Neurological manifestation of SARS-CoV-2: Inflammation and therapeutics

This article discusses extrapulmonary infections and manifestations related to COVID-19. As discussed in previous articles, the usual complaints of ageusia, anosmia, myalgia, and headache are prominent in individuals, however, reports of stroke, encephalopathy, seizure, encephalitis, and loss of consciousness have been reported. Seizures, rhabdomyolysis and Guillain-Barre syndrome have also been reported in patients with COVID-19. The brain is linked to pulmonary organs, physiologically through circulation, and functionally through the nervous system. COVID-19 has been shown to induce a cytokine storm in systemic circulation that may trigger a neuroinflammatory cascade that may compromise the blood-brain barrier, activating microglia and astrocyte-borne receptors leading to neuronal tissue damage. Disruption of the blood-brain barrier, impaired neurovascular coupling and diminished cerebral blood flow increases susceptibility to neuro-invasion in older adults. Research indicates that the viral infection may cause an acceleration in onset or further deterioration of existing neurological deficits. Long-term neuronal follow-ups in the aged adults may be indicated in those who have had a severe infection during COVID-19. Groups that are discussed in detail within this article are those with Parkinson’s, Alzheimer’s, history of stroke, neuromuscular disease, etc. Therapeutic approaches for COVID-19 are discussed in detail.

CHA2DS2-VASc score and modified CHA2DS2-VASc score to predict mortality in COVID-19 patients

In this study from Journal of Thrombosis and Thrombolysis, researchers investigated the use of the CHA2DS2-VASc score to estimate the need for hospitalization/ICU admission, length of stay in ICU, and mortality in COVID-19 patients using a retrospective analysis. Biochemical markers at time of admission were also considered. Of 1,000 enrolled patients, 791 patients were admitted to the general medicine service, 209 to the Intensive Care Unit of which 82 patients expired. The predictor of mortality was analyzed using the CHA2DS2-VASc and M-CHA2DS2-VASc scores. The cut-off values of the scores for predicting mortality were ≥ 3 (2 or under and 3). Regression analysis showed that CHA2DS2-VASc, Troponin I, D-Dimer, and CRP were independent predictors of mortality in COVID-19 patients. Authors suggest that utilizing these scores may be useful in predicting mortality and need for ICU admission in COVID-19 patients.

COVID-19 in patients with autoimmune disease

This article, discusses the 30-day outcomes and mortality of patients with autoimmune diseases in comparison to similar patients with seasonal influenza. Using a multinational network cohort study, authors examined 133,589 patients diagnosed, and 48,418 hospitalized with COVID-19 with prevalent autoimmune diseases. The majority of patients were female, fifty years of age or older, with previous comorbidities. Hypertension, chronic kidney disease, and heart disease were higher in hospitalized patients vs diagnosed patients with COVID-19. When compared with 70,660 patients hospitalized with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia, acute respiratory distress, and a higher 30-day mortality. This study reconfirms that COVID-19 is a more severe disease when compared to influenza, especially in groups with autoimmune conditions.

Prevalence of Acute Stress Disorder (ASD) and symptom persistence in COVID-19 survivors

In this letter to the editor, authors discuss how PTSD may surge following ICU survival in nearly 20% of survivors. Additionally, the pandemics effects on physical and mental health are discussed. Isolation from friends and family members, communication barriers, and lack of hospital staff lend to a significant psychological impact. During follow up visits, 47 patients who had been admitted to the ICU were assessed in person by an intensivist at least one month after discharge. Using the Impact of Event Scale-Revised tool, patients were screened for acute stress disorder, 40.4% of patients screened positive. Loss of smell and/or taste, altered hearing and balance were noted as persistent in this group along with fatigue and shortness of breath. Of the participants, 97.8% reported ongoing fatigue at the one month follow up. Most patients had an unclear memory of their time in the ICU and those who did complained of feeling isolated during their illness. The authors conclude that ASD is high among ICU survivors after a COVID-19 infection. Systematic screenings should be performed to reduce chronic effects.