Guillain-Barré syndrome following COVID-19 vaccination: An updated systematic review of cases.

Key Clinical Message: Guillain-Barré syndrome (GBS) is a rare but possible complication that may occur after COVID-19 vaccination. In this systematic review, we found that GBS presented in patients with an average age of 58. The average time for symptoms to appear was 14.4 days. Health care providers should be aware of this potential complication. Abstract: Most instances of Guillain-Barré syndrome (GBS) are caused by immunological stimulation and are discovered after vaccinations for tetanus toxoid, oral polio, and swine influenza. In this systematic study, we investigated at GBS cases that were reported after receiving the COVID-19 vaccination. Based on PRISMA guidelines, we searched five databases (PubMed, Google Scholar, Ovid, Web of Science, and Scopus databases) for studies on COVID-19 vaccination and GBS on August 7, 2021. To conduct our analysis, we divided the GBS variants into two groups, acute inflammatory demyelinating polyneuropathy and non-acute inflammatory demyelinating polyneuropathy (AIDP and non-AIDP), and compared the two groups with mEGOS and other clinical presentation In this systematic review, 29 cases were included in 14 studies. Ten cases belonged to the AIDP variant, 17 were non-AIDP (one case had the MFS variant, one AMAN variant, and 15 cases had the BFP variant), and the two remaining cases were not mentioned. Following COVID-19 vaccination, GBS cases were, on average, 58 years of age. The average time it took for GBS symptoms to appear was 14.4 days. About 56 percent of the cases (56%) were classified as Brighton Level 1 or 2, which defines the highest level of diagnostic certainty for patients with GBS. This systematic review reports 29 cases of GBS following COVID-19 vaccination, particularly those following the AstraZeneca/Oxford vaccine. Further research is needed to assess all COVID-19 vaccines' side effects, including GBS.

Acute Vertigo in a Patient Following COVID-19 Infection: A Case Report and Literature Review.

COVID-19 has infected millions of people worldwide causing millions of deaths. COVID-19 has many serious effects on organs of the body especially the respiratory system causing pneumonia and acute respiratory distress syndrome (ARDS). The disease also has severe complications on other different organs; kidneys and liver which may end in multi-organ failure. Most common symptoms that have been detected in large section of patients were fever, cough and loss of taste or smell and less commonly sore throat, headache and muscle pain. The incidence of vertigo or dizziness is a rare symptom of COVID-19. In this case report, we introduce a 59-year-old male patient suffering from acute vertigo attack after COVID-19 infection. The patient had negative medical history of vertigo and any ear diseases. The patient received REGEN-COV (casirivimab and imdevimab) for COVID-19 and meclizine for vertigo. Vertigo attacks lasted for the two weeks follow up after disappearance of COVID-19 symptoms despite receiving vertigo medication. In conclusion, vertigo may be the sole neurological manifestation of COVID-19. More observational studies should address this symptom and researchers should also focus on identifying the origin of developing vertigo and the direct or indirect mechanisms that SARS-CoV-2 triggers to develop dizziness in general. This research should deliver a clear message, especially to ER physicians to consider proper referral of these patients without underestimating the risk of developing more serious COVID-19 symptoms as ARDS and multi-organ failure if no proper testing and follow-up are provided.

A rare case of newly diagnosed diabetes mellitus following COVID-19 infection.

Several reports showed the likelihood of a relationship between COVID-19 infection and the onset and prognosis of diabetes mellitus (DM) of all types. A 73-year-old female patient who presented to the clinic with respiratory symptoms and was tested positive for COVID-19 and treated for the next three days. Despite having neither a known history of hyperglycemia nor a family history of diabetes, she was unconscious and suffering from polyuria and polydipsia when she was brought to the emergency department. Once her condition was successfully stabilized, she was sent home with COVID-19 medications and oral anti-diabetic therapy. After subsequent viral recovery and continued anti-diabetic medication, the patient was monitored for the following seven months. DM might be linked to the SARS-CoV-2 infection. Further research is necessary to prove a relationship between COVID-19 and newly-onset diabetes.

