A "new" role of amantadines in COVID-19 in patients with Parkinson's disease: results of own comparative study.

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective(s): to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5+/-5.62 years versus 5.12+/-3.24 years) and had a more pronounced (III-IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

A descriptive study of older medical cannabis users in medical cannabis clinics

Introduction: There is a dearth of information on older users (65+ years) of medical cannabis, who may face unique challenges due to altered metabolism with aging, concurrent medication use, and risk of adverse effects. This observational study aimed to describe a large cohort of older medical cannabis users in Canada. Method(s): From Oct 2014 to Oct 2020, a commercial medical cannabis provider based in Canada collected anonymized data for research purposes from patient volunteers. Data included demographic, social, and health details (at intake) and cannabis products, self-perceived changes in symptoms and change in medications (at follow-up, variable duration). Cannabis products were categorized as cannabidiol (CBD) only, tetrahydocannabinol (THC) only or mixed CBD/THC. Of the mixed, formulations could be in 1:1 ratios (CBD+/THC+), predominantly CBD (CBD+/THC-) or predominantly THC (CBD-/THC+). Result(s): In total, 9766 subjects in the older cohort (65+ years old) completed the entire questionnaire (mean age (SD) = 73.6 (6.8) y, 60% female). They represented 23.1% of the total dataset (N = 42,267, mean (SD) =51.5 (16.8) y). The proportion of adults in the older cohort tended to increase over time (pre-2018: 17.6%;2018: 26.7%;2019: 31.2%;2020: 22.7%, when the overall intake decreased from 8869 to 5644). Among the older cohort, 15.5% were previous cannabis users and 67.7% were referred for chronic pain (mainly arthritis, chronic pain, lower back pain). Concomitant analgesic use was common (over-the-counter analgesics: 44.5%;opioids: 28.3%;NSAIDs: 24.5%). 7.9% of the sample (compared to 19.9% in the whole sample) were referred for psychiatric disorders, though 21.4% indicated antidepressant use and 12.3% indicated benzodiazepine use. Another 7% were referred for neurological disorders. Follow-up data were captured in visits (11,992) from 4698 older patients, averaging 2.5 visits per patient. The type of medical cannabis used changed over time, with increasing use of cannabis oil compared to herbal cannabis. In 2020, of 2478 visits, 78.9% use was cannabis oil and 6.7% was herbal forms (pre-2018: 57.6% vs 36.2%). The composition of cannabis oil demonstrated a preference for cannabinoid oil (CBD+) over tetrahydrocannabinol (THC+) in 6043 visits: 45.2% were using CBD+ preparations, only 3.2% were using THC+ preparations, and for CBD/THC combinations, CBD predominated (CBD+/THC-: 30.5%;CBD+/THC+: 16.8%;CBD-/THC+: 4.3%). Adverse-effects (7062 visits) included dry mouth (15.8%), drowsiness (8.6%), dizziness (4%) and hallucinations (0.6%). Patients reported improved pain, sleep and mood over time, though 15-20% reported no improvement or worsening. Medication use was mostly unchanged, though 40% of opioid users reported requiring reduced dosages. Conclusion(s): These data were drawn from a large convenience sample. The data suggest an increasing proportion of older users of medical cannabis, though COVID-19 may have affected recent use. Female users comprised a higher proportion, and cannabis oil containing CBD was preferred. Systematic studies of effectiveness and safety in older users of cannabinoids are needed given its increasing use. Funding(s): No funding was received for this work.Copyright © 2021

A "new" role of amantadines in COVID-19 in patients with Parkinson's disease: results of own comparative study

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective(s): to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5+/-5.62 years versus 5.12+/-3.24 years) and had a more pronounced (III-IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

A "new" role of amantadines in COVID-19 in patients with Parkinson's disease: results of own comparative study.

