Objectives Headache is considered one of the most frequent neurological manifestations of COVID-19. This work aimed to identify the relative frequency of COVID-19 related headache and to clarify the impact of clinical, laboratory findings of COVID-19 infection on headache occurrence and its response to analgesics. Design Cross-sectional study Setting Recovered COVID-19 patients Subjects 782 patients with a confirmed diagnosis of COVID-19 infection. Methods Clinical, laboratory and imaging data were obtained from the hospital medical records. Regarding patients who developed COVID-19 related headache, a trained neurologist performed an analysis of headache and its response to analgesics. Results The relative frequency of COVID-19 related headache among our sample was 55.1% with 95% CI (0.516–0.586) for the estimated population prevalence. Female gender, malignancy, primary headache, fever, dehydration, lower levels of hemoglobin and platelets and higher levels of neutrophil/lymphocyte ratio (NLR) and CRP were significantly associated with COVID-19 related headache. Multivariate analysis revealed that female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count were independent predictors of headache occurrence. By evaluating headache response to analgesics, old age, diabetes, hypertension, primary headache, severe COVID-19, steroid intake, higher CRP and ferritin and lower hemoglobin levels were associated with poor response to analgesics. Multivariate analysis revealed that primary headache, steroids intake, moderate and severe COVID-19 were independent predictors of non-response to analgesics. Discussion Headache occurs in 55.1% of patients with COVID-19. Female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count are considered independent predictors of COVID-19 related headache.

Objectives To assess risk factors for persistent neuropathic pain in subjects recovered from COVID-19 and to study the serum level of neurofilament light chain (NFL) in those patients. Design Case-control study Setting Persistent post COVID-19 pain Subjects 45 patients with post COVID-19 pain and another 45 age and sex-matched healthcare workers who recovered from COVID-19 without pain. Methods The included participants were subjected to medical history taking, screening for depressive disorders, comprehensive neurological examination, and pain evaluation using the Douleur Neuropathique en 4 questions (DN4). All patients who had a score at least 4/10 on DN4 were included. The serum NFL level was measured for both groups at the time of patients’ enrollment. Results The frequency of depression, moderate and severe COVID-19 cases, disease duration and serum ferritin were significantly higher in the cases with post COVID-19 pain than controls. Binary logistic regression revealed that depression, azithromycin use, moderate and severe COVID-19 increased the odds of post COVID-19 pain by 4.462, 5.444, 4.901, & 6.276 times, respectively. Cases with post COVID-19 pain had significantly higher NFL (11.34 ± 9.7, 95%CI: 8.42 – 14.25) than control group (7.64 ± 5.40, 95%CI: 6.02–9.27), (P-value= 0.029). Patients with allodynia had significantly higher NFL (14.96 ± 12.41, 95%CI: 8.58—21.35) compared to those without (9.14 ± 6.99, 95%CI: 6.43—11.85) (P-value= 0.05). Discussion Depression, azithromycin, moderate and severe COVID-19 are independent predictors of persistent post COVID-19 pain. Serum NFL may serve as a potential biomarker for persistent neuropathic pain after COVID-19.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus that belongs to the coronaviruses and causes coronavirus disease 2019 (COVID-19). In this study, we explored the demographic details, clinical features, and routinely conducted laboratory investigations of patients with COVID-19 during the second and third waves of the pandemic to understand their possible diagnostic and prognostic values in Egypt. Methods In this retrospective cohort study, the demographic characteristics, detailed medical history, laboratory findings, and symptoms of all enrolled patients with SARS-CoV-2 were collected from the medical records of Beni Suef University Hospitals between December 15, 2020, and April 15, 2021. Results This retrospective study included 473 patients, almost all of whom were elderly. The median age of the patients was 48 years, and those with moderate and severe disease were older than those with mild infections. The proportion of females was higher (63.4%) than males (36.6%). Diabetes mellitus (DM) was the most common comorbidity (17.3%), and fever was the most typical manifestation of COVID-19 (62.6%). Those with severe disease showed a higher C-reactive protein level (CRP) than those with moderate (p-value 0.009) or mild (p-value 0.01) diseases. Serum ferritin levels were significantly higher in patients with severe disease than in those with moderate disease (p-value 0.018). In contrast, D-dimer and serum creatinine were normal and showed no significant difference in all comparisons (p-value overall 0.21). Conclusion This study observed several variations in COVID-19 patients’ characteristics. The new manifestations included skin rash, bone and low back pains, and rigors. In contrast to females, most males had moderate-to-severe illness. Old age and higher body mass index was associated with increasing severity. D-dimer and complete blood count were normal and could not identify potential COVID‐19 patients. Patients who had mild illness were still at risk of developing post-COVID complications.

