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Introduction COVID-19 involvement in the nervous system has been reported in many cases. Viral neuroinvasion has multiple routes of entry. Neurological manifestations of COVID-19 can be divided into ones of the central nervous system (CNS), such as headache, dizziness, altered mental status, ataxia, and seizure, and of the peripheral nervous system (PNS), including ageusia, anosmia, acute illness demyelinating polyneuropathy, and neuralgia. Aim and objectives This study aims to observe and report the neurological manifestations in geriatric patients who were diagnosed with COVID-19 at KAMC-J and report the duration of admission to the in-patient and ICU wards. Methods This was a cross-sectional study conducted on admitted geriatric patients with PCR-confirmed COVID-19 from April 1, 2020 to June 30, 2021 at KAMC-J. Using Raosoft®, the sample size was estimated with a CI of 95% and a 36.4% prevalence of neurological symptoms in COVID-19 patients to be 289. Convenience sampling was used, and the data were collected from BESTCare EMRs. IBM SPSS Statistics for Windows, Version 20 (Released 2011) was used for descriptive and inferential statistical analysis. Results In this study, a total of 290 patients' data were collected, 161 (55.5%) of which were males. In addition, the median age was 71 (Q1-Q3: 65-78) years; furthermore, the median body mass index (BMI) was 30(Q1-Q3: 25-34) kg/m2. In descending order, the most prevalent comorbidities were hypertension (HTN) (70.3%), diabetes mellitus (DM) (68.6%), cardiac disease (42.1%), chronic kidney disease (26.6%), neurological disease (23.6%), cancer malignancy (13.1%), and finally chronic respiratory disease (11.4%). Regarding typical COVID-19 manifestations, 181 patients claimed to have experienced cough (62.4%), dyspnea by 164 (56.7%), fever by 154 (53.5%), fatigue by 93 (32.3%), a reading of anoxia by 68 (23.4%), abdominal pain by 58 (20.0%), diarrhea by 56 (19.4%), and finally throat pain by 19 (6.6%). Manifestations and pathologies of the CNS included headache (25.4%), dizziness (21.5%), impaired consciousness (17.2%), delirium (6.6%), ischemic stroke (4.1%), focal cranial nerve dysfunction (2.8%), seizure (2.8%), intracerebral hemorrhage (ICH) (0.3%), and ataxia (0.3%). Moreover, pathologies of the PNS manifested as taste impairment in 46 patients (15.9%), smell impairment in 33 (11.4%), nerve pain in 7 (24%), visual impairment in 5 (1.7%), Bell's palsy in 2 (0.7%), and Guillain-Barre syndrome in 1 (0.3%). Moreover, the majority of patients who developed an ischemic stroke or ICH, or required admission to the ICU had either DM or HTN. In addition, 17 (25.4%) of the 67 patients admitted to the ICU developed impaired consciousness. All-cause mortality in our study was 31 (10.71%) cases. Conclusion Neurological manifestations of COVID-19 are common and can result in serious complications if not detected and managed early, especially in the elderly. These complications are mostly seen in severely ill patients and may be the only symptoms in COVID-19 patients. In addition, patients' clinical conditions could deteriorate rapidly and result in significant morbidity and mortality. Therefore, a high index of suspicion is required among healthcare providers when dealing with such cases. Moreover, we recommend systematically collecting data on the short- and long-term neurological complications of COVID-19 globally and documenting the functional long-term outcomes after these complications.
