COVID-19 severity impacts on long-term neurological manifestation after hospitalisation

ABSTRACTBackgroundPreclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection and for long term sequalae including neurological manifestationsMethodsa sample of 208 previously hospitalized COVID-19 patients, 165 patients were re-assessed at 6 months according to a structured standardized clinical protocol. Premorbid comorbidities and clinical status, severity of COVID-19 disease, complications during and after hospitalization were recorded.ResultsAt 6-month follow-up after hospitalisation due to COVID-19 disease, patients displayed a wide array of neurological symptoms, being fatigue (34%), memory/attention (31%), and sleep disorders (30%) the most frequent. Subjects reporting neurological symptoms were affected by more severe respiratory SARS-CoV-2 infection parameters during hospitalisation. At neurological examination, 37.4% of patients exhibited neurological abnormalities, being cognitive deficits (17.5%), hyposmia (15.7%) and postural tremor (13.8%) the most common. Patients with cognitive deficits at follow-up were comparable for age, sex and pre-admission comorbidities but experienced worse respiratory SARS-CoV-2 infection disease and longer hospitalisation.Conclusionslong term neurological manifestations after hospitalization due to COVID-19 infection affects one third of survivors. Multiple neurological abnormalities including mild cognitive impairment are associated with severity of respiratory SARS-CoV-2 infection.

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Long-term neurological manifestations of COVID-19: prevalence and predictive factors

Neurological Sciences ◽

10.1007/s10072-021-05586-4 ◽

2021 ◽

Author(s):

Andrea Pilotto ◽

Viviana Cristillo ◽

Stefano Cotti Piccinelli ◽

Nicola Zoppi ◽

Giulio Bonzi ◽

...

Keyword(s):

Logistic Regression ◽

Cognitive Deficits ◽

Neurological Manifestations ◽

Regression Analyses ◽

Multivariate Logistic Regression ◽

Sensory Deficits ◽

Clinical Investigations ◽

Neurological Patients

Abstract Background Clinical investigations have argued for long-term neurological manifestations in both hospitalised and non-hospitalised COVID-19 patients. It is unclear whether long-term neurological symptoms and features depend on COVID-19 severity. Methods From a sample of 208 consecutive non-neurological patients hospitalised for COVID-19 disease, 165 survivors were re-assessed at 6 months according to a structured standardised clinical protocol. Prevalence and predictors of long-term neurological manifestations were evaluated using multivariate logistic regression analyses. Results At 6-month follow-up after hospitalisation due to COVID-19 disease, patients displayed a wide array of symptoms; fatigue (34%), memory/attention (31%) and sleep disorders (30%) were the most frequent. At neurological examination, 40% of patients exhibited neurological abnormalities, such as hyposmia (18.0%), cognitive deficits (17.5%), postural tremor (13.8%) and subtle motor/sensory deficits (7.6%). Older age, premorbid comorbidities and severity of COVID-19 were independent predictors of neurological manifestations in logistic regression analyses. Conclusions Premorbid vulnerability and severity of SARS-CoV-2 infection impact on prevalence and severity of long-term neurological manifestations.

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COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort

Respiratory Research ◽

10.1186/s12931-021-01633-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Myriam Calle Rubio ◽

◽

Juan Luis Rodriguez Hermosa ◽

Juan P. de Torres ◽

José María Marín ◽

...

Keyword(s):

Triple Therapy ◽

Clinical Status ◽

Airflow Limitation ◽

Psychological Status ◽

Prognostic Information ◽

Clinical Control ◽

All Cause Mortality ◽

Long Term Follow Up

Abstract Background Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences. Methods We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis. Results 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5.5% versus 19.1%, p = 0.001). The hazard ratio for all-cause mortality was 2.274 (95% CI 1.394–3.708; p = 0.001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72.2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern. Conclusions The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results. Trial registration: Clinical Trials.gov: identifier NCT01122758.

