVID-19 is a public health concern that requires ongoing attention and resources, as well as support for those who are experiencing its debilitating effects. Out of 330 children only 4.6% ( 14 children) were experiencing long covid-19 symptoms for more than 4 weeks after acute infections in Duhok city.

Vertigo and Dizziness After Coronavirus Disease-2019 Vaccination: A Nationwide Analysis.

BACKGROUND: Side effects occurring after COVID-19 vaccination can include vertigo and dizziness. Despite its high incidence, few studies to date have assessed dizziness/vertigo after vaccination. The present study investigated the incidence of dizziness/vertigo after COVID-19 vaccination in South Korea. METHODS: Adverse reactions to COVID-19 vaccination reported to the Korea Disease Control and Prevention Agency from February 26, 2021, to July 31, 2022 (week 74) were analyzed. The incidence rates of dizziness/vertigo in subjects vaccinated with 5 COVID-19 vaccines, AZD1222 (AstraZeneca), BNT162b2 (Pfizer-BioNTech), JNJ-78436735 (Janssen), mRNA-1273 (Moderna), and NVX-CoV2373 (Novavax), were determined. RESULTS: A total of 126 725 952 doses of COVID-19 vaccine were administered, with 473 755 suspected adverse reactions (374 per 100 000 vaccinations) reported. Vertigo/dizziness was reported after the administration of 68 759 doses, or 54.3 per 100 000 vaccinations, making it the third most common adverse reaction after headache and muscle pain. CONCLUSION: Dizziness/vertigo was generally a mild adverse reaction after COVID-19 vaccination, but it was the third most common adverse reaction in Korea. Studies are necessary to clarify the causal relationship between vaccination and dizziness/vertigo and to prepare subjects for this possible adverse reaction.

Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting.

INTRODUCTION: A likely mechanism of Long COVID (LC) is dysautonomia, manifesting as orthostatic intolerance (OI). In our LC service, all patients underwent a National Aeronautics and Space Administration (NASA) Lean Test (NLT), which can detect OI syndromes of Postural Tachycardia Syndrome (PoTS) or Orthostatic Hypotension (OH) in a clinic setting. Patients also completed the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), a validated LC outcome measure. Our objectives in this retrospective study were (1) to report on the findings of the NLT; and (2) to compare findings from the NLT with LC symptoms reported on the C19-YRS. METHODS: NLT data, including maximum heart rate increase, blood pressure decrease, number of minutes completed and symptoms experienced during the NLT were extracted retrospectively, together with palpitation and dizziness scores from the C19-YRS. Mann-Witney U tests were used to examine for statistical difference in palpitation or dizziness scores between patients with normal NLT and those with abnormal NLT. Spearman's rank was used to examine the correlation between the degree of postural HR and BP change with C19-YRS symptom severity score. RESULTS: Of the 100 patients with LC recruited, 38 experienced symptoms of OI during the NLT; 13 met the haemodynamic screening criteria for PoTS and 9 for OH. On the C19-YRS, 81 reported dizziness as at least a mild problem, and 68 for palpitations being at least a mild problem. There was no significant statistical difference between reported dizziness or palpitation scores in those with normal NLT and those with abnormal NLT. The correlation between symptom severity score and NLT findings was <0.16 (poor). CONCLUSIONS: We have found evidence of OI, both symptomatically and haemodynamically in patients with LC. The severity of palpitations and dizziness reported on the C19-YRS does not appear to correlate with NLT findings. We would recommend using the NLT in all LC patients in a clinic setting, regardless of presenting LC symptoms, due to this inconsistency.

Effects of modular new prone positioning tools in patients with acute respiratory distress syndrome due to COVID-19: A randomized controlled trial (preprint)

Background Prone position (PP) ventilation has become an effective and simple treatment for acute respiratory distress syndrome (ARDS) due to COVID-19; however, prolonged prone position not only leads to patient discomfort, but also reduces patient compliance, and is prone to causing adverse events such as pressure injuries, pain, and dizziness. We aim to explore the effects of modular new prone positioning tools in patients with ARDS due to COVID-19.Methods 168 patients with ARDS due to COVID-19 were selected; however, 92 were later disqualified. 76 patients were randomly assigned to the observation group (n = 38) and the control group (n = 38). The observation group used modular new prone positioning tools to implement prone ventilation therapy while the control group used soft pillows to implement prone ventilation therapy. Comfort indicators (including time spent implementing PP, duration of PP, number of postural adjustments during PP, and duration time when first needing to adjust position), adverse events (including artificial airway kinking, shortness of breath, dizziness, and stress injury), and efficacy indicators (including intubation and mortality) were collected. The feeling of comfort, the occurrence of adverse events, and the efficacy of two groups of patients were also evaluated.Results The observation group had shorter time spent implementing PP(2.74 ± 0.86 vs. 4.64 ± 1.02, P < 0.001), longer duration of PP (14.02 ± 1.01 vs. 13.03 ± 0.66, P < 0.001), duration time when first needing to adjust position (59.89 ± 12.73 vs. 36.57 ± 8.69, P < 0.001), and lower number of postural adjustments during PP (11.03 ± 2.67 vs. 17.95 ± 2.58, P < 0.001) in comparison with the control group. No significant differences in intubation (9 vs. 11, P = 0.602) and mortality (4 vs. 6, P = 0.602) were found in both groups. However, in terms of adverse events, the observation group showed lower artificial airway kinking (5 vs. 23, P < 0.001), pain (7 vs. 21, P = 0.001), shortness of breath (2 vs. 9, P = 0.022), dizziness (0 vs. 5, P = 0.021), and stress injury (7 vs. 26, P < 0.001) than the control group.Conclusion Utilizing modular new prone position tools to implement prone ventilation therapy not only improves the efficiency of prone position execution and patient comfort, but also reduces the incidence of adverse events. However, it cannot change the intubation rate and mortality rate of patients.

