SARS-CoV-2 Impairs Vision.

OBJECTIVES: Affection of the central nervous system and the eyes is increasingly recognized as manifestations of a SARS-CoV-2 infection (COVID-19). This review aims at summarizing and discussing recent advances concerning causes and locations of impaired vision because of an infection with SARS-CoV-2. METHODS: On a literature search through PubMed and ScholarOne, all available publications about COVID-19 patients with impaired vision were retrieved. RESULTS: Visual impairment in SARS-CoV-2-infected patients may be due to infection of lacrimal glands (dacryoadenitis), conjunctivitis, tonic pupils, vitritis, central retinal artery/venous occlusion, retinitis, retinal bleeding, panuveitis, anterior ischemic optic neuropathy, optic nerve stroke, optic neuritis, optic perineuritis, or occipital ischemic stroke. Visual impairment may be the initial manifestation of SARS-CoV-2. CONCLUSIONS: This mini review shows that impaired vision may be the initial manifestation of COVID-19, that all sections of the visual tract may be affected and causative for visual impairment in COVID-19 patients, and that SARS-CoV-2 manifests along the visual tract with ischemia, focal infection, and immunological reactions.

Brain-Heart Interactions are More Diverse than Anticipated.

How to cite this article: Finsterer J, Fiorini AC, Scorza CA, Scorza FA. Brain-Heart Interactions are More Diverse than Anticipated. Indian J Crit Care Med 2020;24(10):1003-1004.

The study of attenuation levels and the comfort of earplugs.

INTRODUCTION: This study aimed to analyze and compare four different types of earplugs, divided into premolded plugs and foam plug models, in relation to the level of attenuation, comfort, and the size of the external acoustic meatus (EAM) in an attempt to identify how these variables influence the choice of specific hearing protection devices (HPDs). MATERIALS AND METHODS: A cross-sectional observational study was performed in a sample of 49 participants, oriented toward the ideal placement of four HPDs, two premolded and two foam plugs (3M™). The procedures included otoscopy, EAM diameter measurement using an otometer, EAM volume measurement via an acoustic impedance test, and the obtainment of the bilateral personal attenuation rating (PAR) for each HPD using the E-A-Rfit™ Validation System (3M™). The Bipolar Comfort Rating Scale (BCRS) instrument was applied twice for each individual: once after the evaluations with the premolded HPDs and again after the evaluations with the foam plug HPDs. Then, each participant was asked which was his/her favorite protector. RESULTS: The volume of the EAM was not directly related to the diameter of the EAM. The attenuation did not interfere with the HPD preference, and the PAR of the foam plug was significantly higher regardless of the preferred HPD. Regarding the BCRS, the variables "Placement," "Complexity," and "Occlusion Effect" had higher scores for premolded HPDs and had a direct relationship with the type of preferred HPD. CONCLUSION: Attention to the use of HPDs should be personalized, taking into account the needs of each individual, considering not only the attenuation, but also the user's reported well-being.

Neurogenesis and pesticides: news of no new neurons.

New hippocampal neurons are continuously generated in the adult human brain. Several studies have demonstrated that the proliferation of hippocampal cells is strongly influenced by a variety of stimuli, including pesticides exposure. These effects are particularly important because neurogenesis dysregulation could be associated with the decline of neuronal and cognitive functions and the possible development of neuropsychiatric disorders.

Novos neurônios hipocampais são gerados continuamente no cérebro humano adulto. Vários estudos têm demonstrado que a proliferação de células do hipocampo é influenciada por uma variedade de estímulos, incluindo a exposição a pesticidas. Estes efeitos são particularmente importantes porque a desregulação da neurogênese pode estar associada ao declínio das funções neuronais e cognitivas e ao possível desenvolvimento de doenças neuropsiquiátricas.

Diagnosing SARS-CoV-2 vaccination associated rhombencephalitis requires comprehensive work-up and exclusion of differentials.

In this letter we raise several concerns regarding the interesting article by Walter and Krämer about rhomb-encephalitis as a complication two months after the vaccination with an mRNA-based SARS-CoV_2 vaccine. The causal link between the vaccination and encephalitis remained unproven, a SARS-CoV-2 infection, Bickerstaff encephalitis were not excluded, the MRI rather suggests brainstem-encephlaitis than pure rhomb-encephalitis, and the cerebro-spinal fluid was not investigated for cytokines or glial markers. Neurologists are called to make all available effort to convincingly evaluate the etiology and the pathophysiological background of an undetermined condition.

Repurposing the antioxidant and anti-inflammatory agent N-acetyl cysteine for treating COVID-19.

Although several considerations have been raised suggesting a beneficial effect of N-acetyl cysteine (NAC) for the treatment of severe acute respiratory syndrome coronavirus 2 infection, there is currently no clinical evidence that NAC truly prevents coronavirus disease 2019 (COVID-19), reduces the severity of the disease, or improves the outcome. Appropriately designed clinical trials are warranted to prove or disprove a therapeutic effect of NAC for COVID-19 patients.

Sudden unexpected death in Parkinson's disease: Insights from clinical practice.

Classified as the second most common neurodegenerative disorder associated with aging after Alzheimer's disease, Parkinson's disease (PD) is the most common movement disorder. In the last decade, despite advances in treatment, mortality rates linked with PD continued to reach significant figures. Available studies have shown that compared with healthy controls, patients with PD are accompanied by high rates of premature death. This is usually caused by factors such as pneumonia and cerebrovascular and cardiovascular diseases. Recently, it has been demonstrated that a significant proportion of patients with PD die suddenly. This is referred to as a sudden and unexpected death in PD (SUDPAR). Here, we focus on the magnitude of SUDPAR. Finally, it is important to learn more about SUDPAR for the implementation of effective prevention strategies.

Extrapulmonary onset manifestations of COVID-19.

Coronavirus disease (COVID-19) usually starts with pulmonary signs and symptoms. However, in some cases, the initial clinical presentations are extrapulmonary. This literature review aimed at summarizing and discussing the extrapulmonary onset manifestations of COVID-19. The most frequent initial extrapulmonary manifestations include hypogeusia, hyposmia, non-specific abdominal symptoms, corneal congestion, and deep venous thrombosis. Several rarer extrapulmonary manifestations in locations such as the brain, peripheral nerves, muscles, eyes, ears, myocardium, intestines, skin, or vessels have been additionally reported as onset presentations of COVID-19. In conclusion, it is crucial for clinicians and health care providers to consider extrapulmonary presentations at the onset of COVID-19 to avoid overlooking the infection and contributing to the spread of the disease.