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Neurological and clinical status from early time point to long-term follow-up after in-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2021.01.011 ◽

2021 ◽

Author(s):

Sang-Beom Jeon ◽

Hyunjo Lee ◽

Bobin Park ◽

Soh Hyun Choi ◽

Yoon-Hee Hong ◽

...

Keyword(s):

Cardiac Arrest ◽

Clinical Status ◽

Early Time ◽

Early Time Point ◽

Long Term Follow Up ◽

Hospital Cardiac Arrest ◽

Time Point

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Atypical Manifestation of Polyneuropathy in Covid-19

10.5327/1516-3180.312 ◽

2021 ◽

Author(s):

Nayara de Lima Froio ◽

Ana Luisa Rosas Sarmento ◽

Sonia Maria Cesar de Azevedo Silva ◽

Lilia Azzi Collet da Rocha Camargo

Keyword(s):

Case Report ◽

Physical Therapy ◽

Sore Throat ◽

Neurological Symptoms ◽

Lower Limbs ◽

Neurological Manifestations ◽

Sensory Motor ◽

Hands And Feet ◽

Atypical Manifestation

Context: Neurological manifestations of Sars-CoV-2 are progressively emerging. Cases of Guillain-Barré syndrome and its variants, with onset about 5-10 days after influenza symptoms, have been described. This paper reports a case of polyneuropathy with onset 90 days after a sore throat episode and persistence of IgM positivity in serology for Sars- Cov-2. We aim to raise awareness of this possibility. Case Report: A 56-year-old male, hypertensive, presented with sore throat on April 21, 2020. Serology for Covid-19 was performed with positive IgM. There was complete improvement of the symptom. At the end of July, he started a symmetrical paresthesia in the feet with ascension to the knees and, on August 20, paresthesia in the hands too. So, he went to IAMSPE (SP) and tactile and painful hypoesthesia in hands and feet, hypopalesthesia in lower limbs, a fall in the lower limbs upon Mingazzini’s maneuver, global hyporeflexia and talon gait were found. Just the following tests were changed: second Covid-19 serology IgM and IgG positives; ENMG: sensory motor polyneuropathy, primarily axonal, with signs of chronicity and without signs of acute denervation in the current. Started gabapentin and physical therapy. Patient still has paresthesia in hands and feet, but with partial improvement. Conclusion: This case alerts to neurological symptoms of Covid-19 in the medium and long term.

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Argentine Registry of neurological manifestations due to coronavirus-19 (COVID-19)

10.1101/2021.03.19.21253558 ◽

2021 ◽

Author(s):

Mariana Bendersky ◽

Lucas Alessandro ◽

Franco Appiani ◽

Brenda Borrego Guerrero ◽

Patricia Cairola ◽

...

Keyword(s):

Demographic Variables ◽

Neurological Symptoms ◽

Neurological Manifestations ◽

Cns Involvement ◽

Term Care ◽

Cerebrovascular Complications ◽

Guillain Barré ◽

Neurological Pathology ◽

Degree Of Severity

COVID-19 disease has spread around the world since December 2019. Neurological symptoms are part of its clinical spectrum. Objective: To know the neurological manifestations in patients infected by COVID-19 in Argentina. Methods: Multicenter study conducted in adults, from May 2020 to January 2021, with confirmed COVID-19 and neurological symptoms. Demographic variables, existence of systemic or neurological comorbidities, the form of onset of the infection, alteration in complementary studies and the degree of severity of neurological symptoms were recorded. Results: 817 patients from all over the country were included, 52% male, mean age 38 years, most of them without comorbidities or previous neurological pathology. The first symptom of the infection was neurological in 56.2% of the cases, predominantly headache (69%), then anosmia / ageusia (66%). Myalgias (52%), allodynia / hyperalgesia (18%), and asthenia (6%) were also reported. 3.2% showed diffuse CNS involvement such as encephalopathy or seizures. 1.7% had cerebrovascular complications. Sleep disorders were observed in 3.2%. 6 patients were reported with Guillain Barre (GBS), peripheral neuropathy (3.4%), tongue paresthesia (0.6%), hearing loss (0.4%), plexopathy (0.3%). The severity of neurological symptoms was correlated with age and the existence of comorbidities. Conclusions: Our results, similar to those of other countries, show two types of neurological symptoms associated with COVID-19: some potentially disabling or fatal such as GBS or encephalitis, and others less devastating, but more frequent such as headache or anosmia that demand increasingly long-term care.

