scholarly journals Multinational characterization of neurological phenotypes in patients hospitalized with COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Trang T. Le ◽  
Alba Gutiérrez-Sacristán ◽  
Jiyeon Son ◽  
Chuan Hong ◽  
Andrew M. South ◽  
...  
Keyword(s):  
Severe Disease ◽  
Neurological Complications ◽  
Cerebrovascular Diseases ◽  
Hospitalized Patients ◽  
Disorders Of Consciousness ◽  
Polymerase Chain Reaction Test ◽  
Cross Sectional ◽  
Before And After ◽  
Neurological Conditions ◽  
Chain Reaction Test

AbstractNeurological complications worsen outcomes in COVID-19. To define the prevalence of neurological conditions among hospitalized patients with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test in geographically diverse multinational populations during early pandemic, we used electronic health records (EHR) from 338 participating hospitals across 6 countries and 3 continents (January–September 2020) for a cross-sectional analysis. We assessed the frequency of International Classification of Disease code of neurological conditions by countries, healthcare systems, time before and after admission for COVID-19 and COVID-19 severity. Among 35,177 hospitalized patients with SARS-CoV-2 infection, there was an increase in the proportion with disorders of consciousness (5.8%, 95% confidence interval [CI] 3.7–7.8%, pFDR < 0.001) and unspecified disorders of the brain (8.1%, 5.7–10.5%, pFDR < 0.001) when compared to the pre-admission proportion. During hospitalization, the relative risk of disorders of consciousness (22%, 19–25%), cerebrovascular diseases (24%, 13–35%), nontraumatic intracranial hemorrhage (34%, 20–50%), encephalitis and/or myelitis (37%, 17–60%) and myopathy (72%, 67–77%) were higher for patients with severe COVID-19 when compared to those who never experienced severe COVID-19. Leveraging a multinational network to capture standardized EHR data, we highlighted the increased prevalence of central and peripheral neurological phenotypes in patients hospitalized with COVID-19, particularly among those with severe disease.

scholarly journals Multinational Prevalence of Neurological Phenotypes in Patients Hospitalized with COVID-19

2021 ◽  
Author(s):  
Trang T. Le ◽  
Alba Gutiérrez-Sacristán ◽  
Jiyeon Son ◽  
Chuan Hong ◽  
Andrew M. South ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Severe Disease ◽  
Neurological Complications ◽  
Cross Sectional Study ◽  
Cerebrovascular Diseases ◽  
Disorders Of Consciousness ◽  
Polymerase Chain Reaction Test ◽  
Disease Category ◽  
Cross Sectional ◽  
Wide Range

AbstractOBJECTIVENeurological complications can worsen outcomes in COVID-19. We defined the prevalence of a wide range of neurological conditions among patients hospitalized with COVID-19 in geographically diverse multinational populations.METHODSUsing electronic health record (EHR) data from 348 participating hospitals across 6 countries and 3 continents between January and September 2020, we performed a cross-sectional study of hospitalized adult and pediatric patients with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test, both with and without severe COVID-19. We assessed the frequency of each disease category and 3-character International Classification of Disease (ICD) code of neurological diseases by countries, sites, time before and after admission for COVID-19, and COVID-19 severity.RESULTSAmong the 35,177 hospitalized patients with SARS-CoV-2 infection, there was increased prevalence of disorders of consciousness (5.8%, 95% confidence interval [CI]: 3.7%-7.8%, pFDR<.001) and unspecified disorders of the brain (8.1%, 95%CI: 5.7%-10.5%, pFDR<.001), compared to pre-admission prevalence. During hospitalization, patients who experienced severe COVID-19 status had 22% (95%CI: 19%-25%) increase in the relative risk (RR) of disorders of consciousness, 24% (95%CI: 13%-35%) increase in other cerebrovascular diseases, 34% (95%CI: 20%-50%) increase in nontraumatic intracranial hemorrhage, 37% (95%CI: 17%-60%) increase in encephalitis and/or myelitis, and 72% (95%CI: 67%-77%) increase in myopathy compared to those who never experienced severe disease.INTERPRETATIONUsing an international network and common EHR data elements, we highlight an increase in the prevalence of central and peripheral neurological phenotypes in patients hospitalized with SARS-CoV-2 infection, particularly among those with severe disease.

scholarly journals Use of Public Transport and Contraction of SARS-CoV-2 in a Large Prospective Cohort in Norway.

