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1.
arxiv; 2022.
Preprint in English | PREPRINT-ARXIV | ID: ppzbmed-2212.13032v1

ABSTRACT

The Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in early December 2019 and now becoming a pandemic. When COVID-19 patients undergo radiography examination, radiologists can observe the present of radiographic abnormalities from their chest X-ray (CXR) images. In this study, a deep convolutional neural network (CNN) model was proposed to aid radiologists in diagnosing COVID-19 patients. First, this work conducted a comparative study on the performance of modified VGG-16, ResNet-50 and DenseNet-121 to classify CXR images into normal, COVID-19 and viral pneumonia. Then, the impact of image augmentation on the classification results was evaluated. The publicly available COVID-19 Radiography Database was used throughout this study. After comparison, ResNet-50 achieved the highest accuracy with 95.88%. Next, after training ResNet-50 with rotation, translation, horizontal flip, intensity shift and zoom augmented dataset, the accuracy dropped to 80.95%. Furthermore, an ablation study on the effect of image augmentation on the classification results found that the combinations of rotation and intensity shift augmentation methods obtained an accuracy higher than baseline, which is 96.14%. Finally, ResNet-50 with rotation and intensity shift augmentations performed the best and was proposed as the final classification model in this work. These findings demonstrated that the proposed classification model can provide a promising result for COVID-19 diagnosis.


Subject(s)
9262 , 59585 , 11454
2.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2396934.v1

ABSTRACT

Background COVID-2019 has become a public health crisis, and as a vulnerable group, people with disabilities (PWDs) might be more seriously affected. However, the overall impact of COVID-19 on PWDs is unclear in Mainland China. Thus, we aimed to analyze the overall impact on PWDs from the early remission stage to the regular control stage of the COVID-19 pandemic in Mainland China.Methods In March 2020 and March 2021, anonymous questionnaires were distributed in the WeChat group of the PWDs using a convenient sampling method. The personal and family characteristics, perceived risk of COVID-19 infection, and the overall impact of COVID-19 on daily life and medical services needs were collected. The descriptive analysis, chi-square test, and multiple logistic regression analysis were used.Results 311 and 1083 PWDs were enrolled in 2020 and 2021, respectively. In 2020, 82.0% of the participants reported a negative impact on their daily life, and the proportion of big impact was 20.3%. In 2021, 73.1% of PWDs reported a negative impact on their daily life. Multivariate analysis found the impact on medical services needs was the common associated factor of the overall impact on daily life in 2020 and 2021, and PWDs with lower annual household income or chronic diseases were more likely to suffer bigger negative effects in 2020, while being in quarantine or not at work, having items in shortage and with less disability severity (without multiple disabilities or spinal cord injury) were the associated factors in 2021. Based on the matching method, we found that the overall impact on the daily life of PWDs decreased in 2021.Conclusions A majority of the PWDs reported a negative impact on their daily life in Mainland China at the early remission stage of the COVID-19 pandemic, and the impact has significantly weakened during the normal control period in 2021. It is recommended to fulfill the medical service needs of PWDs in a timely manner, and those being in quarantine or not at work, without SCI or multiple disabilities, and reporting some items in shortage suffered a bigger major overall COVID-19 impact on daily life.


Subject(s)
28563 , 59585 , 9262 , 13502 , 6365
3.
arxiv; 2022.
Preprint in English | PREPRINT-ARXIV | ID: ppzbmed-2212.09276v1

ABSTRACT

Purpose: Considering several patients screened due to COVID-19 pandemic, computer-aided detection has strong potential in assisting clinical workflow efficiency and reducing the incidence of infections among radiologists and healthcare providers. Since many confirmed COVID-19 cases present radiological findings of pneumonia, radiologic examinations can be useful for fast detection. Therefore, chest radiography can be used to fast screen COVID-19 during the patient triage, thereby determining the priority of patient's care to help saturated medical facilities in a pandemic situation. Methods: In this paper, we propose a new learning scheme called self-supervised transfer learning for detecting COVID-19 from chest X-ray (CXR) images. We compared six self-supervised learning (SSL) methods (Cross, BYOL, SimSiam, SimCLR, PIRL-jigsaw, and PIRL-rotation) with the proposed method. Additionally, we compared six pretrained DCNNs (ResNet18, ResNet50, ResNet101, CheXNet, DenseNet201, and InceptionV3) with the proposed method. We provide quantitative evaluation on the largest open COVID-19 CXR dataset and qualitative results for visual inspection. Results: Our method achieved a harmonic mean (HM) score of 0.985, AUC of 0.999, and four-class accuracy of 0.953. We also used the visualization technique Grad-CAM++ to generate visual explanations of different classes of CXR images with the proposed method to increase the interpretability. Conclusions: Our method shows that the knowledge learned from natural images using transfer learning is beneficial for SSL of the CXR images and boosts the performance of representation learning for COVID-19 detection. Our method promises to reduce the incidence of infections among radiologists and healthcare providers.


