Research COVID-19 and its Outcomes in Multiple Sclerosis Patients

Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious disease that resulted in 4533645 deaths until September first, 2021. Multiple Sclerosis (MS) patients receive immunosuppressive drugs. Thus, there is a concern that these drugs will reduce the patient's immune system resistance against COVID19. Objective(s): This study aimed to evaluate the epidemiology of COVID19 and its impact on MS patients in our university hospital in Tehran City, Iran. Material(s) and Method(s): A cross-sectional study was conducted based on hospital-based registry data from May 2020 to March 2021. Among more than 500 registered MS patients in Imam Khomeini Hospital in Tehran City, Iran, referring within our study period, 84 patients reported SARS-COV2 infection. The diagnosis of MS was confirmed by the McDonald criteria. Moreover, the diagnosis of COVID-19 in MS patients was established by the real-time-PCR technique and chest computed tomography. Result(s): Out of 84 MS patients with SARS-COV2 infection, 55(65.5%) were women, and their mean age was 37.48 years. The most commonly used medications by MS patients were Rituximab 20 (26.3%) and Dimethyl Fumarate 14(18.4%). Totally, 9(10.8%) of the patients needed to be hospitalized due to COVID-19, with a mean hospitalization duration of 5.88 days. A total of 1 (1.2%) death was reported. Conclusion(s): Compared to the healthy population, COVID-19 is not more serious in MS patients. Most MS patients with COVID-19 infection were not hospitalized and continued their medication during the infection.Copyright © 2022 The Authors. This is an open access article under the CC-By-NC license. All Rights Reserved.

Prognostic Factors for Predicting COVID-19 Severity and Mortality

Background: COVID-19 has become a serious health problem worldwide. Objective(s): The current study investigated the prognostic factors associated with demographical parameters, clinical and vital signs, and laboratory results for predicting severity and mortality in patients infected with COVID-19. Method(s): This retrospective analysis was conducted on the medical records of 372 COVID-19-positive patients hospitalized at the Khatam al-Anbiya Hospital, Shoushtar, Iran, from Sep 2020 to Sep 2021. The association of demographic parameters, clinical and vital signs, and laboratory results with severity and patients' outcomes (survival/mortality) was studied. The patients were divided into the non-severe group (n = 275) and the severe group (n = 97). COVID-19 disease severity was determined based on the severity of pulmonary involvement using CT chest images. The collected data were analyzed using IBM SPSS software for Windows (version 18). Logistic regression analysis was employed using the Forward LR method to predict COVID-19 severity and mortality. Result(s): The rates of mortality and the severe form of the disease were 87.1% (n = 324) and 12.9% (n = 48), respectively. A prognostic value was observed in predicting COVID-19 severity and mortality for some clinical and vital signs (diabetes (P < 0.001, P = 0.019), hypertension (P = 0.024, P = 0.012), pulmonary diseases (P = 0.038, P < 0.001), and anosmia (P = 0.043, P = 0.044) and paraclinical parameters (FBS (P = 0.014, P = 0.045), BUN (P = 0.045, 0.001), Cr (P = 0.027, P = 0.047), Neut (P = 0.002, P = 0.005), and SpO2 (P = 0.014, P = 0.001)). Cardiovascular disorders (P = 0.037), fever (P = 0.008), and dyspnea (P = 0.020) were also effective at predicting disease-related mortality. Multiple logistic regression analyses showed that diabetes disease, the place of residence, PCO2, and BUN with R2 = 0.18, and age, pulmonary diseases, and BUN with R2 = 0.21 were involved in predicting the severity and mortality, respectively. Conclusion(s): It seems that in addition to the BUN, diabetes and pulmonary diseases play a more significant role in predicting the severity and mortality due to COVID-19, respectively.Copyright © 2023, Author(s).

Immune-mediated necrotizing myopathy following vaccination with the AstraZeneca (AZD1222) COVID-19 vaccine: A case report and brief review.