2021 ◽  
Author(s):  
Merete Ellingjord-Dale ◽  
Karl Trygve Kalleberg ◽  
Mette Istre ◽  
Anders B. Nygaard ◽  
Sonja H. Brunvoll ◽  
...  
Keyword(s):  
Public Transport ◽  
Public Transportation ◽  
Polymerase Chain Reaction Test ◽  
Calendar Time ◽  
Frequency Of Use ◽  
Before And After ◽  
Polymerase Chain ◽  
Chain Reaction Test ◽  
Incident Cases

Abstract Background: For many people public transport is the only mode of travel, and it can be challenging to keep the necessary distances in such a restricted space. The exact role of public transportation and risk of SARS-CoV-2 transmission is not known. Methods: Participants (n=121 374) were untested adult Norwegian residents recruited through social media who in the spring of 2020 completed a baseline questionnaire on demographics and use of public transport. Incident cases (n=1069) had a positive SARS-CoV-2 polymerase chain reaction test registered at the Norwegian Messaging System for Infectious Diseases by January 27, 2021. We investigated the association between use of public transport and SARS-CoV-2 using logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for age, calendar time, gender, municipality, smoking, income level, fitness and underlying medical conditions were estimated. Frequency of use of public transport was reported for 2 week-periods. Results: Before lockdown, those who tested positive on SARS-CoV-2 were more likely to have used public transport 1-3 times (OR =1.28, CI 1.09-1.51), 4-10 times (OR=1.49, CI 1.26-1.77) and ≥11 times (OR=1.50, CI 1.27-1.78, p for trend<0.0001) than those who had not tested positive. Conclusion: Use of public transport was positively associated with contracting SARS-CoV-2 both before and after lockdown.

scholarly journals Effects of Aging Torque Controllers on Screw Tightening Force and Bacterial Micro-Leakage on the Implant-Abutment Complex

Materials ◽  
2022 ◽  
Vol 15 (2) ◽  
pp. 620
Author(s):  
Yousef Jiries ◽  
Tamar Brosh ◽  
Shlomo Matalon ◽  
Vladimir Perlis ◽  
Zeev Ormianer
Keyword(s):  
Polymerase Chain Reaction Test ◽  
Tightening Force ◽  
Reduction In Force ◽  
Implant Abutment ◽  
Before And After ◽  
Spring Type ◽  
Polymerase Chain ◽  
Bacterial Leakage ◽  
Effects Of Aging ◽  
Chain Reaction Test

Aim: We assess the accuracy of torque controllers after several aging processes and the bacterial leakage on Implant-Abutment complexes (IAC).Methods: A total of 12 spring-type and 12 friction-type torque controllers and 48 IAC (24 conical and 24 hexagonal connections) were evaluated. Chemical, mechanical, temperature, and pressure-aging methods were applied individually to replicate clinical use. Torque controller accuracy was analyzed before and after aging using a calibrated gauge. To assess bacterial leakage, the IAC were suspended in a bacterial medium for 24 h. Direct Contact Test (DCT) and Polymerase Chain Reaction Test (RT-PCR) analyzed the infiltration of F. nucleatum and P. gingivalis into the IAC micro-gap. Results: A significant decrease in torque after 10 days of aging was found. The spring-type torque controller was affected the most, regardless of the aging method (P < 0.05). PCR results indicated that all groups exhibited significantly more bacterial leakage, regardless of the method used (P < 0.05). The conical IAC demonstrated more bacterial leakage of P. gingivalis compared with the hexagonal IAC (P = 0.07). DCT found bacterial growth in the IAC only before aging and was not identified after aging. Conclusion: Aging affects torque accuracy. A reduction in force was noticed after 10 days. The conical IAC exhibits more bacterial leakage, although this was not statistically significant.

scholarly journals Epileptic seizures in patients with COVID-19: A systematic review of early evidences

2021 ◽  
Vol 8 (1) ◽  
pp. 33-44
Author(s):  
B Roy ◽  
I Banerjee
Keyword(s):  
Systematic Review ◽  
Epileptic Seizure ◽  
Case Reports ◽  
Neurological Complication ◽  
Epileptic Seizures ◽  
Neurological Complications ◽  
Cross Sectional Study ◽  
Cerebrovascular Diseases ◽  
Cross Sectional ◽  
Demyelinating Lesions