Subject(s)
11443 , 59585 , 9262
4.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.07.22283213

ABSTRACT

Background and Objectives Teleneurology is common in clinical practice partly due to the SARS CoV-2 pandemic. Impressions about teleneurology from patients and providers alike are generally favorable; some of the reported benefits include ease of access to specialized healthcare, savings of time and money, and similar quality of care as an in-person visit. However, comparisons between patient and provider impressions about the same teleneurology encounter have not been described. Here we describe patient impressions about a teleneurology encounter and evaluate concordance with provider impressions about the same encounter. Methods Patients and providers at the University of Pennsylvania Hospital Neurology Department were surveyed about their impressions of teleneurology between April 27 th and June 16 th , 2020. A convenience sample of patients, whose providers completed a questionnaire, were contacted by telephone to solicit their impressions the same encounter. Unique questionnaires for patients and providers focused on similar themes, such as adequacy of technology, assessment of history obtained, and overall quality of the visit. Summaries of patient responses are reported with the raw percent agreement between patients and providers for similar questions. Results One hundred thirty-seven patients completed the survey; 64 (47%) were male and 73 were (53%) female. Sixty-six (47%) patients had a primary diagnosis of PD, 42 (30%) a non-PD movement disorder, and 29 (21%) a non-movement disorder neurological disease. One hundred one (76%) were established patient visits and 36 (26%) were new patient visits. Provider responses from 8 different physicians were included. The majority of patients responded that the ease of joining their visit, their comfort engaging with their physicians during their visit, understanding their plan of care after their visit, and the quality of care from their teleneurology visit were satisfactory. Patients and providers agreed about their impressions of the quality of the history obtained (87% agreement), patient-provider relationship (88% agreement), and overall quality of their experience (70% agreement). Discussion Patients had favorable impressions about their clinical experience with teleneurology and expressed an interest in incorporating telemedicine visits into their ongoing care. Patients and providers were highly concordant for the history obtained, patient-provider relationship, and overall quality.


Subject(s)
9262 , 10489
5.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2353521.v1

ABSTRACT

Background: Autism Spectrum Disorders (ASD) is a neurodevelopmental disability affecting at least 5 million children in South Asia. Majority of these children are without access to evidence-based care. The UK Pre-school Autism Communication Therapy (PACT) is the only intervention to have shown sustained impact on autism symptoms. It was systematically adapted for non-specialist community delivery in South Asia; as the 'Parent-mediated Autism Social Communication Intervention for non-Specialists (PASS) and extended ‘PASS Plus’ interventions. RCTs of both showed feasibility, acceptability and positive effect on parent and child dyadic outcomes. Methods: The Communication-centred Parent-mediated treatment for Autism Spectrum Disorder in South Asia (COMPASS) trial is now a scale-up two centre, two arm single (rater) blinded random allocation parallel group study of the PASS Plus intervention in addition to treatment as usual (TAU) compared to TAU alone, plus health economic evaluation – embedded in the India health system. 240 children (approximately 120 intervention/120 TAU) with ASD aged 2-9 years will be recruited from two tertiary care government hospitals in New Delhi, India. Accredited Social Health Activists will be one of the intervention delivery agents. Families will undertake up to 12 communication sessions over 8 months and will be offered the Plus modules which address coexisting problems. The trial’s primary endpoint is at 9 months from randomization, with follow-up at 15 months. The primary outcome is autism symptom severity; secondary outcomes include parent-child communication, child adaptation, quality of life and parental wellbeing. Primary analysis will follow intention-to-treat principles using linear mixed model regressions with group allocation and repeated measures as random effects. The primary cost-effectiveness analysis will use a societal perspective over the 15-month period of intervention and follow-up. Discussion: If clinically and cost effective, this programme will fill an important gap of scalable interventions delivered by non specialist health workers within the current care pathways for autistic children and their families in low resource contexts. The programme has been implemented through the COVID-19 pandemic when restrictions were in place; intervention delivery and evaluation processes have been adapted to address these conditions. Trial Registration: ISRCTN; ISRCTN21454676; Registered 22 June 2018; https://www.isrctn.com/ISRCTN21454676?q=21454676;