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective(s): to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5+/-5.62 years versus 5.12+/-3.24 years) and had a more pronounced (III-IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

A Feasibility Study of LORETA Z-Score Neurofeedback Training in Adults with Schizophrenia-Spectrum Disorder Experiencing Treatment-Resistant Auditory Verbal Hallucinations

Introduction: The incomplete effectiveness of interventions demands new ways to help people diagnosed with schizophrenia who experience auditory verbal hallucinations (SZ-AVH). We aimed to perform a feasibility study of low-resolution electromagnetic tomography analysis (LORETA) neurofeedback with people exhibiting treatment-resistant SZ-AVH. Method(s): We examined changes in resting-state quantitative electroencephalogram (qEEG) in four people with SZ-AVH (three male, one female) after LORETA Z-score neurofeedback training. Result(s): The study design had to be amended due to a national COVID-19 lockdown. Neurofeedback was well tolerated and no participants dropped out. Recruitment was the main feasibility issue. Barriers included a lack of knowledge of neurofeedback by patients and mental health teams, as well as the travel and time commitment involved. For the only patient who completed all 20 sessions, elevated frontal, central, and temporal theta absolute power measured at baseline normalized after treatment, but decreased temporal delta and an increase in coherence for all frequency bands were also found. Conclusion(s): Two key lessons were drawn for the feasibility of trials of EEG neurofeedback in this population. First, significant effort is needed to educate mental health professionals and patients about neurofeedback. Second, the equipment employed for neurofeedback training needs to be physically based at a site where patients routinely attend.Copyright © 2022. Amico et al.

Parosmia and COVID-19 from the lens of google trends: infodemiology study

Parosmia is a subcategory of olfactory hallucinations and refers to a distorted ability to detect the right smell in the presence of a stimulus. The study aims to investigate the relationship between COVID-19 and parosmia by calculating the interest search volume of parosmia using google trends. Google trends was used to investigate trends in searches regarding parosmia and to track these search engine terms against the coronavirus outbreak in France, Sweden, the United States [USA], and Turkiye. The terms utilized in the search were "Parosmia" and "anosmia" and the data were collected between March 20, 2020, to July 25, 2021. Parosmia searches increase with time in all the countries and the correlation significance values were obtained for France, Sweden, USA, and Turkiye to be Rs 0.660, P-value 0.0038 "Moderate correlation";Rs 0.566, P-value 0.017 "Moderate correlation";Rs 0.842, P-value 0.0001 "Strong correlation";Rs 0.800, P-value 0.0001" Strong correlation" respectively. Relative search volume of parosmia and anosmia changed significantly with time may point out that there are some late COVID-19 complications that haven't been detected yet, and with the pandemic still ongoing, more complications could be discovered by analyzing the trends.Copyright © 2023, Istanbul Medipol University. All rights reserved.

The Language of Smell: Code Failure

In today's world filled with complex signs and symbols, visual and auditory channels are the most intensive in semiotic terms. The language of smell, associated with the most ancient reactions, is usually considered as secondary and supplementary, and its possibilities for conveying meanings are limited to simple recognition. However, experts have been using the alphabet of smells to convey emotional messages from ancient times to date. The assessment of the role of odors in the modern world became possible due to the Covid-19 pandemic which often involved the loss, change or intensification of the sense of smell. In the course of the study 250 cases were considered, representing the stories associated with the disease and deviations in the perception of odors. The loss of the perception of unpleasant odors makes it impossible to learn about the dangers which cannot be perceived visually like in ancient times (spoiled food, poisoned air, etc.). Phantom interpretation of odors is often unpleasant: people can identify the smells of burning, ammonia, acetone, decomposition, feces, and others, and sometimes the excessiveness of an ordinary smell is unpleasant as well. The change of sign recognition can cause serious consequences for people. Phantom unpleasant odors can result in changes in eating habits and cause problems in communication. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Intra-hospital complications during SARS-CoV2 infection