Background: Global emergence of SARS-CoV-2 surfaced neurological complications amongst the patients. COVID-19 resembles with other coronavirus strains follows a trend of neurological complication, damage and encephalopathy, which entails considerable risks, requires attention for the neurologists. This is, to our knowledge, the first systematic review of the literature to investigate solely to elucidate the seizure spectrum by unfolding epileptogenicity of the SARS CoV-2 and potential pathways of neuroinvasion. Methods: A systematic literature search was performed in PubMed and Embase database following standard guidelines, using specific keywords based on epileptic seizure onset described from December 01, 2019, to July 17, 2020 Results: A total of 17 studies were included ranging from case reports, series of cases, multicentre cross-sectional study with the first-time onset of seizure associated with an epileptic origin. We excavated causes of complex COVID-19 related neurological manifestations, e.g., cerebrovascular diseases, encephalitis, demyelinating lesions, cytokine storm and proposed routes of SARS-CoV-2 entry into the nervous system to understand the mechanism of an epileptic seizure. Conclusion: COVID-19 is a potent neuropathogen which causes the new onset of epileptic seizures should get diagnostic recognition to evade possible deterioration of neurological conditions. However, more shreds of evidence from the future will further elucidate the epileptogenic potential of the pandemic.

scholarly journals Median Nerve Neuritis after Infection by the SARS-CoV-2 Virus

2021 ◽  
Vol 6 (1) ◽  
pp. 1-4
Author(s):  
Marcelo de Pinho Teixeira Alves ◽  
João Pedro Gouveia Nóbrega
Keyword(s):  
Median Nerve ◽  
Metabolic Diseases ◽  
Severe Disease ◽  
Neurological Complications ◽  
Neurological Manifestations ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
First Case ◽  
Asymptomatic Patients ◽  
The Right

Background: The spectrum of neurological complications from SARS-CoV-2 infection is under constant investigation. According to numerous publications, occurrence of neurological complications can be about 36.4%. There are no reports to date of the occurrence of bilateral median nerve neuritis in the wrist after SARS-CoV-2 infection. Case: A previously healthy 24 years old female was observed in March 2021 due to dysesthesias in both hands, associated with nocturnal discomfort and decreased grip strength. The symptoms started a month earlier with acroparesthesias. SARS-CoV-2 virus infection was in January 2021 and evolved favorably, with progressive remission in about 10 days. Prior to the infection she didn’t have any of the hand symptoms; denied diabetes or metabolic diseases. Negative tests for SARS-CoV-2 infection since February. April 2021, the patient returned with persistent dysesthesias in her hands. Normal EMG, however with Sensitive Conduction Speed (SCS) of 50 m/sec on the right wrist; on the left SCS 55 m/sec. Sensitive latency 2.8 on the right and 2.6 on the left. Amplitude 17 on the right and 24 on the left. MRI detected an increase in signal in PDFS sequences in both median nerves, in the carpal tunnel, with no detected variations in cross-sectional areas or masses. The treatment was a 30 days 150 mg benfotiamine in two daily doses. Discussion: There is a wide variation in the clinical presentation of SARS-CoV-2 infection, ranging from asymptomatic patients to death. Most frequent symptoms are fever, dry cough, sore throat, dyspnea, myalgia, fatigue, chills, diarrhea, chest pain and vomiting, and the most common complications pneumonia and acute respiratory distress syndrome. Neurological manifestations of viral infection can occur in about 36.4% and in 45.5% in severe disease. They include Guillán-Barré and Miller Fischer syndrome; however, these conditions usually occur in more severe cases of the disease, but this patient hadn’t the typical picture of ataxia, ophthalmoplegia and areflexia. Benfotiamine is a synthetic derivative of thiamine with a multifaceted therapeutic profile, with a therapeutic role especially in diabetic neuropathy. Conclusion: Knowledge and recognition of neurological manifestations of SARS-CoV-2 infection and early detection of secondary peripheral neuropathies result in improvement of patients' clinical results and development of ideal ways of treatment. Although only a small percentage of patients develop peripheral neuropathy, in a pandemic this can result in a major social and health impact. The reported case is the first case of bilateral secondary median nerve neuritis in the literature. Level of evidence 4.

scholarly journals Investigation on Intervention Effects of Applying Proton Pump Inhibitors in Inpatients