Subject(s)
2704 , 1327 , 59585 , 9262
6.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2065618.v1

ABSTRACT

BACKGROUND The severity of coagulation derangement correlates with poor prognosis in COVID-19 patients. However, the clinical impact of coagulation alterations detected with rotational thromboelastometry (ROTEM) in intensive care unit (ICU) COVID-19 patients is not completely defined. The study aimed to identify the correlation between ROTEM parameters and adverse ICU outcomes. The relationship between COVID-19 associated coagulopathy (CAC) and ROTEM alterations and possible risk factors for ICU mortality were also investigated.  METHODS COVID-19 patients admitted to ICU between October 1, 2020 and May 31, 2021, were retrospectively enrolled. The sample was subsequently divided into subgroups (survivors vs. non-survivors, mechanical ventilation (MV) vs. non-invasive ventilation (NIV), venous thromboembolism (VTE) vs. NO-VTE, CAC vs. NO-CAC) among which ROTEM parameters and standard coagulation tests were compared.  RESULTS One hundred ICU patients were enrolled. High D-dimer (DD) (5089 ± 1035 ng/ml) and fibrinogen levels (640 ± 112 mg/dl) and an increase in maximum clot firmness (MCF) were revealed. The non-survivors (n=50, 50%) had higher DD levels and lower platelet counts as well as lower clot lysis rates than survivors. EXTEM maximum lysis (ML) resulted lower in the MV subgroup than in NIV treated patients. Patients with thrombotic complications had higher DD levels than patients without VTE whereas ROTEM parameters were not different. Similarly no coagulation or ROTEM differences were identified in the subgroup of CAC patients (n=29, 29%). Reduced ML values in EXTEM and INTEM resulted as possible risk factors for ICU mortality.  CONCLUSIONS In critically ill COVID-19 patients, hypofibrinolysis and not hypercoagulability seems to be correlated with unfavourable ICU prognosis.


Subject(s)
33361 , 19001 , 30170 , 59585 , 19545 , 23852 , 52618 , 9262 , 14312 , 1805
7.
Curr Opin Neurol ; 35(4): 494-501, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-1978302

ABSTRACT

PURPOSE OF REVIEW: The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP). RECENT FINDINGS: As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine. SUMMARY: COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.


Subject(s)
COVID-19 , Movement Disorders , Parkinson Disease , Telemedicine , COVID-19/complications , COVID-19/epidemiology , Humans , Movement Disorders/epidemiology , Movement Disorders/therapy , Pandemics , Parkinson Disease/epidemiology , Parkinson Disease/therapy , SARS-CoV-2
8.
Brain Nerve ; 74(7): 861-866, 2022 Jul.
Article in Japanese | MEDLINE | ID: covidwho-1954939

ABSTRACT

The new coronavirus SARS-CoV-2 infection (COVID-19) has caused many casualties, mainly respiratory infections. However, it has also caused several neurological disorders including encephalitis/encephalopathy, demyelinating disease, Gullain-Barré sydrome etc. In addition, it has been clarified that movement disorders develop within a few days to weeks after infection. Vaccination for COVID-19 has progressed, but autoimmune neurological complications have also been reported. Although a causal relationship is suspected over time, this paper describes the pathophysiology of movement disorders such as myoclonus, opsoclonus, parkinsonism, and cerebellar ataxia, which are relatively common in COVID-19 infections, and their relevance to the SARS-CoV-2 vaccine.