Coronary Embolism After Infection with Covid-19 in Non-Diabetic Non-Hypertensive Patient. A Case Report

A 72-year-old female patient presented to the emergency department with one week history of dry cough, sore throat, and dyspnea grade 3, and 9 hours history of retrosternal chest pain. The patient had normal pulse, temperature and blood pressure. She had bilateral decreased air entry, S1 and S2 heard normally and had no lower limb edema. The patient had free past medical and surgical history. Laboratory investigations and ECG were done. Laboratory investigations showed that the patient was infected with SARS-CoV-2, and also showed positive cardiac enzymes, low hemoglobin (10.4 g/dl), high WBCs (14.9) 10

Lactate Dehydrogenase can be Considered a Predictive Marker of Severity and Mortality of Covid-19 in Diabetic and Non-Diabetic Patients. A Case Series

Case Series Presentation Eight elderly confirmed SARS-CoV-2 patients who had severe course of COVID-19 and admitted to ICU expressed high lactate dehydrogenase (LDH) above normal level. The mean value of LDH was 440.40 U/L with 84.52 standard deviation (normal range = 100 – 190 U/L). The mean age of patients was 73.63 years (standard deviation = 3.34). The patients were 4 males (50%) and 4 females (50%). The median of stay duration at ICU was 2 days (range = 1-32 days). Four patients died (50%) and four patients survived (50%). All the patients were at the same ICU and received the same treatment course for COVID-19. Discussion It has been shown that LDH is a potential marker of vascular permeability in immune-mediated lung injury. Areas within the body where LDH are most active include the liver, striated muscles, heart, kidneys, lungs, brain, and red blood cells. LDH is a known marker for different inflammatory states, sepsis, myocardial infarctions, infections, and malignancies. One study showed that LDH elevation was associated with a 6-fold increase in the odds of developing a severe COVID-19 disease. Furthermore elevated LDH was associated with a 16 fold increase in patient mortality. Elevated LDH levels seem to reflect that the multiple organ injury and failure may play a more prominent role in influencing the clinical outcomes in patients with COVID-19. This study is a report of 8 elderly critically ill COVID-19 patients who expressed high lactate dehydrogenase above normal level. This indicates that lactate dehydrogenase can predict the outcome of elderly COVID-19 patients. All the eight patients developed severe course of COVID-19, four of them died. Conclusion High levels of lactate dehydrogenase can predict the severity and mortality of COVID-19 in elderly patients. LDH levels could be considered for inclusion in future risk stratification models for COVID-19 severity and mortality. More observational studies

Anxiety and depression among patient's companions during admission to the ICU in the Omicron wave of COVID-19: A cross-sectional study in Aleppo University Hospital.

BACKGROUND: After the COVID-19 pandemic, anxiety and depression have reached high levels, especially after the last wave, Omicron. Healthcare workers in contact with COVID-19 patients or those who come in contact with them may exhibit high levels of anxiety and depression. Therefore, we aimed to assess anxiety and depression symptoms among ICU companions of COVID-19 patients. METHODS: From 30 November 2021 to 1 March 2022, sixth-year medical students at Aleppo University Hospital conducted interviews with the companions of COVID-19 patients who they brought their patient to the ICU centre as part of a cross-sectional quantitative study using the PHQ-9 and GAD-7 tools to gauge their level of anxiety and depression among companions of COVID-19 patients. The data were analyzed using the SPSS program. In addition, logistic regression models were used to study possible factors of anxiety and depression symptoms during COVID-19. RESULTS: The total number was 997 participants in contact with COVID-19 patients. The mean score of the depression assessment tool (PHQ-9) in our questionnaire was 9.5 with a range of 0 to 27. At the same time, the anxiety assessment tool (GAD-7) had a mean score of 9.1, ranging from 0 to 21. A binary logistic regression was used to predict the relationship between depression and anxiety and various factors. We found that the companions with medical specialties were substantially less likely to develop anxiety than other companions [AOR = 0.459; 95%CI (0.23-0.9)], in addition females were substantially higher likely to develop depression than males [AOR = 1.322; 95%CI (0.992-1.762)]. 45.4% of companions had moderate to severe anxiety, in additon 50.8% of companions had moderate to severe depression. CONCLUSION: Our research reveals that moderate to severe anxiety and sadness are present in roughly half of the COVID19 patients' companions. Females, people with children, and hard workers were more inclined to feel anxious than others, and those who are not in the medical field were more likely to suffer from depression than others, thus it is critical to assist these groups during the present outbreaks (Omicron and Monkeybox).

