Role of neuroinflammation mediated potential alterations in adult neurogenesis as a factor for neuropsychiatric symptoms in Post-Acute COVID-19 syndrome-A narrative review.

Persistence of symptoms beyond the initial 3 to 4 weeks after infection is defined as post-acute COVID-19 syndrome (PACS). A wide range of neuropsychiatric symptoms like anxiety, depression, post-traumatic stress disorder, sleep disorders and cognitive disturbances have been observed in PACS. The review was conducted based on PRISMA-S guidelines for literature search strategy for systematic reviews. A cytokine storm in COVID-19 may cause a breach in the blood brain barrier leading to cytokine and SARS-CoV-2 entry into the brain. This triggers an immune response in the brain by activating microglia, astrocytes, and other immune cells leading to neuroinflammation. Various inflammatory biomarkers like inflammatory cytokines, chemokines, acute phase proteins and adhesion molecules have been implicated in psychiatric disorders and play a major role in the precipitation of neuropsychiatric symptoms. Impaired adult neurogenesis has been linked with a variety of disorders like depression, anxiety, cognitive decline, and dementia. Persistence of neuroinflammation was observed in COVID-19 survivors 3 months after recovery. Chronic neuroinflammation alters adult neurogenesis with pro-inflammatory cytokines supressing anti-inflammatory cytokines and chemokines favouring adult neurogenesis. Based on the prevalence of neuropsychiatric symptoms/disorders in PACS, there is more possibility for a potential impairment in adult neurogenesis in COVID-19 survivors. This narrative review aims to discuss the various neuroinflammatory processes during PACS and its effect on adult neurogenesis.

Contrasting Association Between COVID-19 Vaccine Hesitancy and Mental Health Status in India and Saudi Arabia-A Preliminary Evidence Collected During the Second Wave of COVID-19 Pandemic.

Background: Vaccine hesitancy is a global public health threat. Understanding the role of psychological factors in vaccine hesitancy is often neglected and relatively less explored. Aim and Objectives: To analyze the relationship between mental health and COVID-19 vaccine hesitancy before and after the advent of COVID-19 vaccines (AC19V) in the general population of India and Saudi Arabia (KSA) which vary in severity of the pandemic and vaccine mandates. Materials and Methods: A total of 677 adult participants from India and KSA participated in this cross-sectional online web-based survey. Sociodemographic details and current COVID-19 status pertaining to infection and vaccination were collected. Depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and perceptive need for mental health support (MHS) were assessed before and after AC19V. A newly constructed and validated COVID19 vaccine hesitancy scale-12 (COVID19-VHS12) scale was used to evaluate the COVID-19 vaccine hesitancy. Results: Prevalence and levels of depression and anxiety symptoms decreased significantly in Saudis but not in Indians after AC19V. PTSD symptoms showed a significant reduction in both India and KSA. Anxiety symptoms were higher in KSA than India before AC19V while PTSD was higher in India before and after AC19V. Except for the place of residence and employment status, the subgroups of sociodemographic variables which were at higher risk of negative mental health before AC19V showed improvement in their mental health after AC19V. The prevalence of COVID-19 vaccine hesitancy in India and KSA was 50.8% (95% CI 45.73-55.89%) and 55.7% (95% CI 50.16-61.31%), respectively. A bidirectional association between vaccine hesitancy and mental health was observed in KSA but not in India. Higher vaccine hesitancy favored higher levels of depression, anxiety, and perceptive need for MHS and vice versa in KSA. None of the mental health parameters predicted vaccine hesitancy in India, while higher vaccine hesitancy increased the risk of anxiety. Conclusion: Vaccine hesitancy has a negative impact on mental health and vice versa over and above the impact of sociodemographic factors and COVID-19 vaccination and infection status which shows variations between India and KSA.