The combined effect of gaze stability and balance exercises using telerehabilitation in individuals with vestibular disorders during the COVID-19 pandemic: A pilot study.

BACKGROUND: Vestibular rehabilitation is recognized as the most effective intervention to relieve symptoms of dizziness and imbalance related to vestibular disorders. OBJECTIVE: This study aimed to examine the combined effect of gaze stability and balance exercises using telerehabilitation in individuals with vestibular disorders during the COVID-19 pandemic. METHODS: This pilot study was a quasi-experimental, single-group design pre- to post-telerehabilitation intervention. Individuals with vestibular disorders between the ages of 25-60 participated in this study (n = 10). Participants underwent four weeks of combined gaze stability and balance exercises using telerehabilitation at their homes. The Arabic version of the Activities-Specific Balance Confidence scale (A-ABC), Berg Balance Scale (BBS), and the Arabic version of the Dizziness Handicap Inventory (A-DHI) were assessed pre- and post-vestibular telerehabilitation. Wilcoxon signed rank test was used to examine the magnitude of difference pre- and post-intervention scores of outcome measures. The effect size (r) for the Wilcoxon signed rank was calculated. RESULTS: After four weeks of vestibular telerehabilitation, there was an improvement in BBS and A-DHI outcome measures (p < .001), with moderate effect size for both scales (r = 0.6). However, A-ABC showed no significant improvement among participants. CONCLUSION: This pilot study found that the combined effect of gaze stability and balance exercises using telerehabilitation appear to be effective in improving balance and activities of daily living in individuals with vestibular disorders.

Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic.

BACKGROUND: Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological, neuropsychiatric and psychological effects. This review aims to analyze them with a discussion of evolving therapeutic recommendations. METHODS: PubMed and Google Scholar were searched from 1 January 2020 to 30 May 2020 with the following key terms: "COVID-19", "SARS-CoV-2", "pandemic", "neuro-COVID", "stroke-COVID", "epilepsy-COVID", "COVID-encephalopathy", "SARS-CoV-2-encephalitis", "SARS-CoV-2-rhabdomyolysis", "COVID-demyelinating disease", "neurological manifestations", "psychosocial manifestations", "treatment recommendations", "COVID-19 and therapeutic changes", "psychiatry", "marginalised", "telemedicine", "mental health", "quarantine", "infodemic" and "social media". A few newspaper reports related to COVID-19 and psychosocial impacts have also been added as per context. RESULTS: Neurological and neuropsychiatric manifestations of COVID-19 are abundant. Clinical features of both central and peripheral nervous system involvement are evident. These have been categorically analyzed briefly with literature support. Most of the psychological effects are secondary to pandemic-associated regulatory, socioeconomic and psychosocial changes. CONCLUSION: Neurological and neuropsychiatric manifestations of this disease are only beginning to unravel. This demands a wide index of suspicion for prompt diagnosis of SARS-CoV-2 to prevent further complications and mortality.

Les impacts neurologiques et neuropsychiatriques d'une infection à la COVID-19. CONTEXTE: Bien qu'il s'agisse principalement d'une maladie des voies respiratoires, la maladie infectieuse à coronavirus apparue en 2019 (COVID-19) s'est avérée avoir un lien de causalité avec une pléthore d'impacts d'ordre neurologique, neuropsychiatrique et psychologique. Cette étude entend donc analyser ces impacts tout en discutant l'évolution des recommandations thérapeutiques se rapportant à cette maladie. MÉTHODES: Les bases de données PubMed et Google Scholar ont été interrogées entre les 1er janvier et 30 mai 2020. Les termes clés suivants ont été utilisés : « COVID-19 ¼, « SRAS ­ CoV-2 ¼, « Pandémie ¼, « Neuro ­ COVID ¼, « AVC ­ COVID ¼, « Épilepsie ­ COVID ¼, « COVID ­ encéphalopathie ¼, « SRAS ­ CoV-2 ­ encéphalite ¼, « SRAS ­ CoV-2 ­ rhabdomyolyse ¼, « COVID ­ maladie démyélinisante ¼, « Manifestations neurologiques ¼, « Manifestations psychosociales ¼, « Recommandations thérapeutiques ¼, « COVID-19 et changement thérapeutiques ¼, « Psychiatrie ¼, « Marginalisés ¼, « Télémédecine ¼, « Santé mentale ¼, « Quarantaine ¼, « Infodémique ¼ et « Médias sociaux ¼. De plus, quelques articles de journaux relatifs à la pandémie de COVID-19 et à ses impacts psychosociaux ont également été ajoutés en fonction du contexte. RÉSULTATS: Il appert que les manifestations neurologiques et neuropsychiatriques des infections à la COVID-19 sont nombreuses. Les caractéristiques cliniques d'une implication des systèmes nerveux central et périphérique sautent désormais aux yeux. Ces caractéristiques ont fait l'objet d'une brève analyse systématique à l'aide de publications scientifiques. En outre, la plupart des impacts d'ordre psychologique de cette pandémie se sont révélés moins apparents que les changements réglementaires, socioéconomiques et psychosociaux. CONCLUSION: Les manifestations neurologiques et neuropsychiatriques de cette maladie ne font que commencer à être élucidées. Cela exige donc une capacité accrue de vigilance en vue d'un diagnostic rapide, et ce, afin de prévenir des complications additionnelles et une mortalité accrue.

