Increased Prevalence of Neuropsychiatric Disorders during COVID-19 Pandemic in People Needing a Non-Deferrable Neurological Evaluation

Background: The novel coronavirus disease of 2019 (COVID-19) outbreak provoked a profound healthcare system reorganization. This study aimed to compare the reasons for requesting a non-deferrable neurological evaluation before the COVID-19 pandemic and during the lockdown. Methods: Retrospective observational study including non-deferrable neurological outpatients before the pandemic (pre-COVID-19 group, n = 223) and during the Italian second wave of the COVID-19 pandemic (LOCKDOWN group, n = 318). Results: The number of patients sent for cerebrovascular disorders, headache, and vertigo significantly dropped between the pre-COVID-19 era and the lockdown period. While in the pre-COVID-19 group, the most frequent diagnosis was cerebrovascular disorder; neuropsychiatric disorders ranked first in the LOCKDOWN group. Moreover, the percentage of appropriate non-deferrable neurological evaluations significantly increased in the LOCKDOWN group compared with the pre-COVID-19 group. Discussion: Our study shows a significant increase of neuropsychiatric disorders in non-deferrable neurologic evaluations during the Italian second wave of the COVID-19. Overall, cases were more severe and required a more complex management during the lockdown compared with the pre-COVID era. These findings confirm that a careful approach to prevent the psychological consequences of the pandemic is needed, and long-term rearrangements of the healthcare system are desirable to guarantee appropriate management.

Magnetic Resonance Image Feature Analysis under Deep Learning in Diagnosis of Neurological Rehabilitation in Patients with Cerebrovascular Diseases

To explore the impact of magnetic resonance imaging (MRI) image features based on deep learning algorithms on the neurological rehabilitation of patients with cerebrovascular diseases, eighty patients with acute cerebrovascular disease were selected as the research objects. According to whether the patients were with vascular cognitive impairment (VCI), they were divided into VCI group (34 cases) and non-VCI group (46 cases). In addition, based on the convolutional neural network (CNN), a new multimodal CNN image segmentation algorithm was proposed. The algorithm was applied to the segmentation of MRI images of patients with vascular cognitive impairment (VCI) and compared with the segmentation results of CNN and fully CNN (FCN). As a result, the segmentation results of the three different algorithms showed that the Dice coefficient, accuracy, and recall of the multimodal CNN algorithm were 0.78 ± 0.24, 0.81 ± 0.28, and 0.88 ± 0.32, respectively, which were significantly increased compared to those of other two algorithms ( P < 0.05). The neurological evaluation results showed that the MMSE and MoCA scores of VCI patients were 15.4 and 14.6 ± 5.31, respectively, which were significantly lower than those of the non-VCI group ( P < 0.05). The TMT-a and TMT-b scores of VCI patients were 221.7 and 385.9, respectively, which were significantly higher than those of the non-VCI group ( P < 0.05). The FA and MD values of nerve function-related fibers shown in the MRI images of the VCI group were significantly different from those of the non-VCI group ( P < 0.05). Therefore, the neurological recovery process of VCI patients was affected by multiple neurocognitive-related fiber structures. To sum up, the multimodal CNN algorithm can sensitively and accurately reflect the degree of neurological impairment in patients with cerebrovascular disease and can be applied to disease diagnosis and neurological evaluation of VCI patients.

Understand My Language, to Understand My Pain: Challenges of Neurological Evaluation Among Refugees

The increasing number of migrants and refugees entering Albania during the last decade has been a challenge to the medical service of the country. Many of the migrants arrive from remote areas of Middle East or other Asian regions, heading toward northern Europe, deprived from medical assistance during their tormenting journey. An exacerbation of previous medical conditions is expected and is related to the hardship of traveling conditions. The medical professionals working in migration medicine have little, if any, training on the field and need to familiarize themselves with a variety of previously unknown conditions. Empathy, necessary on an individual basis, may not be sufficient in itself; the burden of medically treating migrants needs a holistic and multidisciplinary approach.

The value of clinical examination in preterm newborns after neonatal sepsis: a case control study.

Background Neonatal sepsis is an important risk factor for lesions in the white matter of the brain of preterm newborns (PTNB) and the most effective strategies to minimize its deleterious effects are early detection and intervention. However, no studies were found to analyze the neurological behavior of PTNBs with neonatal sepsis. Thus, the objective of the present study was to investigate the presence of neurological abnormalities in PTNBs, after neonatal sepsis, by neonatal clinical evaluation. Methods This is a prospective cross-sectional study with 100 PTNBs selected at random, 50 of the study group (sepsis) and 50 of the control group (non-sepsis) of the university municipal hospital. PTNBs were evaluated at adjusted gestational age (37 to 42 weeks). The neurological evaluation protocol adopted was the Hammersmith Neonatal Neurological Examination (HNNE), which consists of 34 items grouped into six categories. Statistical analysis: Statistical analysis was performed using the Chi-square, Mann-Whitney and Binary Logistic Regression tests using the assumption of each statistical test. The statistical program used was Stata version 11.0. Results The PTNBs of the sepsis group had total HNNE scores lower than expected for normality in 86% of the cases, and the non-sepsis group in 26% (p<0.001). Higher prevalence levels of altered scores in tone category (p<0.001), tone patterns (p=0.026), reflexes (p=0.002), movements (p<0.001), abnormal signs (p<0.001) and behavior (p<0.001), were also found in the sepsis group, as well as in 26 of the 34 evaluation items. Conclusion The preterm neonatal sepsis showed significant frequency of neurological alterations. Thus, it is concluded that neurological dysfunctions in preterm newborns after neonatal sepsis can be identified by clinical neonatal neurological evaluation.