COVID-19-associated myoclonus in a series of five critically ill patients.

BACKGROUND: In addition to respiratory symptoms, many patients with coronavirus disease 2019 (COVID-19) present with neurological complications. Several case reports and small case series described myoclonus in five patients suffering from the disease. The purpose of this article is to report on five critically ill patients with COVID-19-associated myoclonus. MATERIAL AND METHODS: The clinical courses and test results of patients treated in the study center ICU and those of partner hospitals are described. Imaging, laboratory tests and electrophysiological test results are reviewed and discussed. RESULTS: In severe cases of COVID-19 myoclonus can manifest about 3 weeks after initial onset of symptoms. Sedation is sometimes effective for symptom control but impedes respiratory weaning. No viral particles or structural lesions explaining this phenomenon were found in this cohort. CONCLUSION: Myoclonus in patients with severe COVID-19 may be due to an inflammatory process, hypoxia or GABAergic impairment. Most patients received treatment with antiepileptic or anti-inflammatory agents and improved clinically.

Commuter exposure to fine and ultrafine particulate matter in Vienna.

Mass concentrations PM10, PM2.5, PM1, particle number concentrations of ultrafine particles and lung deposited surface area were measured during commutes with a subway, tram, bus, car and bicycle in Vienna for the first time. Obtained data were examined for significant differences in personal exposure when using various transport modalities along similar routes. Mean PM2.5 and PM1 mass concentrations were significantly higher in the subway when compared to buses. Mean PM10, PM2.5 and PM1 mass concentrations were significantly higher in the subway when compared to cars using low ventilation settings. Particle number concentrations of ultrafine particles were significantly higher in trams when compared to the subway and lung deposited surface area was significantly greater on bicycles when compared to the subway. After adjusting for different vehicle speeds, exposure to PM10, PM2.5 and PM1 along the same route length was significantly higher in the subway when compared to cars while exposure to ultrafine particles and partly also lung deposited surface area was significantly higher in bus, tram and on bicycle when compared to the subway. Car and bus passengers could be better isolated from ambient fine particulate matter than passengers in the subway, where a lot of ventilation occurs through open windows and larger doors. Tram passengers and cyclists might be exposed to increased amounts of ultrafine particles and larger lung deposited surface area due to a closer proximity to road traffic. Comparing cumulative exposure along the same route length leads to different results and favors faster traffic modes, such as the subway.