Disability evaluation in patients with Guillain-Barre syndrome and SARS-CoV-2 infection from a neurological reference center in Peru (preprint)

Introductions: everal cases of Guillain-Barre Syndrome (GBS) associated with SARS-CoV-2 infection have been described. This study illustrated the demographic, clinical, and neurophysiological characteristics of patients with GBS and COVID-19, as well as associated factors with disability at discharge. Methods: A retrospective analytical observational study was conducted. It included patients diagnosed with GBS admitted in a national reference center in Peru between 2019 and 2021. Epidemiological, clinical, neurophysiological and cerebrospinal fluid data were analyzed. A multivariate analysis, using the generalized linear model, was performed, considering the presence of disability at discharge as the dependent variable. Results: 81 subjects diagnosed with GBS were included. The mean age was 46.8 years (SD: 15.2), with a predominance of males (61.73%). The most frequent clinical presentation was the classic sensory-motor form in 74 cases (91.36%) with AIDP (82.35%) as the most frequent neurophysiological pattern in the group with COVID-19,while AMAN pattern predominated (59.26%) in those without COVID-19 (p=<0.000). The disability prevalence ratio at discharge between subjects with COVID-19 and those without COVID-19 was 1.89 (CI 1.06 - 3.34), p=0.030, adjusted for age, sex, and neurophysiological subtype. Conclusions: The neurophysiologic subtype AIDP, and a higher disability were associated with the presence of COVID-19.

CHARACTERISTICS OF ACUTE PSYCHIATRIC DISORDERS IN PATIENTS WITH COVID-19 IN A THIRD-LEVEL HOSPITAL IN PERU (preprint)

Objective: To describe the sociodemographic and clinical characteristics of acute psychiatric disorders in COVID-19 patients in an emergency department at a national reference psychiatry and mental health hospital. Methods: A descriptive observational study was performed. Data were collected from medical records of patients admitted by emergency according to the International Classification of Diseases (ICD-11). The group of patients with a first acute psychiatric episode vs. patients with more than one acute psychiatric episode were compared. Results: 110 patients were included; 61.8% corresponded to the female sex and the mean age was 36 years. 49.1% corresponded to schizophrenia, followed by acute polymorphic psychotic disorder (13.6%), bipolar disorder (10%), and depressive episodes (7.3%). Psychotic disorders and depressive episodes occurred in a higher percentage in the group with a first episode, 42.4% (p< 0.001), and 15.2% (p< 0.001), respectively. The episodes of schizophrenia were higher in the group of patients with previous episodes (63.6%). Conclusions: A higher frequency of cases of acute psychotic disorder and depressive disorders was found as the first episode in patients with COVID-19 infection; however, within the group with previous episodes, greater predominance of patients with acute disorders due to schizophrenia was found.

Neuromyelitis Optica Spectrum Disorder After BIBP COVID-19 Vaccine: A Case Report (preprint)

Background: With the availability of the COVID-19 vaccine, post-vaccination neurological complications have occasionally been reported. Case presentation: We present a case of neuromyelitis optica spectrum disorder (NMOSD) that developed 1 month after the second dose of BIBP COVID-19 vaccine (SARS-CoV-2-Vaccine [Vero Cell] Inactived). The patient presented itching, numbness of the hand and right side of the face, associated with nausea, vomiting and hiccups. Brain MRI showed lesions in the area postrema, medulla, and bilateral hypothalamus, typical of NMOSD. Serum antibodies to anti-AQP4 and anti-MOG were negative. Conclusions: The pathogenesis of NMOSD development and the vaccine is still unknown. The presentation of NMOSD is generally aggressive and disabling, it is important for the neurologist to be attentive to the highly variable clinical presentation after vaccination against COVID-9 for early diagnosis and effective treatment.

Severity Tomographic Score as a Predictor of Mortality in Patients With Covid-19 Pneumonia From a Third-level Hospital in Peru (preprint)

Objective: Determine whether the tomographic characteristics of patients with COVID-19 pneumonia at the hospital admission and the initial tomographic severity score (TSS) as well as some laboratory tests or clinical characteristics predict mortality. Methods: Retrospective analytical study that included patients with a clinical diagnosis of SARSCoV2 virus infection, performed by reverse transcriptase polymerase chain reaction (RT-PCR), serologic reactive test (IgM/IgG) and/or thoracic computed tomography (CT). Patients were divided into two groups: recovered and deceased. Two radiologists (blind evaluators) described the tomographic findings. TSS, clinical and laboratory parameters in relation to mortality were analyzed. Mortality predictions were made by binary logistic regression. Results: Hypertension was the most frequent associated disease, the most common clinical presentation included cough, discomfort, fever, and dyspnea. The ground glass opacity pattern was the most frequent, followed by consolidation and distortion of the architecture; however, they were not associated with higher mortality. The pattern of pleural effusion and bronchial dilation showed a significant difference from mortality (p <0.05). The binary logistic regression model showed that a moderate and high TSS (≥ 8), as well as a higher degree of lymphopenia, history of asthma and age were associated with an increased risk of death (p< 0.05). Conclusions: TSS is useful in the initial and comprehensive diagnostic evaluation of COVID-19 pneumonia, in conjunction with markers such as lymphopenia that can predict a poor short-term outcome. A high TSS score is a predictor of mortality.