Immune-Mediated Necrotizing Myopathy (IMNM) after vaccination has been reported previously, however it is rare after COVID-19 vaccination. We report the first case of IMNM two weeks after vaccination with the AstraZeneca (AZD1222) COVID-19 vaccine. There was a probable temporal relationship between the COVID-19 vaccination and the development of IMNM due to lack of known causative factors for IMNM. This may have been due to 1) autoimmunity directly caused by the vaccine, 2) exacerbation of autoimmunity triggered by the vaccine or 3) autoimmune syndrome triggered by the vaccine adjutants. Further studies are needed to assess the underlying mechanisms.

COVID-19 and its outcomes in multiple sclerosis patients

Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious disease that resulted in 4533645 deaths until September first, 2021. Multiple Sclerosis (MS) patients receive immunosuppressive drugs. Thus, there is a concern that these drugs will reduce the patient's immune system resistance against COVID19. Objective(s): This study aimed to evaluate the epidemiology of COVID19 and its impact on MS patients in our university hospital in Tehran City, Iran. Material(s) and Method(s): A cross-sectional study was conducted based on hospital-based registry data from May 2020 to March 2021. Among more than 500 registered MS patients in Imam Khomeini Hospital in Tehran City, Iran, referring within our study period, 84 patients reported SARS-COV2 infection. The diagnosis of MS was confirmed by the McDonald criteria. Moreover, the diagnosis of COVID-19 in MS patients was established by the real-time-PCR technique and chest computed tomography. Result(s): Out of 84 MS patients with SARS-COV2 infection, 55(65.5%) were women, and their mean age was 37.48 years. The most commonly used medications by MS patients were Rituximab 20 (26.3%) and Dimethyl Fumarate 14(18.4%). Totally, 9(10.8%) of the patients needed to be hospitalized due to COVID-19, with a mean hospitalization duration of 5.88 days. A total of 1 (1.2%) death was reported. Conclusion(s): Compared to the healthy population, COVID-19 is not more serious in MS patients. Most MS patients with COVID- 19 infection were not hospitalized and continued their medication during the infection.

Psychological Status during COVID-19 Pandemic on the Patients with Cancer

Background: Coronavirus disease 2019 (COVID-19) emerged in December 2019 in China and exhibited as a highly contagious viral infection which led to a high level of mortality and morbidity. It is followed by a great deal of complications, such as serious psychological disorders. There are a few studies evaluating the psychological status of COVID-19 on the patients with cancer in Iran. Method: This was a cross-sectional study carried out on 94 patients with cancer who referred to Haft-e-Tir hospital for radiotherapy and chemotherapy from 20 April to 15 may, 2020. The data collection tool was the impact of events scale-revised (IES-R). Results: The prevalence of anxiety disorders and obsessive compulsive disorder based on past psychiatric history in the patients was 11.7% and 2.1%, respectively. The results revealed that age was significantly related to avoidance dimension score (B =-0. 209, 95% CI:-0.084 to-0.335). Regarding hyper arousal dimension score, the results were as follows: rural residency (B = 5.091, 95% CI: 0.610 to 9.573), past psychiatric history (PPH) (B = 8.312, 95% CI: 4.314 to 12.310), and radiotherapy (B =-2.976, 95% CI:-5.878 to-0.074) had a statistically significant relationship with the hyper arousal dimension score. Conclusion: The patients with cancer had a severe form of COVID-19. Individuals with cancer who had a previous psychiatric history are more vulnerable to post-traumatic stress disorder symptoms after trauma.

