Neurologic Manifestations of COVID-19.

Coronavirus disease (COVID-19) caused by a new coronavirus, SARS-CoV-2, has become a serious health problem throughout the world. Although COVID-19 primarily presents as an acute respiratory tract infection, many neurological findings have also been described in patients. Neurological findings are classified into three groups as central, peripheral nervous system and musculoskeletal system. The most common central nervous system symptom is headache. Encephalitis, encephalopathy, seizures, acute ischemic stroke are also seen. The most common symptoms in the peripheral nervous system are loss of smell and taste. Myalgia, myositis and rhabdomyolysis also can be seen in musculoskeletal system involvement. Awareness of the neurological symptoms by physicians will be beneficial in early diagnosis and treatment of the disease.Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Neurologic Manifestations of COVID-19

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

Neurological Manifestations of Multisystem Inflammatory Syndrome in Children

Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 first reported from South East London has a wide spectrum of neurological signs and symptoms including headache, impaired consciousness, aseptic meningitis, encephalitis, seizure, ataxia, and stroke. It is important to diagnose these patients as soon as possible and treat them with a multidisciplinary ap-proach. A few studies have reported post-discharge follow-up data in MIS-C patients with neurological symptoms most of whom showed neurological improvement. Long-term follow-up of MIS-C patients is required to determine possible neurological sequelae. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Neurologic Manifestations of COVID-19.

Coronavirus disease (COVID-19) caused by a new coronavirus, SARS-CoV-2, has become a serious health problem throughout the world. Although COVID-19 primarily presents as an acute respiratory tract infection, many neurological findings have also been described in patients. Neurological findings are classified into three groups as central, peripheral nervous system and musculoskeletal system. The most common central nervous system symptom is headache. Encephalitis, encephalopathy, seizures, acute ischemic stroke are also seen. The most common symptoms in the peripheral nervous system are loss of smell and taste. Myalgia, myositis and rhabdomyolysis also can be seen in musculoskeletal system involvement. Awareness of the neurological symptoms by physicians will be beneficial in early diagnosis and treatment of the disease. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Parents' Opinions About Having Their Children Vaccinated Against COVID-19

Objective: Children can develop immunological reactions weeks after being infected by COVID-19. These reactions increase children's rates of mortality and morbidity due to COVID-19. Therefore, vaccination may be an important way to reduce the delayed effects of COVID-19 infection in children. Vaccinating children against COVID-19 will also contribute to controlling the pandemic and the global economy's recovery. Parents are responsible for deciding whether or not their children receive vaccinations against COVID-19. This study aimed to determine parents' opinions about having their children vaccinated against COVID-19. Material and Methods: This cross-sectional study was conducted with 423 parents with children under 18 years old. The data were collected using an "Information Form for Parents and Children," and a web-based questionnaire. The questionnaire was developed by the researchers based on the literature. It has questions about parents' willingness to have their children vaccinated against COVID-19 and their experiences with the vaccines included on Turkey's National Vaccination Schedule. Results: Of the parents, 27.7% wanted to get their children vaccinated against COVID-19. Of the children, 15.1% had been infected by COVID-19. The parents with older children (11-15 year-olds and 16-18 year-olds) wanted the have them vaccinated against COVID-19 at a higher rate than the parents of children who were under 5 years old (p=0.003). The parents cited distrust, negative effects on children and being unnecessary as their reasons for not wanting to have their children vaccinated against COVID-19. Conclusion:Transparency is important in the vaccine development process and vaccine safety tests. Public health authorities should address incorrect information in a timely manner. This will help to manage parents' perceptions of and behaviors concerning the vaccination of their children against COVID-19.

Receptor-Binding-Motif-Targeted Sanger Sequencing: a Quick and Cost-Effective Strategy for Molecular Surveillance of SARS-CoV-2 Variants.