Introduction: The SARS-CoV2 virus has a respiratory tropism. Although pulmonary complications are most often in the foreground, other complications affecting other organs have been observed and associated with a greater bad prognosis. The aim of this work was to report the various complications observed in patients hospitalized with COVID-19 pneumonia. Method(s): We carried out a retrospective study from the records of patients treated for pneumonia COVID-19 hospitalized between March 2020 and July 2021. Result(s): We collected 578 patients aged between 18 and 98 years old. Thoracic complications were dominated by bronchial superinfection(4.3%), pericarditis(3.3%), pneumomediastinum(1.2%) and pneumothorax(0.8%). Among the thromboembolic complications, we counted 30 pulmonary embolisms(5.2%), 7 acute limb ischemia (1.2%), 2 strokes(0.3%) and 1 venous thrombosis deep(0.1%). Cardiac arrhythmias were observed in 6% of cases. Bradycardia sinusitis was observed in 14 patients (2.4%) and first degree atrioventricular block in 4 patients (0.7%). Acute heart failure occurred in 31 patients (5.3%). Neurological disorders were observed in 23 patients with agitation (4%) and hallucinations (1%). Acute renal failure was the most common metabolic complication (20%) followed by rhabdomyolysis (28%) and cytolysis hepatic (36%). Two patients presented with diabetic ketoacidosis (0.3%). Complications cardiac, neurological and renal were associated with a worse prognosis (p=0.001) and the pulmonary complications with longer hospitalization (p=0.01). Conclusion(s): SARS-CoV2 infection is a polymorphic disease. Identification of the different complications respiratory and extra respiratory is essential for rapid multidisciplinary care.

Taste and smell disorders during and post-acute Covid-19 in the population of Agadir

Introduction: The pandemic caused by SARS-CoV-2 affects the whole world and the entire population, it is mainly manifested by fever, cough and asthenia but also other various symptoms. Thus, the aim of this study, to describe taste and smell disorders during and post-acute covid-19 Material(s) and Method(s): In January 2022, we conducted a comprehensive descriptive and analytical cross-sectional study carried out on 90 patients from Agadir who contracted covid 19 with taste and / or smell disorders, by administering a questionnaire on the google forms platform, data analysis was performed by IBM SPSS Statistics v26 Results: The mean age was 30.1 +/- 8.4 years, predominantly female (84.4%), 33.3% were vaccinated against covid 19 with 2 doses, and 43.3% were not vaccinated, the main manifestations of acute covid 19 disease were anosmia (90%) ageusia (66.7%) asthenia (64.4%), other taste and smell disorders observed were dysgeusia (25.6%) parosmia (20%) and phantosmia (7.8%), and 94.4% did not require hospitalization, the treatment received was vitamin C (76.2%), Zinc (68.3%), azithromycin (61.6%) The mean duration of anosmia initially was 51.4 +/- 77.6 days, with partial recovery in 45.6%, and total recovery in 35.6%, 60% presented a secondary odor disorder after recovery, made up of parosmia (69.5%) and anosmia (20.3%), the parosmia concerned onions (70.8%) perfume (66.2) coffee (63.1%) and meat (55.4%) The mean duration of ageusia initially was 38.9 +/- 60.8 days, with partial recovery in 30%, total recovery in 42.2%, 50% presented a secondary taste disorder after recovery Conclusion(s): Taste and smell disorders are common in covid-19 patients, and many continue to suffer from this condition even months after recovery from covid-19.

Olfactory training in long COVID-19 patients with lasting symptoms including olfactory dysfunction

INTRODUCTION. Two-thirds of patients with COVID-19 developed smell and taste dysfunction, of whom half experienced improvement within the first month. After six months, 5-15% still suffered from significant olfactory dysfunction (OD). Before COVID-19, olfactory training (OT) was proved to be effective in patients with post-infectious OD. Therefore, the present study aimed to investigate the progress of olfactory recovery with and without OT in patients with long COVID-19. METHODS. Consecutive patients with long COVID-19 referred to the Flavour Clinic at Godstrup Regional Hospital, Denmark, were enrolled. The diagnostic set-up at the first visit and follow-up included smell and taste tests, questionnaires, ENT examination and instructions in OT. RESULTS. From January 2021 to April 2022, 52 patients were included due to long COVID-19-related OD. The majority of patients complained of distorted sensory quality, in particular, parosmia. Two-thirds of the patients reported a subjective improvement of their sense of smell and taste along with a significant decline in the negative impact on quality of life (p = 0.0001). Retesting at follow-up demonstrated a significant increase in smell scores (p = 0.023) where a minimal clinically important difference (MCID) in smell scores was found in 23% of patients. Full training compliance was significantly associated with the probability of MCID improvement (OR = 8.13;p = 0.04). CONCLUSIONS. The average effect of OT is modest;however, full training compliance was significantly associated with an increased probability of a clinically relevant olfactory improvement. FUNDING. none. TRIAL REGISTRATION. not relevant.Copyright © 2023, Almindelige Danske Laegeforening. All rights reserved.