The Prevalence of Electrolyte Imbalances and Their Relationship with Disease Severity in Hospitalized COVID-19 Patients

Since the identification of COVID-19, its various manifestations have been reported in numerous studies. However, few studies have specifically examined the electrolyte imbalances seen in this disease. Patients with a definitive diagnosis of COVID-19 admitted to our hospital entered this retrospective cross-sectional study. Upon admission of the patients, a blood sample was sent for the analysis of the electrolytes. The relationship between electrolyte imbalances and disease severity, ICU admission, and mortality was also stated. Of 1072 hospitalized patients studied, 657 were men, and 415 were women. The prevalence of hypocalcemia (47.7%), hypophosphatemia (21.1%), hypomagnesemia (15.8%), and hyponatremia (13%) was higher compared to other electrolyte imbalances in these patients. Lower levels of sodium, calcium, and magnesium were seen in severe cases, while higher serum levels of potassium and phosphorus were detected in severe cases and ICU hospitalized patients. Causes such as albumin decrease in inflammation, the role of PTH, and the effect of vitamin D can play a role in hypocalcemia in these patients. In addition, electrolyte loss from the digestive tract can contribute to electrolyte imbalances. Because of the high prevalence of electrolyte imbalance in these patients, electrolyte monitoring is recommended in COVID-19 patients to ensure better care. © 2022, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Factors influencing international collaboration on the prevention of COVID-19.

OBJECTIVES: COVID-19 has spread rapidly throughout the world, which has highlighted the importance of collaboration between countries to prevent further transmission of the virus. This review aims to identify the factors that influence international collaboration between policymakers for COVID-19 prevention and consider strategies to manage pandemics in the future. STUDY DESIGN: A scoping review was conducted using the Arksey and O'Malley framework for scoping reviews. METHODS: A literature search was performed across PubMed, Google Scholar, Scopus and Embase databases using relevant keywords. The initial search identified 1010 articles; after selection criteria were applied, 28 studies were included in the review. RESULTS: Most of the selected articles were literature reviews, and China had the greatest contribution of articles to this study. The following seven key categories influencing international collaboration were identified: political, structure, infrastructure, leadership and governance, knowledge and information sharing, community engagement, and process/action. CONCLUSION: Leadership and governance was the most important factor identified in international collaboration between countries. In addition, knowledge and information sharing were seen to help avoid repetition of negative situations experienced in other countries. Moreover, controlling COVID-19 on a global scale is more likely to be achieved when there are sufficient structures and resources and when appropriate communication between countries, health systems and communities is used. This collaboration can also greatly benefit low- and middle-income countries where resources and expertise are often limited.

Status epilepticus due to COVID-19;a cases series and literature review

Complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. Various mechanisms have been proposed to justify the cause of seizures in Covid-19 patients. To our knowledge, 13 cases of status epilepticus (SE) associated with COVID-19 have been reported so far. Here, we present a single-center case series, including the clinical, laboratory, and imaging characteristics, and the EEG and the outcome of SE in 5 Iranian patients with laboratory-confirmed SARS-CoV-2 virus. SE was para-infectious in four patients and post-infectious in one other patient. In Three patients, the causes of seizure were included severe hyponatremia, acute ischemic stroke, and meningoencephalitis. However, in two other patients, no specific reason for seizure was found, but there are possibilities for lesser-known mechanisms of Covid-19 that play roles in developing SE. Two of the patients recovered, and three patients, older and with higher comorbidities, failed to recover and died.

Subtle Neurological Symptoms as Early Signs of Watershed Infarction in COVID-19 Infection