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Help-Seeking in Depressed Out-patients Following Maintenance Therapy

The British Journal of Psychiatry ◽

10.1192/bjp.129.3.252 ◽

1976 ◽

Vol 129 (3) ◽

pp. 252-260 ◽

Cited By ~ 7

Author(s):

Myrna M. Weissman ◽

Stanislav V. Kasl

Keyword(s):

Maintenance Therapy ◽

Help Seeking ◽

Maintenance Treatment ◽

Suicide Attempts ◽

Clinical Status ◽

Subsequent Treatment ◽

Access To Treatment ◽

One Year

SummaryThis paper reports on the clinical status, help-seeking and subsequent treatment experiences of 150 women one year after they had completed out-patient maintenance treatment by amitriptyline and/or psychotherapy for a depressive episode.While the majority of patients were asymptomatic at follow-up, a substantial minority had a return of acute symptoms and 2 per cent made minor suicide attempts during the year. Admission to hospital was rare. However, only 30 per cent of the patients did not seek any treatment during the year and the majority received some psychotropic medication.The findings support the long-term need for prompt access to treatment by patients who have recovered from an acute depression.

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Long-term follow-up of neurological manifestations in a boy with incontinentia pigmenti

European Journal of Pediatrics ◽

10.1007/s00431-013-2021-8 ◽

2013 ◽

Vol 172 (9) ◽

pp. 1259-1262 ◽

Cited By ~ 5

Author(s):

Lucia Margari ◽

Anna Linda Lamanna ◽

Maura Buttiglione ◽

Francesco Craig ◽

Maria G. Petruzzelli ◽

...

Keyword(s):

Incontinentia Pigmenti ◽

Neurological Manifestations ◽

Long Term Follow Up

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Pathophysiological Mechanisms in Gaseous Therapies for Severe Malaria

Infection and Immunity ◽

10.1128/iai.01404-15 ◽

2016 ◽

Vol 84 (4) ◽

pp. 874-882 ◽

Cited By ~ 2

Author(s):

Ana Carolina A. V. Kayano ◽

João Conrado K. Dos-Santos ◽

Marcele F. Bastos ◽

Leonardo J. Carvalho ◽

Júlio Aliberti ◽

...

Keyword(s):

Severe Malaria ◽

Cognitive Deficits ◽

Clinical Status ◽

Neurological Complications ◽

Adjunctive Treatment ◽

Pathophysiological Mechanisms ◽

Endothelium Dysfunction ◽

Clinical Complications ◽

Cerebrovascular Dysfunction

Over 200 million people worldwide suffer from malaria every year, a disease that causes 584,000 deaths annually. In recent years, significant improvements have been achieved on the treatment of severe malaria, with intravenous artesunate proving superior to quinine. However, mortality remains high, at 8% in children and 15% in adults in clinical trials, and even worse in the case of cerebral malaria (18% and 30%, respectively). Moreover, some individuals who do not succumb to severe malaria present long-term cognitive deficits. These observations indicate that strategies focused only on parasite killing fail to prevent neurological complications and deaths associated with severe malaria, possibly because clinical complications are associated in part with a cerebrovascular dysfunction. Consequently, different adjunctive therapies aimed at modulating malaria pathophysiological processes are currently being tested. However, none of these therapies has shown unequivocal evidence in improving patient clinical status. Recently, key studies have shown that gaseous therapies based mainly on nitric oxide (NO), carbon monoxide (CO), and hyperbaric (pressurized) oxygen (HBO) alter vascular endothelium dysfunction and modulate the host immune response to infection. Considering gaseous administration as a promising adjunctive treatment against severe malaria cases, we review here the pathophysiological mechanisms and the immunological aspects of such therapies.

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