Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

SARS-CoV-2

 

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,

Insomnio y factores asociados entre los estudiantes de medicina que se recuperaron de la infección aguda por COVID-19. Insomnia and associated factors among medical students recovering from acute COVID-19 infection

Introduction: The SARS-CoV-2 pandemic significantly affected the mental health of a large portion of the population, with sleep disorders, including insomnia, being notable after COVID-19 infection. One of the populations most affected were university students in the healthcare field, which was the focus of our study.

Objective: To evaluate the relationship between factors associated with insomnia in medical students during the Long-Covid period.
Methods: Data was collected through a survey that included questions about sociodemographic aspects, health habits, sleep disturbances such as insomnia, and COVID-19 history. The severity of insomnia and subjective sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, Spearman and Kendall correlations, one-way ANOVA, and odds ratios were evaluated.

Results: A total of 117 students were included in the study, with a mean age of 21.8 ± 1.96 years and 58.1% being female. It was found that 65% of medical students experienced some degree of insomnia, while 78.6% reported difficulty sleeping. The Kendall and Spearman correlation coefficients between PSQI and ISI were 0.49 and 0.55, respectively (p < 0.001). Significant correlations were found between self-reported physical health, emotional health, among others.
Discussion: The prevalence of subclinical insomnia (39.3%) and moderate sleep difficulty (47%) is noteworthy. Significant correlations were found between insomnia scales, sleep quality, and an inverse correlation with emotional health. Limitations of the study include the use of ordinal and nominal variables, as well as the number of participants. It is recommended to replicate the study with a larger sample size and utilize a longitudinal design to assess the evolution of insomnia and sleep difficulty over time.

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Palabras clave: calidad de sueño, COVID persistente, Insomnio, SARS-CoV-2, trastornos del sueño,

Keywords: Insomnia, Long COVIDs, SARS-CoV-2, sleep disorders, sleep quality,

Complicaciones neurológicas post-vacuna COVID. Neurological complications post-COVID vaccine.

Post-vaccine SARS-CoV-2 neurological complications are rare. However, due to the SARS-CoV-2 pandemic, massive vaccination has been carried out worldwide, which is why we have seen a greater report of post-vaccination neurological adverse effects.
We present 4 cases, which after receiving the SARS-CoV-2 vaccine presented 4 different neurological pathologies at the Hospital Comarcal de Vinaroz during the year 2021.
A relationship between vaccination and the onset of neurological symptoms is observed. Three patients presented clinical manifestations in relation to the BNT162b2 vaccine. The first patient after administration of the first dose of the BNT162b2 vaccine presented diplopia and palpebral ptosis, a condition compatible with ocular Myasthenia gravis. The second patient had symptoms of acute sensory motor axonal polyneuropathy after the third dose. The third patient, who after the third dose of BNT162b2 presented lethargic encephalopathy. The fourth patient presented symptoms compatible with aseptic meningitis after AZD1222 and mRNA-1273 vaccination.
Due to the worldwide mass vaccination campaign, reports of accidentally related or causally linked neurological complications are emerging. These are very varied; they could be related to immunological and/or toxic mechanisms. Physicians must be aware of these possible adverse effects and rule out other causes. Studies should be carried out that allow us to clarify the pathological mechanisms in relation to post-vaccination complic ations.

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Palabras clave: Encefalopatía, meningitis, miastenia, polineuropatía, SARS-CoV-2,

Keywords: Encephalopathy, meningitis, myasthenia, polyneuropathy, SARS-CoV-2,

Cefalea post COVID-19: Una nueva entidad a considerar en la consulta diaria. Post COVID-19 headache: A new entity to consider in daily consultation

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Palabras clave: Cefalea, COVID-19, SARS-CoV-2,

Hemorragia intracerebral espontánea en pacientes con Covid-19 severa: Reporte de dos casos. Spontaneous Intracerebral Hemorrhage in severe Covid-19 patients: Report of two cases

The respiratory system is mainly affected by the SARS-CoV-2 infection, producing a severe acute respiratory syndrome known as COVID-19 (Coronavirus disease 2019), patients with severe disease usually develop multiorgan failure; among these we can focus on the nervous system, due to its potential neurotropism. Recent clinical data reveal that patients may manifest symptoms such as anosmia, dysgeusia, impaired consciousness, headache, seizures, and cerebrovascular disease (CVD). We describe two physically active male patients with complicated SARS-CoV-2 infection without significant comorbidities related to the development of intracranial hemorrhage, nor a history of head trauma or documented anatomic malformations. Both were admitted by the emergency department and during their stay in the ICU they developed intracranial hemorrhage diagnosed by computed tomography. The paraclinical findings in the two cases were compatible with a prothrombotic state as possible etiologies of bleeding in both.

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Palabras clave: estado protrombótico, hemorragia intracraneal, SARS-CoV-2,

Keywords: intracranial hemorrhage, prothrombotic state, SARS-Cov2,

La historia del COVID-19 no terminará con el control del SARS-CoV-2. ¿Qué se debe esperar de las comunidades rurales de América Latina más allá de la pandemia. Una perspectiva neurológica. The COVID-19 history will not end with the control of SARS-CoV-2. What should be expected in rural communities of Latin America beyond the pandemic? A neurological perspective

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Palabras clave: COVID-19, SARS-CoV-2, Síndrome Respiratorio Agudo Severo,

Demencia en Tiempos de COVID-19. Dementia in the time of COVID-19

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Palabras clave: COVID-19, demencia, SARS-CoV-2,

Complicaciones neurológicas del COVID-19 (SARS-CoV-2), revisión de la literatura. Neurological complications of COVID-19 (SARS-CoV-2), literature review.

Since the diagnosis of the first person infected with SARS-Cov-2, it has quickly spread throughout the world causing a pandemic and putting healthcare systems on maximal alert. Currently, evidence indicates that SARS-Cov-2 infection is not a disease limited to the respiratory system but it can also affect the central nervous system, causing anosmia, headache, seizures, stroke and altered mental status.  For this reason, it is important to be aware of the neurological complications associated SARS-CoV-2 infection.

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Palabras clave: neuroinvasión, neurotropismo, SARS-CoV-2,

Keywords: neuroinvasion, neurotropism, SARS-CoV-2,

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.

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Palabras clave: Coronavirus, COVID-19, neurología, Pandemia, SARS-CoV-2,

Keywords: Coronavirus, COVID-19, neurology, Pandemic, SARS-CoV-2,
 
 
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