Objective: In this study we aimed to evaluate the clinical and imaging characteristics of a cohort of COVID-19 patients with stroke. Background: Cerebrovascular diseases comprise a significant portion of neurological disorders related to COVID-19. Design/Methods: In this cross-sectional study, ninety-five COVID-19 patients with stroke were included between October 2020 and January 2021. Patients were evaluated based on the following clinical and imaging features: severity of COVID-19 (critical/non-critical), stroke type, presence or absence of clinical suspicion of stroke (suspicious/non-suspicious), medical risk factors, Fazekas scale, ASCOD criteria classification, and presence or absence of watershed infarction. Clinical outcomes were assessed based on Modified Rankin Scale (MRS) and mortality (during hospitalization and within three months of discharge). Chi-square test, independent t-test, and one-way ANOVA were used to compare variables. Multivariable logistic regression was applied to evaluate the effects of relevant factors on the likelihood that participants have watershed infarction. Results: Ischemic stroke (n=79, 83.1%) and intracerebral hemorrhage (n=7, 7.4%) were the most prevalent types of stroke. According to ASCOD classification, most common causes of ischemic stroke were cardioembolic (n=21, 26.6%) or other determined causes (n=18, 22.8%). Watershed infarction was the most common etiology among other determined causes (16/18, 88.9%). Watershed infarction was significantly associated with being clinically non-suspicious (OR=8.46, p<0.001) and death after discharge (OR=12, p<0.001). Patients with watershed infarction had a higher odds of having a high Fazekas score (OR=6.42, p=0.002) which was confirmed by logistic regression model (adjusted OR=26.1, p=0.006). Conclusions: Watershed infarct is one of the common causes of Ischemic stroke in COVID-19 patients, which should be considered in patients with critical COVID-19 and those without obvious clinical symptoms of stroke. Patients with chronic small vessel disease are more susceptible to watershed infarctions. Early neuroimaging can play an important role to better identify these patients.

Persistent cognitive impairment as a rare manifestation of mild COVID-19 infection – A case series

Coronavirus (COVID-19) is a worldwide epidemic. Although the main target of COVID-19 is the respiratory system, it is known that the virus can cause neurological complications. Previous studies have shown that its neurological manifestations are usually seen in critically ill patients. In this study, we introduced patients who developed COVID-induced encephalitis despite their good general condition and mild symptoms. The only symptoms of encephalitis in these patients were cognitive impairment, that persisted for more than 6 months. This disorder was confirmed by Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) test results in patients. While previous studies have shown that COVID-induced cognitive impairment improves over time. Therefore, it is recommended that the diagnosis and treatment of encephalitis be considered in patients with COVID-19 who have mild cognitive and behavioral symptoms.

Chest CT Findings (COVID-19), Analysis of 200 Cases (Postmortem)

Background & Objective: COVID-19 was first seen in Wuhan-China in December 2019, and became a widely-spreadepidemic and caused a terrifying life-threatening problem in most societies of the world. In Iran, a declaration was made on January 20, 2020, and all health systems were alerted of the disease threats. Materials & Methods: We collected all chest CT scans of 200 cases diagnosed as COVID-19 who died in 22 hospitals of Golestan Province, Iran. All data were collected in a designed checklist, then statistical evaluation was made using descriptive analysis and Chi-Square test. Results: The most frequent complaints in patients were dyspnea (38.5%), fever (15%), and dry cough (13%). Hypertension (22.5%), Heart disease (18.5%), and diabetes (15%) were present as underlying diseases. CT scan findings showed Ground Glass Opacity (96%), consolidation (44%), pleural effusion (26.5%), crazy paving (15%), and cardiomegaly (15.5%). Conclusion: Based on this study, hypertension as an underlying disease was significantly related to Highly Suggestive CT scans. No relation was found between cardiomegaly and death under 48 hours. Our findings Showed Ground Glass Opacity (GGO) in 192 (96%), consolidation in 88 (44%), crazy paving in 30 (15%), cardiomegaly in 30 (15%), and pleural effusion in 53 (26.5%) cases. © 2022, Zanjan University of Medical Sciences and Health Services. All rights reserved.