The Language of Smell: Code Failure

In today's world filled with complex signs and symbols, visual and auditory channels are the most intensive in semiotic terms. The language of smell, associated with the most ancient reactions, is usually considered as secondary and supplementary, and its possibilities for conveying meanings are limited to simple recognition. However, experts have been using the alphabet of smells to convey emotional messages from ancient times to date. The assessment of the role of odors in the modern world became possible due to the Covid-19 pandemic which often involved the loss, change or intensification of the sense of smell. In the course of the study 250 cases were considered, representing the stories associated with the disease and deviations in the perception of odors. The loss of the perception of unpleasant odors makes it impossible to learn about the dangers which cannot be perceived visually like in ancient times (spoiled food, poisoned air, etc.). Phantom interpretation of odors is often unpleasant: people can identify the smells of burning, ammonia, acetone, decomposition, feces, and others, and sometimes the excessiveness of an ordinary smell is unpleasant as well. The change of sign recognition can cause serious consequences for people. Phantom unpleasant odors can result in changes in eating habits and cause problems in communication. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Possible autoimmune pediatric encephalitis following COVID-19 infection with focal cerebral dysfunction in a young female: A case report

Introduction: Post-COVID-19 autoimmune encephalitis is a rare manifestation following COVID-19. Most cases have not demonstrated solid evidence regarding their pathogenesis. Some believe it to be an immune process. Case presentation: In this case report, we present a case of a young female who presented to our emergency department with visual, auditory, and olfactory hallucinations after successfully treating COVID-19 two weeks prior to this visit. On examination, her vital signs were stable, but she was agitated, distressed, and hallucinating. Neurological examinations were normal. Laboratory investigations, including autoimmune profiles, were all negative. Magnetic resonance imaging of the brain showed non-specific changes in the bilateral frontal area. Electroencephalography (EEG) showed lateralized rhythmic delta activity (LRDA) arising more from the right occipital lobes. Autoimmune psychosis was suspected due to psychosis, abnormal imaging, and abnormal EEG findings. She was given corticosteroids and antipsychotic medication. Her symptoms improved within ten days. On follow-up, she remained well without any return of psychosis. Conclusion(s): Possible autoimmune pediatric encephalitis following COVID-19 is a rare entity that has scarcely been reported. The majority of the cases were reported to have been related to stress following the infection. To establish the correct diagnosis, an extensive workup, including an autoimmune profile, lumbar puncture, magnetic resonance imaging, and electroencephalography, is recommended.Copyright © 2022 The Author(s)

Clinical and Epidemiological Characteristics of Multisystem Inflammatory Syndrome in Children amid the COVID-19 Pandemic.