Subject(s)
COVID-19 , Cerebellar Ataxia , Movement Disorders , Nervous System Diseases , Ataxia , COVID-19/complications , COVID-19 Vaccines , Humans , Movement Disorders/complications , Nervous System Diseases/etiology , SARS-CoV-2
10.
Neurol Sci ; 43(9): 5165-5168, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1877850

ABSTRACT

BACKGROUND: Several neurological complications have been reported following SARS-Cov-2 vaccination, without a clear causal relationship ever being verified, including some cases of worsening of Parkinson's disease (PD) symptoms and new onset of movement disorders in non-parkinsonian patients. METHODS: We describe two new cases of PD patients treated with device-aided therapy who developed worsening of parkinsonian symptoms after receiving the third vaccine dose (booster). We also conducted a short review of the cases reported in literature of PD symptoms worsening and new onset of movement disorders in non-parkinsonian patients after SARS-Cov-2 vaccination. RESULTS: The first patient, a 46-year-old man implanted with bilateral Subthalamic Deep Brain Stimulation, experienced temporary motor and non-motor symptoms worsening after mRNA-1273 booster, improved after stimulation settings modification. The second patient, a 55-year-old man implanted with percutaneous endoscopic transgastric jejunostomy (PEG-J) for levodopa-carbidopa intestinal gel (LCIG) infusion experienced severe temporary worsening of dyskinesia and managed through temporary LCIG dose reduction. Other seven cases of vaccine-related movement disorder are currently reported in literature, four describing PD symptoms worsening and three the onset of new movement disorders in otherwise healthy people. CONCLUSION: Both our patients and the cases described so far completely recovered after few days with parkinsonian therapy modification, symptomatic treatment, or even spontaneously, underlining the transient and benign nature of side effects from vaccine. Patients should be reassured about these complications, manageable through a prompt evaluation by the reference neurologist.


Subject(s)
COVID-19 Vaccines , COVID-19 , Movement Disorders , Parkinson Disease , Vaccination , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Carbidopa/therapeutic use , Deep Brain Stimulation , Drug Combinations , Humans , Immunization, Secondary/adverse effects , Levodopa/therapeutic use , Male , Middle Aged , Movement Disorders/etiology , Movement Disorders/therapy , Parkinson Disease/etiology , Parkinson Disease/therapy , Treatment Outcome , Vaccination/adverse effects
11.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-1749644.v1

ABSTRACT

Background: The relearning of movements after brain injury can be optimized by providing intensive, meaningful, and motivating training using virtual reality (VR). However, most current solutions use two-dimensional (2D) screens, where patients interact via symbolic representations of their limbs (e.g., a cursor). These 2D screens lack depth cues, potentially deteriorating movement quality and increasing cognitive load. Head-mounted displays (HMDs) have great potential to provide naturalistic movement visualization by incorporating improved depth cues, reduce visuospatial transformations by rendering movements in the space where they are performed, and preserve eye-hand coordination by showing an avatar – with immersive VR (IVR) – or the user’s real body – with augmented reality (AR). However, elderly populations might not find these novel technologies usable, hampering potential motor and cognitive benefits. Methods: : We compared movement quality, cognitive load, motivation and system usability in twenty elderly participants (>59 y.o.) while performing a dual motor-cognitive task with different visualization technologies: IVR HMD, AR HMD, and a 2D screen. We evaluated participants’ self-reported cognitive load, motivation, and usability using questionnaires. We also conducted a pilot study with five brain-injured patients comparing the visualization technologies while using an assistive device. Results: : Elderly participants performed straighter, shorter duration, and smoother movements when the task was visualized with the HMDs than screen. The IVR HMD led to shorter duration movements than AR, and both HMDs were associated with shorter movement duration than the screen. Movement onsets were shorter with IVR than AR, and shorter for both HMDs than the screen, potentially indicating facilitated reaction times due to reduced cognitive load. No differences were found in the questionnaires regarding cognitive load, motivation, or usability between technologies in elderly participants. Both HMDs proved high usability in our small sample of patients. Conclusions: : HMDs are a promising technology to be incorporated into neurorehabilitation, as their more naturalistic movement visualization improves movement quality compared to conventional screens. HMDs demonstrate high usability, without decreasing participants’ motivation, and might potentially lower cognitive load. Our preliminary clinical results suggest that brain-injured patients may especially benefit from more immersive technologies. However, larger patient samples are needed to draw stronger conclusions.