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Objective The aim of this study was to assess the cognitive, emotional, social, and physical domains of quality of life (QoL) in pediatric patients with intractable epilepsy with an emphasis on depressed mood and suicidal ideation (SI). Methods This is a cross-sectional study conducted in pediatric neurology outpatient clinics in King Abdulaziz Medical City, Jeddah, Saudi Arabia. The sample consisted of 59 parents whose children aged 4-14 years of either sex had intractable epilepsy. The Quality of Life in Childhood Epilepsy Questionnaire - 55 (QOLCE-55) scale examined four domains of life: cognitive, emotional, social, and physical. Depressed mood and SI were part of the emotional domain. Results The mean ± SD age of children was 8.2 ± 3.25. The mean ± SD of overall QoL was 43.02 ± 15.70, which reflected a poor QoL. Age was not related to the QoL. Female gender was significantly associated with a lower overall QoL (P = 0.0477). Patients with comorbidities had statistically insignificant lower QoL in the cognitive, social, and physical domains in addition to lower overall QoL. Seven of nine participants who reported feeling down reported having SI in the last four weeks (P < 0.001). Conclusions An intractable epilepsy-imposed burden negatively impacts all domains of QoL. Furthermore, females experience lower overall QoL compared to males. Children with comorbidities also tend to have lower QoL scores, although the differences were statistically insignificant. Additionally, a history of feeling down is associated with SI.
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Hydrocephalus, which is caused by the accumulation of cerebrospinal fluid (CSF), is a common condition in children. It is known to be most likely treated by the insertion of a ventriculoperitoneal (VP) shunt. However, a VP shunt can lead to multiple complications. The upward migration of a VP shunt is considered rare. A newborn male baby with a known case of Chiari malformation type 2 associated with myelomeningocele (MMC) and hydrocephalus had a VP shunt inserted for control of the hydrocephalus. He presented two months after the surgery with occipital swelling at the surgical site. Shunt series followed by Computerized tomography (CT) scan showed that the distal end of the catheter had migrated upward and coiled around the valve. Urgent revision of the VP shunt was performed. Reabsorption of subgaleal fluid, increased abdominal pressure, repeated abdominal wall contraction, and repeated head motion of the child are the previously suggested theories of upward migration of distal catheter to the site of the valve. However, the combination of multiple theories can be the logical explanation, as they do not oppose each other.
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Background Urinary tract infection (UTI) is one of the most common clinical presentations that exhaust the patients and confuse physicians. Some of the risk factors that contribute to UTIs are age, female gender, and diabetes. Urinalysis is used to detect abnormalities in the urine, such as the presence of leukocytes, blood, and nitrite. However, urinalysis accuracy depends on the patient and the analyzer. On the other hand, urine culture is considered gold standard for diagnosing UTI. For that, the aim of this study is to determine the sensitivity of white blood cells (WBC) and nitrite in dipstick urinalysis in detecting UTI. Methods A cross-sectional study was conducted at King Abdulaziz Medical City on adult patients aged 19-65 years who underwent dipstick urinalysis and culture at the same visit from October 2016 to October 2019. The data were collected from the medical records from all the departments by using a data collection sheet through Best Care system. The sample was selected conveniently, and it was determined to be 359 patients with a confidence interval of 95%. Data were analyzed using IBM SPSS version 20 (IBM Corp., Armonk, NY, USA). Chi-square test was used to analyze the association between the outcome and the results of the dipstick urinalysis and urine culture. P-value lower than 0.05 was considered significant. Results Three hundred and fifty-nine patients were included into the study with a majority of females (81.1%) with a mean age of 47.5 years. Two hundred and fifty-two patients were culture positive, WBC sensitivity and specificity were 62.7% and 100%, and nitrite sensitivity and specificity were 20.6% and 93.5%, respectively. Ninety-nine diabetic patients were culture positive; for diabetic patients, WBC sensitivity and specificity were 65.7% and 100% and nitrite sensitivity and specificity were 18.2% and 97.6%, respectively, while for non-diabetic patients, WBC sensitivity and specificity were 60.85% and 100% and nitrite sensitivity and specificity were 22.2% and 90.8%, respectively. Conclusion Our study showed that results of WBC are more sensitive and specific than those of nitrite in comparison to the gold standard (urine culture). Diabetics and non-diabetics have slightly different results. According to our results it is difficult to depend on the dipstick urinalysis without culture. More studies are recommended in this field.