Whole-genome sequencing (WGS) is the gold standard for characterizing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome and identification of new variants. However, the cost involved and time needed for WGS prevent routine, rapid clinical use. This study aimed to develop a quick and cost-effective surveillance strategy for SARS-CoV-2 variants in saliva and nasal swab samples by spike protein receptor-binding-motif (RBM)-targeted Sanger sequencing. Saliva and nasal swabs prescreened for the presence of the nucleocapsid (N) gene of SARS-CoV-2 were subjected to RBM-specific single-amplicon generation and Sanger sequencing. Sequences were aligned by CLC Sequence Viewer 8, and variants were identified based upon specific mutation signature. Based on this strategy, the present study identified Alpha, Beta/Gamma, Delta, and Omicron variants in a quick and cost-effective manner. IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic resulted in 427 million infections and 5.9 million deaths globally as of 21 February 2022. SARS-CoV-2, the causative agent of the COVID-19 pandemic, frequently mutates and has developed into variants of major public health concerns. Following the Alpha variant (B.1.1.7) infection wave, the Delta variant (B.1.617.2) became prevalent, and now the recently identified Omicron (B.1.1.529) variant is spreading rapidly and forming BA.1, BA.1.1, BA.2, BA.3, BA.4, and BA.5 lineages of concern. Prompt identification of mutational changes in SARS-CoV-2 variants is challenging but critical to managing the disease spread and vaccine/therapeutic modifications. Considering the cost involved and resource limitation of WGS globally, an RBM-targeted Sanger sequencing strategy is adopted in this study for quick molecular surveillance of SARS-CoV-2 variants.

The Bad Bug is Back: Acinetobacter Baumannii Bacteremia Outbreak during the COVID-19 Pandemic in an Intensive Care Unit.

Background: Epidemiology of nosocomial infections may show variability because of under-estimation of infection control measures (ICMs) in coronavirus disease 19 (COVID-19) outbreak. Aim: To investigate the Acinetobacter bacteremia outbreak developed in an intensive care unit (ICU) between March 20 to May 15, 2020, examine the risk factors, and re-evaluate ICM retrospectively. Material and Methods: A retrospective cohort analysis was conducted to determine the risk factors, pulsed field gel electrophoresis (PFGE) was performed for analysis of the outbreak, ICM practices were observed by a team, and infection control interventions were undertaken. Results: Acinetobacter bacteremia developed in 17 patients (21.5%) within 79 COVID-19 patients included in the study. The mean age of the bacteremic patients was 67.3 (SD = 14.82) years, and 82.4% of them were male; of these, 15 died, leading to 88.2% mortality. The bacteremia rate was higher compared with a 14-month period preceding the COVID-19 pandemic (17/79 versus 12/580 patients, respectively). PFGE revealed that the outbreak was polyclonal. On multi-variate analysis, the bacteremia development rate was 13.7 and 5.06 times higher with central venous catheter (CVC) use and in patients with chronic obstructive pulmonary disease (COPD), respectively. The mortality rate was higher in bacteremic patients (p = 0.0016). It was observed that ICMs were not followed completely, especially change of gloves and hand hygiene. Contamination of A. baumannii was observed in 38% of the gloves. Conclusion: COPD and CVC use were determined as risk factors for Acinetobacter bacteremia development, and failures in ICM may have led to cross-contamination of endemic A. baumannii. The outbreak could be controlled within 3 weeks of interventions.

Maternal Attachment and Preventive Intervention Methods in Mothers Under Covid-19 Stress

The aim of this review study is to examine the effects of Covid-19, a global health crisis that paves the way for a great increase in the morbidity of psychological and psychosocial disorders, on mothers in the groups at risk and the role of these effects in the maternal attachment relationship and the methods of coping with it are discussed within the framework of the literature. In addition to the life change and anxiety that comes with being a parent, the fear of contagion and uncertainty can negatively affect women's emotional well-being and cause anxiety. Sometimes mothers find it difficult to relate to their babies due to environmental factors such as stress, and such failure can have long-term effects on the baby. Considering that the pandemic period is a major source of stress in itself, it is predicted that the bonding process of mothers with their babies will be affected by the epidemic. In light of this information, healthcare providers and policy makers should be aware of the possible long-term impact on women and children of the significant burden of psychological morbidity during the perinatal period among Turkish women. Implementation of effective screening and intervention programs can help improve perinatal mental health and improve the quality of postnatal care in Turkey. © 2021 The Author(s).