Subject(s)
9262 , 1956
12.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.06.16.22276533

ABSTRACT

Abstract Introduction Contemporary literature has revealed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes acute sialadenitis and related symptoms, such as discomfort, pain, swelling, and secretory dysfunction in salivary glands. The secretory dysfunction is due to SARS-CoV-2 infection-induced xerostomia and other associated clinical courses such as sore tongue, mucosal ulcer, and gingivitis in the oral cavity. Furthermore, it has been reported that COVID-19 causes the development of other oral manifestations. Materials and Methods A prospective clinical follow-up (a prevalent cohort) study was conducted to identify the possible oral manifestations of SARS-CoV-2 infection among patients admitted at the Eka General Hospital COVID-19 treatment center. Furthermore, the study aimed to calculate the prevalence rate of oral clinical courses in the cohorts. The study had two follow-up phases: Hospital and patient-home-based. Results A total of 55 patients (36 males and 19 females) met the inclusion criteria and were followed for 7.5 weeks. The 3.5 weeks hospital-based prospective follow-up study documented an 18% (n=10) prevalence rate of oral clinical courses among the cohorts. Twelve oral symptoms appeared in these ten patients. The manifested oral symptoms were oral mucosal lesions (n=6), xerostomia (n=5), and thickening of saliva (n=1). The oral mucosal lesions per se consisted of aphthous lesions (n=3), candidiasis (n=1), geographic tongue (n=1), and localized gingivitis (n=1). On the other hand, the four weeks home-based follow-up study disclosed four newly manifested oral symptoms: hemorrhagic crust, bulla, buccal mucositis, and petechiae. These manifestations appeared among six patients (four males and two females) who had not manifested any oral symptoms during the hospital-based follow-up. Accordingly, the overall prevalence of oral clinical courses among patients presented with SARS-CoV-2 is raised from 18% (n=10) to 29% (n=16). Similarly, the number of clinical courses increased from 12 to 16 after four additional weeks of follow-up. Discussion The study's findings suggest the importance of initiating oral health care for patients with COVID-19. Therefore, multidisciplinary healthcare approaches should be delivered to assure optimal health outcomes. Accordingly, oral health professionals must be a substantial part of the interdisciplinary approach in caring for patients with COVID-19.


Subject(s)
13173 , 14854 , 59585 , 10333 , 15386 , 6030 , 2209 , 9252 , 9262 , 37050 , 4555
13.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.05.27.22275701

ABSTRACT

IntroductionAbnormal coagulation and inflammation are hallmarks of SARs-COV-19. Stratifying affected patients on admission to hospital may help identify those who are risk of developing severe disease early on. ROTEM is a point of care test that can be used to measure abnormal coagulation and calprotectin is a measure of inflammation. AimAssess if ROTEM can measure hypercoagulability on admission and identify those who will develop severe disease early on. Assess if calprotectin can measure inflammation and if there is a correlation with ROTEM and calprotectin. MethodsCOVID-19 patients were recruited on admission and ROTEM testing was undertaken daily for a period of 7 days. Additionally inflammatory marker calprotectin was also tested. Results33 patients were recruited to the study out of which 13 were admitted to ITU and 20 were treated on the ward. ROTEM detected a hypercoagulable state on admission but did not stratify between those admitted to a ward or escalated to ITU. Calprotectin levels were raised but there was no statistical difference (p=0.73) between groups. Significant correlations were observed between FIBA5 (p<0.00), FIBCFT (p<0.00), FIBMCF (p<0.00) and INMCF (p<0.00) and calprotectin. ConclusionCOVID19 patients were hypercoagulable in admission. The correlations between ROTEM and calprotectin underline the interactions between inflammation and coagulation.


Subject(s)
33771 , 33361 , 59585 , 36024 , 9262 , 7426
14.
Curr Neurol Neurosci Rep ; 22(5): 305-311, 2022 05.
Article in English | MEDLINE | ID: covidwho-1800311

ABSTRACT

PURPOSE OF REVIEW: This review discusses advances in functional movement disorders (FMD) over the past 3 years, with a focus on risk factors, diagnosis, pathophysiology, neuroimaging studies, and treatment. RECENT FINDINGS: The past decade has brought a revived interest in functional movement disorders, with a growing number of studies exploring pathophysiological mechanisms. Here, we review recent studies demonstrating changes in attention, emotional and sensorimotor function in FMD. Through international collaborative efforts, progress has been made in defining biomarkers and outcome measures, an important prerequisite towards standardization of diagnosis and reporting of outcomes in clinical trials. Of particular interest are neuroimaging studies demonstrating functional and structural changes in motor and emotional brain circuits, deepening our understanding of FMD as a neurocircuit disorder and potentially paving the way towards new treatments. Currently available treatment modalities have shown successful outcomes via outpatient, inpatient, and virtual delivery. The last 3 years have seen tremendous efforts to better understand, diagnose, and treat FMD. The disease model has been broadened to include a biopsychosocial formulation, and insights on the pathophysiology on FMD are informing treatment efforts. Several international multidisciplinary research collaborations are underway to define biomarkers and best outcome measures, highlighting the path towards improved standardization of future treatment trials. Additionally, the rise of telemedicine during the COVID-19 pandemic has reduced geographic barriers and paved the way for virtual therapy sessions and self-guided programs.