Purpose. The study of epidemiological and clinical and laboratory features and outcomes of multisystem inflammatory syndrome in children who were hospitalized against the backdrop of the current COVID-19 pandemic. Materials and methods. In 19 months (May 2020 - December 2021) 63 patients with a diagnosis of "Multisystem inflammatory syndrome in children" (MIS-C) associated with COVID-19 were observed in Anesthesiology and Intensive Care departments of the Healthcare Institution "City Children's Infectious Clinical Hospital" in Minsk, Republic of Belarus. MIS-C was diagnosed according to CDC/WHO criteria, 2020. All calculations were carried using the R Statistical Package, version 4.1. The results of the analysis were considered statistically significant with p<0.05. Results. Focusing on the periods of circulation of dominant coronaviruses, we generated 3 groups of patients. The 1st group included 40 patients (63.5%) received treatment from 05.25.2020 to 02.21.2021 ("wuhan" strains);the 2nd group comprised 9 children (14.3%) from 02.23.2021 to 06.13.2021 ("alpha");and the 3rd group consists of 14 children (22.2%) from 07.01.2021 to 11.19.2021 ("delta"). 47 (74.6%) patients had complete and incomplete Kawasaki Disease phenotype of MIS-C;nonspecific phenotype was observed in 16 (25.4%) children. The mean age didn`t differ in study groups. It was 7+/-2.5;9.4+/-4.2;7.9+/-5 years respectively. All children presented hyperthermic syndrome with febrile fever 3-4 times a day of an average duration of 3.2 (1-15) days. Clinically, the course of MIS-C in children was not dependent on the circulating strain of the virus, and gastrointestinal dysfunction was observed with equal frequency in all three groups (73%, 78% and 57%, respectively). The only statistically significant increase in number of children with cheilitis was observed in the 2 group - 8 (89%) and the 3 group - 13 (93%), p=0.002. Neurological disorders such as headache, hyperesthesia, hallucinations, photophobia were more frequently observed in the 1st group of children - 19 (48%) cases, and less frequently in the 2nd and 3rd group (in 11% and 14% of cases), p=0.022. Pathological blood flow regurgitation was the most common disorder (68-71%). Several biochemical markers of inflammation levels, such as C-reactive protein (CRP) and procalcitonin (PCT) were high. CRP levels were 162 mg/l (130;245);130 mg/l (90;160);130 mg/l (106;149) in 1-2-3 study groups, respectively. In children of the 1st group CRP level was significantly higher, p=0.052. PCT level was higher in patients of the 3rd group (4.2 ng/ml (2.4;8.8);3.9 ng/ml (3.2;11.9);8.7 ng/ml (3.4;14.1), respectively, p=0.625). Conclusion. The study revealed no appreciable association between clinical or laboratory features of MIS-C and the dominant circulating strain of SARS-CoV-2 within given time periods. During "alpha" and "delta" strains circulation, only a decrease in the number of patients with neurological disorders and an increase in the frequency of cheilitis were of significant differences, p=0.002. The remaining indicators of organ dysfunction were similar in all three groups of children. There was 1 (1.6%) fatal outcome in our study.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.

Clinical and Epidemiological Characteristics of Multisystem Inflammatory Syndrome in Children amid the COVID-19 Pandemic.