Research Paper: COVID-19 and its Outcomes in Multiple Sclerosis Patients

Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious disease that resulted in 4533645 deaths until September first, 2021. Multiple Sclerosis (MS) patients receive immunosuppressive drugs. Thus, there is a concern that these drugs will reduce the patient's immune system resistance against COVID19. Objectives: This study aimed to evaluate the epidemiology of COVID19 and its impact on MS patients in our university hospital in Tehran City, Iran. Materials & Methods: A cross-sectional study was conducted based on hospital-based registry data from May 2020 to March 2021. Among more than 500 registered MS patients in Imam Khomeini Hospital in Tehran City, Iran, referring within our study period, 84 patients reported SARS-COV2 infection. The diagnosis of MS was confirmed by the McDonald criteria. Moreover, the diagnosis of COVID-19 in MS patients was established by the real-time-PCR technique and chest computed tomography. Results: Out of 84 MS patients with SARS-COV2 infection, 55(65.5%) were women, and their mean age was 37.48 years. The most commonly used medications by MS patients were Rituximab 20 (26.3%) and Dimethyl Fumarate 14(18.4%). Totally, 9(10.8%) of the patients needed to be hospitalized due to COVID-19, with a mean hospitalization duration of 5.88 days. A total of 1 (1.2%) death was reported. Conclusion: Compared to the healthy population, COVID-19 is not more serious in MS patients. Most MS patients with COVID-19 infection were not hospitalized and continued their medication during the infection. © 2022 The Authors. This is an open access article under the CC-By-NC license. All Rights Reserved.

COVID-19 and RAAS inhibitors: is there a final conclusion?

Coronavirus disease 2019 (COVID-19), the first pandemic caused by a human infecting coronavirus, has drawn global attention from the first time it appeared in Wuhan city of China in late December 2019. Detection of the responsible viral pathogen, named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by WHO, and its possible pathogenesis lead to the forming of many hypotheses about the factors that may affect the patients' outcome. One of the SARS-CoV-2 infection concerns was the potential role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in COVID-19 patients' morbidity and mortality. Studies demonstrated that because SARS-CoV-2 uses human ACE2 cell receptors as an entry receptor to invade the cells, there might be an association between antihypertensive drugs such as RAAS inhibitors (specifically ACEIs and ARBs) and the COVID-19 disease. Data are scarce and conflicting regarding ACEI or ARB consumption and how it influences disease outcomes, and a single conclusion has not been reached yet. According to the literature review in our article, the most evidentially supported theory about the use of RAAS inhibitors in COVID-19 is that these medications, including ACEI/ARB, are not associated with the increased risk of infection, disease severity, and patient prognosis. However, further studies are needed to support the hypothesis.

Studying COVID-19 disease management: a review study

Background: This study has been examined in order to examine the studies conducted on disease management in the field of coronavirus caused disease in the type of COVID-19 in the form of area review regarding the development of coronavirus caused disease as a significant challenge in the 21st century and the importance of managing and controlling this disease.

A review on chest CT scanning parameters implemented in COVID-19 patients: bringing low-dose CT protocols into play

Background: This study aims to review chest computed tomography (CT) scanning parameters which are utilized to evaluate patients for COVID-19-induced pneumonia. Also, some of radiation dose reduction techniques in CT would be mentioned, because using these techniques or low-dose protocol can decrease the radiation burden on the population. Main body: Chest CT scan can play a key diagnostic role in COVID-19 patients. Additionally, it can be useful to monitor imaging changes during treatment. However, CT scan overuse during the COVID-19 pandemic raises concerns about radiation-induced adverse effects, both in patients and healthcare workers. Conclusion: By evaluating the CT scanning parameters used in several studies, one can find the necessity for optimizing these parameters. It has been found that chest CT scan taken using low-dose CT protocol is a reliable diagnostic tool to detect COVID-19 pneumonia in daily practice. Moreover, the low-dose chest CT protocol results in a remarkable reduction (up to 89%) in the radiation dose compared to the standard-dose protocol, not lowering diagnostic accuracy of COVID-19-induced pneumonia in CT images. Therefore, its employment in the era of the COVID-19 pandemic is highly recommended. © 2021, The Author(s).

M-Cypher: A GQL Framework Supporting Motifs

Graph databases witness the rise of Graph Query Language (GQL) in recent years, which enables non-programmers to express a graph query. However, the current solution does not support motif-related queries on knowledge graphs, which are proven important in many real-world scenarios. In this paper, we propose a GQL framework for mining knowledge graphs, named M-Cypher. It supports motif-related graph queries in an effective, efficient and user-friendly manner. We demonstrate the usage of the system by the emerging Covid-19 knowledge graph analytic tasks. © 2020 ACM.