Neurological Manifestations in COVID-19 Infection: A Systematic Review and Meta-Analysis.

BACKGROUND: Growing evidence showed that coronavirus disease 2019 (COVID-19) infection may present with neurological manifestations. This review aimed to determine the neurological manifestations and complications in COVID-19. METHODS: We conducted a systematic review and meta-analysis that included cohort and case series/reports involving a population of patients confirmed with COVID-19 infection and their neurologic manifestations. We searched the following electronic databases until April 18, 2020: PubMed, Embase, Scopus, and World Health Organization database (PROSPERO registration number: CRD42020180658). RESULTS: From 403 articles identified, 49 studies involving a total of 6,335 confirmed COVID-19 cases were included. The random-effects modeling analysis for each neurological symptom showed the following proportional point estimates with 95% confidence intervals: "headache" (0.12; 0.10-0.14; I2 = 77%), "dizziness" (0.08; 0.05-0.12; I2 = 82%), "headache and dizziness" (0.09; 0.06-0.13; I2 = 0%), "nausea" (0.07; 0.04-0.11; I2 = 79%), "vomiting" (0.05; 0.03-0.08; I2 = 74%), "nausea and vomiting" (0.06; 0.03-0.11; I2 = 83%), "confusion" (0.05; 0.02-0.14; I2 = 86%), and "myalgia" (0.21; 0.18-0.25; I2 = 85%). The most common neurological complication associated with COVID-19 infection was vascular disorders (n = 23); other associated conditions were encephalopathy (n = 3), encephalitis (n = 1), oculomotor nerve palsy (n = 1), isolated sudden-onset anosmia (n = 1), Guillain-Barré syndrome (n = 1), and Miller-Fisher syndrome (n = 2). Most patients with neurological complications survived (n = 14); a considerable number of patients died (n = 7); and the rest had unclear outcomes (n = 12). CONCLUSION: This review revealed that neurologic involvement may manifest in COVID-19 infection. What has initially been thought of as a primarily respiratory illness has evolved into a wide-ranging multi-organ disease.

Neurological and Psychiatric Manifestations of Post-COVID-19 Conditions.

BACKGROUND: We aimed to investigate the factors associated with neurological manifestations of post-coronavirus disease 2019 (COVID-19) conditions. METHODS: We retrospectively collected data from 440 patients who visited our post-COVID-19 clinic more than 4 weeks after severe acute respiratory syndrome coronavirus 2 infection. We analyzed the prevalence of different neurological symptoms (brain fog, memory impairment, headache, and dizziness) and assessed the associated factors. RESULTS: Brain fog was the most common symptom, observed in 170 patients (38.6%), followed by headaches (n = 137, 31.1%), dizziness (n = 128, 29%), and memory impairment (n = 104, 23.6%). Brain fog was associated with hyposmia or hypogeusia (odds ratio [OR], 2.54; P < 0.001), Fatigue Severity Scale (FSS) (OR, 1.06; P < 0.001), and Hospital Anxiety and Depression Scale-Anxiety (OR, 1.09; P = 0.037). Memory impairment was associated with sleep problems (OR, 2.83; P < 0.001), FSS (OR, 1.05; P < 0.001), and age (OR, 1.02; P = 0.015). Headache was associated with sleep problems (OR, 2.28; P = 0.001), sex (OR, 1.68; P = 0.042), and FSS (OR, 1.04; P < 0.001). Dizziness was associated with sleep problems (OR, 2.88; P < 0.001), and FSS (OR, 1.04; P < 0.001). The incidence of brain fog (P < 0.001), memory impairment (P < 0.001), dizziness (P = 0.007), and headache (P = 0.045) accompanied by hyposmia and hypogeusia was higher in patients with the aforementioned symptoms than in those without. CONCLUSION: This study suggests that there is a relationship between neurological symptoms and other clinical factors, such as fatigue, depression, anxiety, hyposmia, and hypogeusia.