Subject(s)
COVID-19 , Conversion Disorder , Movement Disorders , Humans , Movement Disorders/diagnosis , Movement Disorders/therapy , Neuroimaging , Pandemics
15.
Curr Neurol Neurosci Rep ; 22(2): 113-122, 2022 02.
Article in English | MEDLINE | ID: covidwho-1773003

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic has dramatically affected the health and well-being of individuals with movement disorders. This manuscript reviews these effects, discusses pandemic-related changes in clinical care and research, and suggests improvements to care and research models. RECENT FINDINGS: During the on-going COVID-19 pandemic, individuals with movement disorders have experienced worsening of symptoms, likely due to decreased access to care, loss of social connection, and decreased physical activity. Through telemedicine, care has moved out of the clinic and into the home. Clinical research has also been significantly disrupted, and there has been a shift to decentralized approaches. The pandemic has highlighted disparities in access to care and representation in research. We must now translate these experiences into better care and research models with a focus on equitable integration of telemedicine, better support of patients and caregivers, the development of meaningful digital endpoints, and optimization of decentralized research designs.


Subject(s)
COVID-19 , Movement Disorders , Telemedicine , Humans , Movement Disorders/epidemiology , Movement Disorders/therapy , Pandemics , SARS-CoV-2
16.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-1473735.v1

ABSTRACT

The neurologic manifestations during the acute phase of COVID-19 are well characterized, but a comprehensive evaluation of the risks and burdens of post-acute neurologic disorders at 1-year after the initial infection has not been yet undertaken. Here we use national healthcare databases from the US Department of Veterans Affairs to build a cohort of 154,068 individuals with COVID-19 as well as two sets of control cohorts with 5,638,795 (contemporary controls) and 5,859,621 (historical controls) individuals to estimate risks and burdens of a set of pre-specified incident neurologic disorders at 12 months. Our results show that in the post-acute phase of COVID-19, there was increased risk of an array of neurologic disorders including stroke, cognition and memory disorders, peripheral nervous system disorders, episodic disorders (e.g., migraine and seizure), extrapyramidal and movement disorders, musculoskeletal disorders, sensory disorders, and other disorders including Guillain-Barré, and encephalitis or encephalopathy. The risks and burdens were significantly elevated even in people who did not require hospitalization during the acute phase of COVID-19. Taken together, our results provide evidence of increased risk of broad array of long-term neurologic disorders in people with COVID-19. This evidence will inform the management of the ongoing pandemic and guide post-acute COVID-19 clinical care and health care systems planning.


Subject(s)
4736 , 59585 , 31887 , 8739 , 9068 , 9615 , 9262 , 30524 , 30392
17.
biorxiv; 2022.
Preprint in English | bioRxiv | ID: ppzbmed-10.1101.2022.03.09.483239

ABSTRACT

Animal sociality emerges from individual decisions on how to balance the costs and benefits of being sociable. Movement strategies incorporating social information — the presence and status of neighbours — can modulate spatial associations, helping animals avoid infection while benefiting from indirect information about their environment. When a novel pathogen is introduced into a population, it should increase the costs of sociality, selecting against gregariousness. Yet current thinking about novel pathogen introductions into wildlife neglects hosts’ potential evolutionary responses. We built an individual-based model that captures essential features of the repeated introduction, and subsequent transmission of an infectious pathogen among social hosts. Examining movements in a foraging context, widely shared by many species, we show how introducing a novel pathogen to a population provokes a rapid evolutionary transition to a dynamic social distancing movement strategy. This evolutionary shift triggers a disease-dominated ecological cascade of increased individual movement, decreased resource harvesting, and fewer social encounters. Pathogen-risk adapted individuals form less clustered social networks than their pathogen-risk naive ancestors, which reduces the spread of disease. The mix of post-introduction social movement strategies is influenced by the usefulness of social information and disease cost. Our work demonstrates that evolutionary adaptation to pathogen introductions and re-introductions can be very rapid, comparable to ecological timescales. Our general modelling framework shows why evolutionary dynamics should be considered in movement-disease models, and offers initial predictions for the eco-evolutionary consequences of wildlife pathogen spillover scenarios.