Purpose Much effort has been directed toward studying COVID-19 symptoms; however, the post–COVID-19 phase remains mysterious. The aim of this work was to conduct a clinical and neurophysiological evaluation of physical and mental fatigue in COVID-19 long-haulers and to study whether markers of COVID-19 severity are able to predict the likelihood of developing postinfectious fatigue syndrome (PIFS) in such patients. Patients and Methods This case–control study was conducted on 46 COVID-19 long-haulers who met the criteria for PIFS and 46 recovered COVID-19 subjects without any residuals. Clinical assessment of fatigue was done using a fatigue questionnaire. Repetitive nerve stimulation and single-fiber electromyography were done after excluding neuropathy and myopathy. Results The median value for physical fatigue was 4 (IQR 2–7), while that for mental fatigue was 2 (IQR 0–3). Each day’s increase in the period of COVID-19 illness increased the odds of PIFS in COVID-19 long-haulers 1.104-fold, and each unit increase in ferritin increased the odds of PIFS 1.006-fold. A significant decrement in at least one muscle was observed in 50% of patients. Patients with PIFS had significantly higher mean consecutive difference (MCD) in the extensor digitorum communis than the control group. There were statistically significant positive correlations between MCD values and physical, mental, and total fatigue scores. Conclusion Higher ferritin levels and prolonged COVID-19 infection were independent predictors of PIFS in COVID-19 long-haulers. There was electrophysiological evidence of abnormalities in the peripheral portion of the motor unit in COVID-19 long-haulers with PIFS.

The purpose of this study was to explore the value of using cefepime and ceftazidime in treating patients with COVID-19. A total of 370 (162 males) patients, with RT-PCR-confirmed cases of COVID-19, were included in the study. Out of them, 260 patients were treated with cefepime or ceftazidime, with the addition of steroids to the treatment. Patients were divided into three groups: Group 1: patients treated with cefepime (124 patients); Group 2: patients treated with ceftazidime (136 patients); Group 3 (control group): patients treated according to the WHO guidelines and the Egyptian COVID-19 management protocol (110 patients)/ Each group was classified into three age groups: 18–30, 31–60, and >60 years. The dose of either cefepime or ceftazidime was 1000 mg twice daily for five days. Eight milligrams of dexamethasone were used as the steroidal drug. Careful follow-ups for the patients were carried out. In vitro and in silico Mpro enzyme assays were performed to investigate the antiviral potential of both antibiotics. The mean recovery time for Group 1 was 12 days, for Group 2 was 13 days, and for Group 3 (control) was 19 days. No deaths were recorded, and all patients were recovered without any complications. For Group 1, the recovery time was 10, 12, and 16 days for the age groups 18–30, 30–60, and >60 years, respectively. For Group 2, the recovery time was 11, 13, and 15 days for the age groups 18–30, 30–60, and >60 years, respectively. For Group 3 (control), the recovery time was 15, 16, and 17 days for the age groups 18–30, 30–60, and >60 years, respectively. Both ceftazidime and cefepime showed very good inhibitory activity towards SARS CoV-2′s Mpro, with IC50 values of 1.81 µM and 8.53 µM, respectively. In conclusion, ceftazidime and cefepime are efficient for the management of moderate and severe cases of COVID-19 due to their potential anti-SARS CoV-2 activity and low side effects, and, hence, the currently used complex multidrug treatment protocol can be replaced by the simpler one proposed in this study.