2019 ◽  
Author(s):  
Guotong Qing ◽  
Jian Wu ◽  
Runfong Wei ◽  
Di Wu ◽  
Yipping Gou ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Age Distribution ◽  
Information Management System ◽  
Hospitalized Patients ◽  
Utilization Rate ◽  
Coincidence Rate ◽  
Cross Sectional ◽  
Clinical Pharmacists ◽  
Before And After

Abstract Background. To investigate the intervention effect of clinical pharmacists on irrational use of proton pump inhibitors (PPIs) in clinicians. Methods. A cross-sectional study was used to through the hospital information management system survey, before intervention (July 15th, 2016, Aug 15th, 2016 and Sep 15th 2016) and dry prognosis (July 15th, 2017, Aug 15th, 2017 and Sep 15th, 2017) all the use of PPIs inpatients related information. According to the guidelines of "drug instructions" and "experts on stress ulcer prevention and treatment experts", the standard of drug use was formulated, and the use of PPIs before and after intervention was evaluated and analyzed in accordance with the standard, and the results of intervention were evaluated. Results. The total number of hospitalized patients surveyed before the intervention was 1,693, the average utilization rate of proton pump inhibitors was 27.05% and the coincidence rate was 52.40%. The total number of hospitalized patients investigated after the intervention was 2,095, the average utilization rate of proton pump inhibitors was 8.54%, and the coincidence rate was 68.16%. Before and after the intervention, there was no difference in gender ratio and age distribution, the decrease of the utilization rate and the improvements of the qualified rate after intervention were statistically significant.Conclusion. According to the standards of PPIs, clinical pharmacists strictly implement the special prescription review system and other intervention measures, which can significantly improve the level of PPIs rational clinical medication.

scholarly journals 82. Multisystem Inflammatory Syndrome in Children and non-sars-cov-2 Infections: A Retrospective Cross-sectional Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S173-S173
Author(s):  
Jeffrey Campbell ◽  
Jordan E Roberts ◽  
Melanie Dubois ◽  
Caitlin Li ◽  
Thomas Sandora ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Evaluation Research ◽  
Cross Sectional Study ◽  
Case Definition ◽  
Polymerase Chain Reaction Test ◽  
Parasitic Infections ◽  
Cross Sectional ◽  
Positive Polymerase Chain Reaction ◽  
Chain Reaction Test ◽  
Inflammatory Syndrome

Abstract Background Multisystem inflammatory syndrome in children (MIS-C) has been described in areas with high Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) burden. Clinical features included in the MIS-C case definition (e.g fever, elevated inflammatory markers) overlap with features of other childhood infections. The prevalence of non-SARS-CoV-2 infection in patients evaluated for MIS-C has not been described. Patients evaluated for MIS-C, and therapies administered. Methods Retrospective cohort study of patients &lt; 21 years of age admitted to a freestanding children’s hospital in Boston, MA from May 14-June 6, 2020 who were evaluated for MIS-C. We identified patients undergoing Rheumatology consultation and echocardiogram (per the hospital’s protocol for evaluating children with suspicion for MIS-C). We tabulated patients evaluated for MIS-C found to have non-SARS-CoV-2 infection detected on standard microbiologic testing. Results 39 patients met inclusion criteria. Median age was 5 years (IQR 2–12 years). Of evaluated patients, 19/39 (49%) were diagnosed with MIS-C according to the Massachusetts Department of Public Health case definition; 10/39 (26%) required ICU admission. Non-SARS-CoV-2 infections were identified in 7/39 (18%), of whom 5/7 (71%) had bacterial infections, 1/7 (14%) had viral infection, and 1/7 (14%) had viral and bacterial co-infections; no fungal or parasitic infections were identified. Of patients diagnosed with MIS-C, 2/19 (11%) were found to have non-SARS-CoV-2 infection. Additionally, 5/19 (26%) had a positive polymerase chain reaction test for SARS-CoV-2 at time of MIS-C diagnosis, of whom 4/5 (80%) received remdesivir. Of patients evaluated for MIS-C, 17/39 (44%) received intravenous immune globulin, 14/39 (36%) aspirin, 4/39 (10%) anakinra, and 14/39 (36%) methylprednisolone. Additionally, 21/39 (54%) received antibacterial and 5/39 (13%) antiviral therapy (Table). Conclusion In this study, non-SARS-CoV-2 infections were diagnosed in 18% of children evaluated for MIS-C. Clinicians should consider alternative or concomitant infectious diagnoses in patients undergoing MIS-C evaluation. Research is needed to identify clinical and laboratory features that may distinguish patients with MIS-C from those with non-SARS-CoV-2 infection. Disclosures All Authors: No reported disclosures

scholarly journals Vitamin A Plasma Levels in COVID-19 Patients: A Prospective Multicenter Study and Hypothesis