Subject(s)
9262
18.
J Neurol Sci ; 435: 120201, 2022 04 15.
Article in English | MEDLINE | ID: covidwho-1703833

ABSTRACT

The field of neurology has experienced a dramatic push towards providing care via telemedicine approaches, triggered by the COVID-19 pandemic. The remote monitoring of movement disorders, including tremor, provides a set of challenges compared to gold-standard in-clinic assessments, but also opens opportunities to assess patients' symptoms in a setting where it most matters, such as patients' homes, and during their daily life activities. A successful remote interaction with patients experiencing tremor is dependent on a seamless teleneurology interaction allowing for a high-quality medical history and physical examination. In addition to the clinical evaluation, tremor may be characterized and quantified remotely using transducer-based methods, which may be applying devices containing sensors to objectively and precisely capture tremor movements. This review aims to provide (Zheng et al., 2017 [1]) a practice-oriented overview of telemedicine basics, when it comes to the assessment of tremor, Powers et al. (2021) [2] an update of the most notable techniques and devices, and (Mari, 2021 [3]) an outlook into future opportunities and challenges, as well as and next steps towards seamless remote care of patient with tremor. In conclusion, teleneurology, propelled by the COVID-19 pandemic, has evolved into to a widely established method of physician-patient interaction, aided by technological advancement of remote assessment tools of tremor. However, as the technological, regulatory and reimbursement environment is increasingly adapting to serve the needs of telemedicine, the methods presented for remote measurement of tremor using devices are still largely experimental and largely limited to the research setting. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.


Subject(s)
COVID-19 , Movement Disorders , Telemedicine , Humans , Pandemics , Tremor/diagnosis
19.
Semin Pediatr Neurol ; 41: 100953, 2022 04.
Article in English | MEDLINE | ID: covidwho-1665479

ABSTRACT

Functional movement disorders (FMD) are complex neurobehavioral disorders that can be a significant source of disability for both children and their caregivers. While FMD in the adult population is better characterized, the aim of this paper is to review the pertinent clinical and historical features, diagnostic criteria, and multi-disciplinary management of FMD in the pediatric population. We highlight recent trends in pediatric FMD, including the increase in functional tic-like behaviors that has been observed during the COVID-19 pandemic.


Subject(s)
COVID-19 , Conversion Disorder , Movement Disorders , Adult , Child , Conversion Disorder/epidemiology , Humans , Movement Disorders/diagnosis , Movement Disorders/therapy , Pandemics
20.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.01.08.22268928

ABSTRACT

Background: During the COVID-19 pandemic, medical education migrated to digital environments, without clear guidelines for virtual courses or evaluations of how these courses have been developed. Objective: To adapt and validate a scale to evaluate the quality of virtual courses developed for human medicine students in Peru. Methods: Cross-sectional study that adapted a scale to assess the quality of virtual courses to the context of Peruvian medical students during the COVID-19 pandemic, using the Delphi methodology and pilot tests for a rigorous evaluation of the items, resulting in a scale of 30 items that were described with summary statistics. In addition to the exploratory factor analysis (EFA) with Oblimin rotation, together with the adequacy and sample fit with Bartlett test and Kaiser-Meyer-Olkin (KMO), while the internal consistency was estimated with the alpha coefficient. Results: A total of 297 medical students in Peru were surveyed. The descriptive statistics for the items showed a normal distribution, while the Bartlett test showed no inadequacy (X2=6134.34, p<0.01) and with the KMO test an overall value greater than 0.92 was found, therefore an AFE was performed where five factors were identified (General Quality and Didactic Methodology, Design and Navigation of the Virtual Platform, Multimedia Resources, Academic Materials) with 30 items. In the internal consistency, an alpha coefficient greater than 0.85 was estimated for the factors evaluated. Conclusions: The adapted scale of 30 items grouped into five factors or domains, show adequate evidence of validity and reliability to be used in the evaluation of the quality of virtual courses developed for Peruvian human medicine students during the context of the COVID-19 pandemic. Keywords: Education, Medical; Education, Distance; Validation; Surveys and Questionnaires; COVID-19.


Subject(s)
9262 , 59585
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