Background and Purpose Autoimmune encephalitis (AIE) following coronavirus disease 2019 (COVID-19) is an underexplored condition. This study aims to systematically review the clinico-investigational and pathophysiologic aspects of COVID-19 and its vaccines in association with AIE, and identify the factors predicting neurological severity and outcomes. Methods Relevant data sources were searched using appropriate search terms on January 15, 2022. Studies meeting the criteria for AIE having a temporal association with COVID-19 or its vaccines were included. Results Out of 1,894 citations, we included 61 articles comprising 88 cases: 71 of COVID-19-associated AIE, 3 of possible Bickerstaff encephalitis, and 14 of vaccine-associated AIE.There were 23 definite and 48 possible seronegative AIE cases. Anti-NMDAR (N-methyl-D-aspartate receptor; n =12, 16.9%) was the most common definite AIE. Males were more commonly affected (sex ratio=1.63) in the AIE subgroup. The neurological symptoms included alteredmental state ( n =53, 74.6%), movement disorders ( n =28, 39.4%), seizures ( n =24, 33.8%), behavioural ( n =25, 35.2%), and speech disturbances ( n =17, 23.9%). The median latency to AIE diagnosis was 14 days (interquartile range=4–22 days). Female sex and ICU admission had higherrisks of sequelae, with odds ratio (OR) of 2.925 (95% confidence interval [CI]=1.005–8.516)and 3.515 (95% CI=1.160–10.650), respectively. Good immunotherapy response was seen in42/48 (87.5%) and 13/13 (100%) of COVID-19-associated and vaccine-associated AIE patients, respectively. Sequelae were reported in 22/60 (36.7%) COVID-19 associated and 10/13 (76.9%) vaccine-associated cases. Conclusions The study has revealed diagnostic, therapeutic, and pathophysiological aspects of AIE associated with COVID-19 and its vaccines, and its differences from postinfectious AIE. Systematic review registration PROSPERO registration number CRD42021299215
Background: While several trials are ongoing for treatment of COVID-19, scientific research on chemoprophylaxis is still lacking even though it has potential to delay the pandemic allowing us time to complete research on vaccines. Methods: We have conducted a cohort study amongst Health Care Workers (HCW) exposed to COVID-19 patients, at a tertiary care center in India where there was an abrupt cluster outbreak within on duty personnel. HCWs who had voluntarily taken hydroxychloroquine (HCQ) prior to exposure were considered one cohort while those who had not were considered to be another. All participants with a verifiable contact history were tested for COVID-19 by rtPCR. The two cohorts were comparable in terms of age, gender, comorbidities and exposure. The primary outcome was incidence rates of rtPCR positive COVID-19 infection amongst HCQ users and non - users. Results: 106 healthcare workers were examined in this cohort study of whom 54 were HCQ users and rest were not. The comparative analysis of incidence of infection between the two groups demonstrated that voluntary HCQ usage was associated with lesser likelihood of developing SARS-CoV-2 infection, compared to those who were not on it, X2=14.59, p<0.001. None of the HCQ users noted any serious adverse effects. Conclusions: This study demonstrated that voluntary HCQ consumption as pre-exposure prophylaxis by HCWs is associated with a statistically significant reduction in risk of SARS-CoV-2. These promising findings therefore highlight the need to examine this association in greater detail among a larger sample using Randomised Controlled Trials (RCT).
Background: While several trials are ongoing for treatment of Corona virus 2019 (COVID-19), scientific research on chemoprophylaxis is still lacking even though it has potential to flatten the curve allowing us time to complete research on vaccines.Methods: This retrospective cohort study explores the potential of hydroxychloroquine (HCQ) as a pre- exposure prophylaxis for COVID-19 among 106 health care workers (HCW) exposed to COVID-19 patients, at a tertiary care hospital in India where there was an abrupt cluster outbreak within on duty personnel. HCWs who had voluntarily taken HCQ prior to exposure were considered one cohort while those who had not were considered to be the Control group. All participants with a verifiable high-risk contact history were tested for COVID-19 by RT- PCR.Results: The two cohorts were comparable in terms of age, gender, co-morbidity and exposure. The primary outcome was incidence rates of RT-PCR positive COVID-19 infection among HCQ users and Controls.106 HCW were examined of whom 54 were HCQ users. The comparative analysis of incidence of infection between the two groups demonstrated that voluntary HCQ usage was associated with lesser likelihood of developing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection (4 out of 54 HCW), compared to those who were not on it (20 out of 52 HCW), χ2=14.59, p<0.001. None of the HCQ users noted any serious adverse effects.Conclusions: The study demonstrated that voluntary pre- exposure HCQ prophylaxis by HCWs is associated with a statistically significant reduction in risk of SARS-CoV-2.
Till date, no proven therapy exists for treatment of SARS-coV-2 infections which has been de-clared a pandemic by WHO in March, 2020. Objective: This study will attempt to explore the demographic profile and outcome in the pa-tients receiving multidisciplinary, personalised approach including use of Broad Spectrum Antivi-rals - Ivermectin, anti-inflammatory and antioxidants roles of Statins and N-acetyl-cysteine along with Standard of Care (SOC) in hospitalised COVID19 patients in a tertiary care centre. Setting: Inpatient department (designated COVID ward) Participants: COVID-19 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the year 2020 between June 14- 28, 2020. Main outcome measures: The outcome of Interests are : a. Studying the demographic profile of COVID 19 cases b. Study the treatment outcomes in terms of death or discharge in patients receiving Ivermectin+N-acetyl-cysteine+Statin along with Standard of care. Results: 148 patients were included in the study. All of them had confirmed COVID19 infec-tion by the rtPCR method. Average age of the patients was 57.57 years ( Range = 17 - 88), 49% were male, 51% female. 81% of the patients had at least one or more comorbidities. Most com-mon comorbidities included diabetes( 32%), Hypertension (27%),Ischaemic Heart Disease (8%). More comorbidities. The in hospital, Case Fatality Rate was 1.35 %. The remaining 146 were dis-charged from the facility after an average 12 days duration of stay. Conclusions:. Triple therapy with Ivermectin, N-acetyl-cysteine and Atorvastatin along with standard of care is safe and effective in SARS-coV-2 infection.
Background: Chronic obstructive pulmonary disease (COPD) has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Echocardiography provides a rapid, non-invasive portable, and almost accurate method to evaluate the right ventricle function, right ventricular filling pressure, tricuspid regurgitation, left ventricular function, and valvular functions. Early diagnosis and intervention for cardiac comorbidities would reduce mortalities in COPD. Aims and Objectives: This study was undertaken to evaluate cardiac function with echocardiography in COPD patients which may further help to assess the prognosis and assist in identifying the individuals likely to suffer increase morbidity and mortality. Materials and Methods: A hospital based cross sectional study in which 100 patients over a period of 1 year were selected according to inclusion and exclusion criteria and cardiac comorbidities were observed in COPD patients by 2D echocardiography. All patients were studied on the basis of following variables- Demographic evaluation, Clinical evaluation, Pulmonary function test, echocardiography. Results: Distribution of the study population showed that a large number of COPD patients developed cardiac complication - Right and left ventricular dysfunction and pulmonary arterial hypertension especially in higher grades of COPD patients which can contribute to increased morbidity and mortality. Conclusion: Cardiac dysfunction is quite common in COPD patients, especially in the higher grades of COPD. So, we recommend that echocardiography should be included in routine evaluations of all COPD patients for early diagnosis and management of cardiac complications.
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