Transmission of SARS-COV-2 and prevention strategies

The main transmission routes of SARS-CoV-2 are through respiratory droplets and close contact with the index case but other possible routes are also reported. Although the virus may spread during aerosol-generating procedures, the probability of airborne transmission in other circumstances is controversial. Experimental studies demonstrated that SARS-CoV-2 remained viable in aerosols and on fomite surfaces up to 72 hours. However, no reports directly demonstrated transmission from the fomites. SARS-CoV-2 RNA was isolated in various biological specimens but currently, there is no report demonstrating direct transmission of SARS-CoV-2 apart from respiratory secretions except for two cases of vertical transmission. The type, time, and duration of exposure, application of preventive measures, and the amount of the virus are among the most important predictors of the risk of transmission. Infectiousness begins approximately 3 days before symptom onset and peaks on the day of onset. The risk of transmission remains high in case of exposure to the index case within 5 days of symptom onset and is thought to continue until to10-20 days depending on the severity of the disease and presence of underlying immunosuppressive diseases. Although the preventive measures may differ according to public and healthcare settings the main strategy is to accept everyone as potential COVID-19 patients. In public settings, everyone should be encouraged to wear a facemask, maintain social distance, apply hand hygiene, avoid touching mouth, nose, and eyes, keep clean high touch areas, and obey isolation rules in case of illness or contact with COVID-19 patient. Every healthcare center should redesign the structuring of its facility to maintain the physical distance and isolate COVID-19 patients. The administration should consider making arrangements regarding surgical and invasive procedures, outpatient and inpatient clinics in terms of COVID-19. Patients and visitors should wear a facemask. Healthcare workers who care for patients with suspected or confirmed COVID-19 should wear personal protective equipment. © 2021 Nova Science Publishers, Inc.

Student Survey Results of a Virtual Medical Student Course Developed as a Platform for Neurosurgical Education During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Before the coronavirus disease 2019 (COVID-19) pandemic, medical students training in neurosurgery relied on external subinternships at institutions nationwide for immersive educational experiences and to increase their odds of matching. However, external rotations for the 2020-2021 cycle were suspended given concerns of spreading COVID-19. Our objective was to provide foundational neurosurgical knowledge expected of interns, bootcamp-style instruction in basic procedures, and preinterview networking opportunities for students in an accessible, virtual format. METHODS: The virtual neurosurgery course consisted of 16 biweekly 1-hour seminars over a 2-month period. Participants completed comprehensive precourse and postcourse surveys assessing their backgrounds, confidence in diverse neurosurgical concepts, and opinions of the qualities of the seminars. Responses from students completing both precourse and postcourse surveys were included. RESULTS: An average of 82 students participated live in each weekly lecture (range, 41-150). Thirty-two participants completed both surveys. On a 1-10 scale self-assessing baseline confidence in neurosurgical concepts, participants were most confident in neuroendocrinology (6.79 ± 0.31) and least confident in spine oncology (4.24 ± 0.44), with an average of 5.05 ± 0.32 across all topics. Quality ratings for all seminars were favorable. The mean postcourse confidence was 7.79 ± 0.19, representing an improvement of 3.13 ± 0.38 (P < 0.0001). CONCLUSIONS: Feedback on seminar quality and improvements in confidence in neurosurgical topics suggest that an interactive virtual course may be an effective means of improving students' foundational neurosurgical knowledge and providing networking opportunities before application cycles. Comparison with in-person rotations when these are reestablished may help define roles for these tools.

Individuals with Special Needs in the Coronavirus Disease 2019

Coronavirus pandemic 2019 (COVID-19) originated in Wuhan, China and spread rapidly all over the world. The epidemic, declared as a pandemic by the World Health Organization (WHO), has affected many areas or groups. In this study, the effect of the pandemia on education and students, the process of compulsory distance education and its effects is debated. The study is also focused on the impact of the pandemia on individuals with special needs, the services provided to individuals with special needs during the pandemic, the reflection of the pandemic on the families of individuals with special needs, and the reflection of the pandemic on the teachers of individuals with special needs. Additionally, the long-term effect of the pandemic process and its aftermath and health effects on individuals with special needs are emphasized. © 2020. All Rights Reserved.