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2173
Author(s):  
Phil-Robin Tepasse ◽  
Richard Vollenberg ◽  
Manfred Fobker ◽  
Iyad Kabar ◽  
Hartmut Schmidt ◽  
...  
Keyword(s):  
Vitamin A ◽  
Plasma Levels ◽  
High Performance ◽  
Acute Inflammation ◽  
Severe Disease ◽  
Hospitalized Patients ◽  
Control Group ◽  
Immune Functions ◽  
Oxygen Supplementation ◽  
Cross Sectional

COVID-19 is a pandemic disease that causes severe pulmonary damage and hyperinflammation. Vitamin A is a crucial factor in the development of immune functions and is known to be reduced in cases of acute inflammation. This prospective, multicenter observational cross-sectional study analyzed vitamin A plasma levels in SARS-CoV-2 infected individuals, and 40 hospitalized patients were included. Of these, 22 developed critical disease (Acute Respiratory Distress Syndrome [ARDS]/Extracorporeal membrane oxygenation [ECMO]), 9 developed severe disease (oxygen supplementation), and 9 developed moderate disease (no oxygen supplementation). A total of 47 age-matched convalescent persons that had been earlier infected with SARS-CoV-2 were included as the control group. Vitamin A plasma levels were determined by high-performance liquid chromatography. Reduced vitamin A plasma levels correlated significantly with increased levels of inflammatory markers (CRP, ferritin) and with markers of acute SARS-CoV-2 infection (reduced lymphocyte count, LDH). Vitamin A levels were significantly lower in hospitalized patients than in convalescent persons (p < 0.01). Of the hospitalized patients, those who were critically ill showed significantly lower vitamin A levels than those who were moderately ill (p < 0.05). Vitamin A plasma levels below 0.2 mg/L were significantly associated with the development of ARDS (OR = 5.54 [1.01–30.26]; p = 0.048) and mortality (OR 5.21 [1.06–25.5], p = 0.042). Taken together, we conclude that vitamin A plasma levels in COVID-19 patients are reduced during acute inflammation and that severely reduced plasma levels of vitamin A are significantly associated with ARDS and mortality.

scholarly journals Persistent Positivity of Reverse Transcriptase-Polymerase Chain Reaction Test among Patients with COVID-19 in Rural Teaching Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (243) ◽  
pp. 1136-1140
Author(s):  
Narayani Maharjan ◽  
Niresh Thapa ◽  
Bibek Pun Magar ◽  
Muna Maharjan ◽  
Jiancheng Tu
Keyword(s):  
Polymerase Chain Reaction ◽  
Reverse Transcriptase ◽  
Teaching Hospital ◽  
Cross Sectional Study ◽  
Polymerase Chain Reaction Test ◽  
Chain Reaction ◽  
Cross Sectional ◽  
Reaction Test ◽  
Polymerase Chain ◽  
Chain Reaction Test

Introduction: The persistence positivity detected for severe acute respiratory syndrome coronavirus 2 ribonucleic acid by real-time reverse transcriptase-polymerase chain reaction test in asymptomatic coronavirus disease 2019 positive patients has attracted a lot of attention. There is limited data on the duration of viral shedding. We aimed to determine the proportion of coronavirus disease patients with persistent positivity of real-time reverse transcriptase-polymerase chain reaction test in a teaching hospital of Nepal. Methods: A descriptive cross-sectional study was conducted using medical records from May to September 2020 in a teaching hospital of Nepal. The study was approved by the Institutional Review Committee of Karnali Academy of Health Sciences (Reference no 077/078/03). Convenient sampling method was used. Data was analysed by Statistical Package for the Social Sciences. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Of the total 95 cases, 9 (9.5%) cases (4.6-14.4 at 90% Confidence Interval), were repeat positive after achieving the first negative. The mean day required of achieving the last negative for the repeat positive group was 62.11±3.95, range (60-70 days). The mean time duration for the virus shedding was found to be 20.43±12.19 days (range 7-60 days) after the first positive test result. Conclusions: This study concludes that there might be a persistent positivity of the polymerase chain reaction test among patients with COVID-19. The majority of the patients were test positive for 8-14 days, and some were positive till 60-70 days.

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