Background Thromboembolism was a chief cause of mortality in 70% of patients with COVID-19. Our objective was to see if serum interleukins 1 beta (IL-1β) and soluble platelets selectin (sP-selectin) could serve as novel markers of thromboembolism in COVID-19 patients. Methods This cross sectional study involved 89 COVID-19 patients who were recruited from 1st of February to 1st of May 2021. Clinical and laboratory data were collected, and chest imaging was performed. The levels of IL-1β and sP-selectin were assessed in all cases through ELISA kits. Comparisons between groups were done using an unpaired t-test in normally distributed quantitative variables. In contrast, a non-parametric Mann-Whitney test was used for non-normally distributed quantitative variables. Results Severe COVID-19 infection was associated with higher serum levels of CRP, Ferritin, LDH, D dimer, IL-1β and sP-selectin (P <  0.001) with significant correlation between levels of IL-1β and sP-selectin (r 0.37, P <  0.001), D-dimer (r 0.29, P 0.006) and Ferritin (r 0.5, p <  0.001). Likewise, a positive correlation was also found between levels of sP-selectin, D-dimer and Ferritin (r 0.52, P <  0.001) (r 0.59, P <  0.001). Imaging studies revealed that 9 (10.1%) patients developed venous and 14 (15.7%) developed arterial thrombosis despite receiving anticoagulant therapy. Patients with thrombotic events had significantly higher levels of IL-1β, sP-selectin and LDH serum levels. Meanwhile, there was no statistical significance between CRP, D-dimer or Ferritin levels and the development of thrombotic events. Conclusion IL-1β and sP-selectin levels can be promising predictors for severe COVID-19 infection and predictable thrombosis.

Background Specific dietary recommendations for migraine patients with comorbid irritable bowel syndrome (IBS) are lacking. This work aimed to study the severity scores of such two common pain-related disorders in relation to various macronutrients and micronutrients intake. Methods A cross-sectional study was conducted on patients with concomitant migraine and IBS. The frequency and intensity of migraine attacks and the severity of IBS were evaluated. Data on dietary intake were collected using food frequency questionnaires and 24-hour dietary recall. Results One-hundred patients with a median age of 36 years participated. The severity scores for migraine and IBS were positively correlated with fat and copper and negatively correlated with fiber and zinc intake. Copper intake was an independent predictor of the severity of both migraine and IBS (P 0.033, < 0.001). Patients with episodic migraine (n = 69) had a significantly higher frequency of cooked, fresh vegetables, and wheat bran bread intake (P 0.009, 0.004, 0.021) and lower frequency of hydrogenated oils intake (P 0.046), in comparison to patients with chronic migraine (n = 31). Patients with moderate intensity of migraine (n = 37) had a significantly higher frequency of herbal drinks intake (P 0.014) than patients with a severe intensity of migraine (n = 63). Patients with mild (n = 13) and moderate IBS (n = 41) had a significantly higher frequency of wheat bran bread and sen bread intake (P 0.003, 0.022) than patients with severe IBS (n = 46). Conclusion Patients with comorbid migraine and IBS are advised to adhere to a diet low in fat and copper and rich in fiber and zinc.

Gastric cancer (GC) is considered lethal aggressive cancer. In Egypt, GC has a low incidence but unfortunately, it is mostly diagnosed at an advanced stage with a poor prognosis. Assessment of novel markers that can be used in the early detection of GC is an urgent need. The present study was performed to assess the association of the Pleckstrin homology domain-containing S1 (PLEKHS1)، arylacetamide deacetylase (AADAC, and Cyclin-dependent kinase inhibitor 3 (CDKN3) genes with GC and to correlate their gene expression levels with tumor stage, grade, and other clinicopathological features. The current work was performed on forty gastric tissue samples; twenty in Group 1 with GC tissues at different stages, and grades and twenty in Group 2 (control group) with non-tumorous tissue. PLEKHS1, AADAC, and CDKN3 gene expression were assessed by RT-qPCR. AADAC, CDKN3 genes were significantly (p<0.001) upregulated, while PLEKHS1 gene was significantly (p<0.001) downregulated in the GC group than the control group. AADAC gene expression exhibited a high significant (p<0.001) positive correlation with the tumor grades and the tumor stages. A high significant negative correlation between AADAC, and CDKN3 gene expression (r = -.760, p<0.001) was found. The three studied parameters showed high significant sensitivity and specificity in the prediction of the presence of GC. PLEKHS1, AADAC, and CDKN3 gene expressions were suggested to be used as diagnostic and predictive biomarkers of GC, additionally, AADAC may be used as a prognostic marker in these patients for further future confirming studies.