By the Numbers Analysis of Effect of COVID-19 on a Neurosurgical Residency at the Epicenter.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 pandemic has created challenges to neurosurgical patient care. Despite editorials evaluating neurosurgery responses to 2019 novel coronavirus disease (COVID-19), data reporting effects of COVID-19 on neurosurgical case volume, census, and resident illness are lacking. The aim of this study was to present a real-world analysis of neurosurgical volumes, resident deployment, and unique challenges encountered during the severe acute respiratory syndrome coronavirus 2 outbreak peak in New York City. METHODS: Daily census and case volume data were prospectively collected throughout the severe acute respiratory syndrome coronavirus 2 outbreak in spring 2020. Neurosurgical census was compared against COVID-19 system-wide data. Neurosurgical cases during the crisis were analyzed and compared with 7-week periods from 2019 and early 2020. Resident deployment and illness were reviewed. RESULTS: From March 16, 2020, to May 5, 2020, residents participated in 72 operations and 69 endovascular procedures compared with 448 operations and 253 endovascular procedures from January 2020 to February 2020 and 530 operations and 340 endovascular procedures from March 2019 to May 2019. There was a 59% reduction in neurosurgical census during the outbreak (median 24 patients, 2.75 average total cases daily). COVID-19 neurosurgical admissions peaked in concert with the system-wide pandemic. Three residents demonstrated COVID-19 symptoms (no hospitalizations occurred) for a total 24 workdays lost (median 7 workdays). CONCLUSIONS: These data provide real-world guidance on neurosurgical infrastructure needs during a COVID-19 outbreak. While redeployment to support the COVID-19 response was required, a significant need remained to continue to provide critical neurosurgical service.

Emergent Large Vessel Occlusion Stroke During New York City's COVID-19 Outbreak: Clinical Characteristics and Paraclinical Findings.

BACKGROUND AND PURPOSE: The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COVID-19 outbreak. METHODS: This is a retrospective, observational case series. Data were collected from all patients who presented with ELVO to the Mount Sinai Health System Hospitals across New York City during the peak 3 weeks of hospitalization and death from COVID-19. Patients' demographic, comorbid conditions, cardiovascular risk factors, COVID-19 disease status, and clinical presentation were extracted from the electronic medical record. Comparison was made between COVID-19 positive and negative cohorts. The incidence of ELVO stroke was compared with the pre-COVID period. RESULTS: Forty-five consecutive ELVO patients presented during the observation period. Fifty-three percent of patients tested positive for COVID-19. Total patients' mean (±SD) age was 66 (±17). Patients with COVID-19 were significantly younger than patients without COVID-19, 59±13 versus 74±17 (odds ratio [95% CI], 0.94 [0.81-0.98]; P=0.004). Seventy-five percent of patients with COVID-19 were male compared with 43% of patients without COVID-19 (odds ratio [95% CI], 3.99 [1.12-14.17]; P=0.032). Patients with COVID-19 were less likely to be White (8% versus 38% [odds ratio (95% CI), 0.15 (0.04-0.81); P=0.027]). In comparison to a similar time duration before the COVID-19 outbreak, a 2-fold increase in the total number of ELVO was observed (estimate: 0.78 [95% CI, 0.47-1.08], P≤0.0001). CONCLUSIONS: More than half of the ELVO stroke patients during the peak time of the New York City's COVID-19 outbreak were COVID-19 positive, and those patients with COVID-19 were younger, more likely to be male, and less likely to be White. Our findings also suggest an increase in the incidence of ELVO stroke during the peak of the COVID-19 outbreak.

"Staying Home"-Early Changes in Patterns of Neurotrauma in New York City During the COVID-19 Pandemic.

OBJECTIVE: New York City is the epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic in the United States. Traumatic brain injury accounts for a significant proportion of admissions to our trauma center. We sought to characterize the effect of the pandemic on neurotraumas, given the cancellation of nonessential activities during the crisis. METHODS: Retrospective and prospective reviews were performed from November 2019 to April 2020. General demographics, clinical status, mechanism of trauma, diagnosis, and treatment instituted were recorded. We dichotomized the data between pre-COVID-19 (before 1 March) and COVID-19 periods and compared the differences between the 2 groups. We present the timeline of events since the beginning of the crisis in relation to the number of neurotraumas. RESULTS: A total of 150 patients composed our cohort with a mean age of 66.2 years (standard deviation ±18.9), and 66% were male. More males sustained neurotrauma in the COVID-19 period compared with the pre-COVID-19 (60.4% vs. 77.6%, P = 0.03). The most common mechanism of trauma was mechanical fall, but it was observed less frequently compared with the pre-COVID-19 period (61.4% vs. 40.8; P = 0.03). Subdural hematoma, traumatic subarachnoid hemorrhage, and intracerebral contusion accounted for the most common pathologies in both periods. Nonoperative management was selected for most patients (79.2 vs. 87.8%, P = 0.201) in both periods. CONCLUSIONS: A decrease in the frequency of neurotraumas was observed during the COVID-19 crisis concomitant with the increase in COVID-19 patients in the city. This trend began after the cancellation of nonessential activities and implementation of social distancing recommendations.