COVID-19

Disappointing agreement in the interpretation of neurological adverse events following immunization with SARS-CoV-2 vaccines. A case-series study. Pobre concordancia en la interpretación de eventos adversos neurológicos después de la inmunización con vacunas contra el SARS-CoV-2. Estudio de una serie de casos.

Background: A sizable proportion of the world’s population has been vaccinated to prevent SARS-CoV-2 infections. In clinical practice, however, almost any neurological manifestation occurring after vaccination has been attributed to the vaccine, generating doubts on their safety. In 2013, the WHO created the Adverse Event Following Immunization (AEFI) criteria to establish the relationship between a vaccine and side effects, but they seem not to dispel doubts regarding severity and causality of neurological events following SARS-CoV-2 vaccination. This study aims to analyze consistency of the AEFI to designate probable side effects of SARSCoV-2 vaccines among patients who develop neurological symptoms after vaccination.

Methods: We measured the level of agreement using the Fleiss kappa methodology. Seventeen observers (five neurologists, four infectious disease specialists, and eight internal medicine residents) independently rated 11 cases treated in our service presenting neurological symptoms within 21 days after SARS-CoV-2 vaccination according to the AEFI criteria.

Results: We found low concordance agreements among the 17 raters regarding severity (k=0.088) and causality (k=0.025). When analyzing by raters’ subgroups, agreement for severity was moderately higher among neurologists (k=0.383) and for causality among internal medicine residents (k=0.117).

Conclusions: AEFI criteria do not allow, by themselves, to establish the relationship between a vaccine and adverse neurological effects. Therefore, it is essential to create more useful tools that allow doctors and lay people to be more confident in this challenge.

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Palabras clave: COVID-19, Efectos adversos luego de inmunización, Estadísticas Kappa, SARS-CoV-2,

Keywords: Adverse Event Following Immunization, COVID-19, Kappa statistics, SARS-CoV-2, Vaccine,

Predictores de ansiedad durante la pandemia COVID-19 en estudiantes de medicina de Morelos, México. Predictors of anxiety during the COVID-19 pandemic in medical students from Morelos, Mexico.

Introduction: Medical students are a group of concern in the face of COVID-19, as social distancing measures may affect their anxiety and be vulnerable to the emotional impact, since the profession is part of the first line of care in the face of this pandemic.

Objective: To describe the prevalence and predictors of anxiety caused by the COVID-19 pandemic in university medical students from Morelos, Mexico.

Method: Cross-sectional descriptive observational study using an online questionnaire, with Sociodemographic Characterization, Generalized Anxiety Disorder-7 (GAD-7), Passion for Study, Self Compassion Scale (SCS), Connor-Davidson Resilience Scale (CDRISC), Life Satisfaction and Demoralization Scale (DS).

Results: In a sample of 292 medical students, women (62.8%), older than 21 years (66.9%), 72.7% reported anxiety and 65.5% sleep problems. The multiple regression model shows that dysphoria is the variable that reports the greatest predictive capacity of importance with 34.8%, followed by having trouble sleeping with 24.4%, discouragement 22.4%, over-identification 13.9% and concern about getting infected 4.5%.

Conclusions: Concern and uncertainty in the hospital environments where medical students are prepared and trained increase the risk of anxiety, due to the perception of adverse conditions and frustration as part of their profession.

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Palabras clave: ansiedad, COVID-19, desmoralización, estudiantes universitarios, malestar psicológico,

Keywords: anxiety, COVID-19, demoralization, psychological distress, university students,

Mareo, vértigo y COVID-19. Dizziness, vertigo and COVID-19

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Palabras clave: COVID-19, mareo, síntomas vestibulares, vértigo,

Keywords: COVID-19, dizziness, vertigo, vestibular symptoms,

Discapacidad asociada a manifestaciones neurológicas de COVID-19. Disability associated with COVID-19’s neurological manifestations

Introduction: COVID-19 is mainly a respiratory illness, however, with an incidence in nearly a third of patients of neurological manifestations secondary to affection to the central or peripheral nervous system, used to be more frequent in severe illness, having a wide range of disability and mortality.

Clinical case: We present the clinical case of a 39 years old female ,previously healthy, with diagnosis of COVID-19, initiating her illness with encephalitis and status epilepticus, posteriorly longitudinally extensive myelitis and anoxic-ischemic encephalopathy, which, despite of opportune diagnosis and treatment, she had a poor outcome developing persistent vegetative state.

Conclusions: COVID-19’s neurological manifestations could lead to a high risk of disability and mortality, needing an opportune detection and treatment, with a high suspicion of encephalitis and status epilepticus in patients with decrease of alertness and focal motor symptoms.

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Palabras clave: COVID-19, Discapacidad, encefalitis, estado epiléptico, Manifestaciones neurológicas, Mielitis,

Keywords: COVID-19, Disability, encephalitis, myelitis, neurological manifestations, Status Epilepticus,

Impacto de la COVID-19 en el Ecuador: De los datos inexactos a las muertes en exceso. Impact of COVID-19 in Ecuador: From inaccurate data to using excess mortality.

COVID19 has hit Ecuador drastically. In fact, until today around 75.000 confirmed cases and almost 9.000 deaths because of the virus has been showed by Official Statistics in the country. Good decisions can be made having data of high quality, but the national public health system was not able to provide such as input. Because of this, multiple sources of information and insights about the behavior of the pandemic in the country has appeared. From journalists and economists to health experts, all have published graphics and statistics that show how bad was managed the sanitary crisis in Ecuador. The typical elements to track a pandemic in any country are contagious and mortality curves but the difference in the results across the government, academic units and experts has woke up an intense debate. As information was not accurate, many people left to pay attention and as a result it might be seen that this disinformation contributed to the increase of contagious in our country. The crisis has been hard for many countries but international media like The Economist¹ and Financial Times² in United Kingdom developed an easy method to track the evolution of pandemics in any country.

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Palabras clave: COVID-19,

Keywords: COVID-19,

Neurologic Manifestations Associated With SARS-CoV-2 Infection: A Neuro-Review of COVID-19. Manifestaciones Neurológicas Asociadas a la Infección Por SARS-CoV-2: Una Neuro-Revisión de COVID-19

Background. In December 2019, multiple cases of pneumonia of unknown etiology surged in China. In January 2020, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was the identified cause. The World Health Organization (WHO) defined the condition as “Coronavirus 2019 Disease” (COVID-19). In February, its presence was confirmed in South America and Ecuador. On March 11th, the WHO declared COVID-19 as a pandemic. This condition mainly afflicts the respiratory system. However, reports of neurological manifestations in confirmed COVID-19 patients have recently emerged.

Methods. Multiple databases were reviewed, the information was extracted and analyzed independently by 3 authors.

Results. Neurological manifestations associated with COVID-19 were identified. Including: myalgia, headache, altered mental status, cerebrovascular events, dizziness, hypogeusia, hyposmia, neuropathic pain, visual impairment, ataxia, seizures, Central Hypoventilation Syndrome, encephalopathy, rhabdomyolysis, Acute Hemorrhagic Necrotizing Encephalopathy, Guillain Barre Syndrome (GBS), meningitis and encephalitis.

Conclusion. COVID-19 is associated with neurological involvement. It is most frequently observed in cases that are severe, atypical, and with comorbidities. Health care providers and neurologists alike, must remain alert and keep high suspicion of severity when these manifestations are present. Timely recognition might help initiate early treatment and isolation, preventing clinical decline and viral spread.