Parents' acceptance to vaccinate children against COVID-19: A Syrian online survey

After the widespread of COVID-19 virus worldwide, vaccination targeted reducing spread of cases and mortality rates. However, vaccination hesitancy was observed among the communities worldwide. Vaccination hesitancy involved parents regarding the decision of vaccinating their children- After obtaining ethical approval, an online cross-sectional study was conducted from 1 March to 22 April 2021 to evaluate the parents' acceptance of vaccinating their children against the COVID-19 virus in Syria. Data were analyzed using descriptive and multivariate logistic regression analysis in IBM, SPSS V. 28.0 package program (IBM Corporation, Armonk, NY, USA). Among 283 participants, 105 participants agreed to vaccinate their children, and 178 were not. A significant correlation between age and vaccine willingness was found (P-value < 0.0001*), especially in the age group between 18 and 30 years old (45.2%). Parents who accepted vaccinating themselves were more willing to vaccinate their children (34.6%). According to our results, there is a greater need to enhance awareness and knowledge programs about the vaccine's effectiveness and encourage parents to accept giving the vaccine to their children.

Knowledge, attitudes, and practices related to COVID-19 infection, related behavior, antibiotics usage, and resistance among Syrian population: A cross-sectional study.

Background and Aims: Antibiotic resistance is seen as a worldwide health risk as a result of the overuse of antibiotics. Many countries noted that antibiotic usage was high during the COVID-19 pandemic. The purpose of this study is to evaluate Syrians' knowledge, attitudes, and practice about the use of antibiotics and antibiotic resistance during the COVID-19 epidemic. Methods: A cross-sectional study was conducted using an online questionnaire to collect the data from the Syrian population from February 5 to March 4, 2022. Syrians 18 years or older all over the world were able to participate in this study. A convenience snowball sampling method was used. SPSS version 20.0 was used to analyze the data. To examine the results, binominal logistic regression was used. Statistical significance was defined as a p < 0.05. Results: Out of 2406 respondents, 60.2% knew that transmission of COVID-19 could occur even if the patient has not developed any symptoms, and 91.6% were able to recognize the main clinical symptoms of COVID-19. There was a statistically significant difference between male and female knowledge of COVID-19 (p = 0.002), with males having 3.78 ± 2.1 (2.7-3.87) and females scoring 3.93 ± 2.3 (3.7-4.1). Newly graduated students have more knowledge of COVID-19 than other subtypes of Job (p = 0.0001), and those with medical practice are more knowledgeable than those without (p = 0.0001). Only 16.6% answered that taking antibiotics would not speed up the recovery from all the infections. 65.3% answered correctly that misuse of antibiotics could cause antibiotic resistance. Conclusion: Our study concluded that the Syrian population demonstrated good knowledge of COVID-19 and moderate acceptance of the new norm. Knowledge regarding antibiotic use and resistance and practice of preventive measures was poor, which can encourage the health authorities to develop community education programs to increase public awareness of the usage of antibiotics and safety protocols during the COVID-19 pandemic.

Rare case of pneumoperitoneum in nonintubated COVID‐19 patient

We report a rare case of a 50‐year‐old female patient with COVID‐19 presented to the emergency department where supplementary oxygen is delivered via noninvasive face mask ventilation. X‐ray imaging confirmed the existence of pneumoperitoneum. CT scan was not applicable due to the advanced status of the patient. There have been a few cases of COVID‐19 patients getting pneumoperitoneum after they were intubated or given mechanical ventilation. We suggest that doctors think about this complication when treating patients with COVID‐19 so that they can respond fast to save the patient's health and avoid more serious problems.

Rare case of pneumoperitoneum in nonintubated COVID-19 patient.

We report a rare case of a 50-year-old female patient with COVID-19 presented to the emergency department where supplementary oxygen is delivered via noninvasive face mask ventilation. X-ray imaging confirmed the existence of pneumoperitoneum. CT scan was not applicable due to the advanced status of the patient.

New Onset Vertigo After COVID-19 Infection. A Case Report.

In addition to the known pathophysiological sequelae of the SARS-COV-2 virus and its related respiratory symptoms, several studies have recently reported cardiovascular, gastrointestinal, and neurological symptoms of new-onset after a history of infection. Vertigo is a symptom indicating dysfunction of the vestibular system and this report of a 60-year-old female patient points out the possible association between new-onset vertigo and SARS-COV-2 infection. A 60-year-old diabetic and hypertensive female patient with a 9-days history of COVID-19 symptoms presented to the emergency department with acute vertigo attack without nausea or vomiting. A full physical examination showed no other auditory or neurological symptoms and she never experienced vertigo before. Laboratory findings confirmed a current COVID-19 infection. The patient was managed with antihypertensive, anti-vertigo medications, and COVID-19 protocol for mild cases. After discharge, the patient was advised to continue the anti-vertigo drugs and COVID-19 medications. SARS-COV-2 may lead to vestibular neuritis causing vertigo and other related symptoms, but more well-designed observational studies with a large sample size are needed to establish a definite association between COVID-19 and vertigo.