Purpose. The study of epidemiological and clinical and laboratory features and outcomes of multisystem inflammatory syndrome in children who were hospitalized against the backdrop of the current COVID-19 pandemic. Materials and methods. In 19 months (May 2020 - December 2021) 63 patients with a diagnosis of "Multisystem inflammatory syndrome in children" (MIS-C) associated with COVID-19 were observed in Anesthesiology and Intensive Care departments of the Healthcare Institution "City Children's Infectious Clinical Hospital" in Minsk, Republic of Belarus. MIS-C was diagnosed according to CDC/WHO criteria, 2020. All calculations were carried using the R Statistical Package, version 4.1. The results of the analysis were considered statistically significant with p<0.05. Results. Focusing on the periods of circulation of dominant coronaviruses, we generated 3 groups of patients. The 1st group included 40 patients (63.5%) received treatment from 05.25.2020 to 02.21.2021 ("wuhan" strains);the 2nd group comprised 9 children (14.3%) from 02.23.2021 to 06.13.2021 ("alpha");and the 3rd group consists of 14 children (22.2%) from 07.01.2021 to 11.19.2021 ("delta"). 47 (74.6%) patients had complete and incomplete Kawasaki Disease phenotype of MIS-C;nonspecific phenotype was observed in 16 (25.4%) children. The mean age didn`t differ in study groups. It was 7+/-2.5;9.4+/-4.2;7.9+/-5 years respectively. All children presented hyperthermic syndrome with febrile fever 3-4 times a day of an average duration of 3.2 (1-15) days. Clinically, the course of MIS-C in children was not dependent on the circulating strain of the virus, and gastrointestinal dysfunction was observed with equal frequency in all three groups (73%, 78% and 57%, respectively). The only statistically significant increase in number of children with cheilitis was observed in the 2 group - 8 (89%) and the 3 group - 13 (93%), p=0.002. Neurological disorders such as headache, hyperesthesia, hallucinations, photophobia were more frequently observed in the 1st group of children - 19 (48%) cases, and less frequently in the 2nd and 3rd group (in 11% and 14% of cases), p=0.022. Pathological blood flow regurgitation was the most common disorder (68-71%). Several biochemical markers of inflammation levels, such as C-reactive protein (CRP) and procalcitonin (PCT) were high. CRP levels were 162 mg/l (130;245);130 mg/l (90;160);130 mg/l (106;149) in 1-2-3 study groups, respectively. In children of the 1st group CRP level was significantly higher, p=0.052. PCT level was higher in patients of the 3rd group (4.2 ng/ml (2.4;8.8);3.9 ng/ml (3.2;11.9);8.7 ng/ml (3.4;14.1), respectively, p=0.625). Conclusion. The study revealed no appreciable association between clinical or laboratory features of MIS-C and the dominant circulating strain of SARS-CoV-2 within given time periods. During "alpha" and "delta" strains circulation, only a decrease in the number of patients with neurological disorders and an increase in the frequency of cheilitis were of significant differences, p=0.002. The remaining indicators of organ dysfunction were similar in all three groups of children. There was 1 (1.6%) fatal outcome in our study.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.

Initial Psychotic Episode in a Patient with an Inborn Error of Cobalamin Metabolism Methylcobalamin Type cblG Deficiency: A Case Report

Background: The relationship between neuropsychiatric disorders and cobalamin deficiency is well known, but little information is available on psychiatric complications of inborn errors of intracellular cobalamin metabolism. These patients present with developmental delay, seizures, dementia and psychosis, causing elevated levels of homocysteine and intrinsic vitamin B12 deficiency (Watkins, 2011). In this report, we describe the manifestations and successful psychiatric treatment of a patient with an inborn error of cobalamin metabolism. Case: Mr. W is a 23-year-old male with cobalamin G defect, who was hospitalized for encephalopathy and hallucinations. Notable past medical history includes chronic kidney disease, seizures, intellectual disability, and hypothyroidism. He has no significant past psychiatric history. Due to the COVID-19 pandemic, the patient was increasingly isolated. Psychosis began with disorganized thoughts, progressing to delusions and eventually both auditory and visual hallucinations. Other notable exam findings include blunted affect and psychomotor retardation. Homocysteine levels were elevated from baseline. Cerebrospinal fluid showed elevated protein levels with the presence of 3-0-meythldopa. Risperidone was initiated, then switched to olanzapine due to reported side effects with persistence of psychosis. He was switched from olanzapine to aripiprazole after cross-titration and optimized on aripiprazole 10mg nightly, leading to a resolution in his psychiatric symptoms. Discussion(s): Mr. W's increased isolation may have led to increased stress, which has been associated with high levels of homocysteine in the literature (Gun Kang, 2005). Elevated homocysteine is reported in individuals with neuropsychiatric disorders (Moustafa, 2014). Additionally, high levels of homocysteine are linked with inflammatory bio-makers (Li, 2015). Aripiprazole and risperidone have been shown to decrease inflammatory biomarkers in patients with psychosis (Juncal-Ruiz, 2018). Conclusion(s): Patients with inborn errors of cobalamin metabolism have increased levels of homocysteine, which is associated with an inflammatory response and neuropsychiatric disorders. We recommend that psychosis in patients with an inborn error of cobalamin metabolism be initially treated with risperidone, and aripiprazole as a second-line treatment. Learning Objectives: 1. Describe the relationship between metabolic cobalamin deficiency and psychosis. 2. Question the role of transient biomarker elevation and psychosis. 3. Assess the treatment considerations for patients with metabolic cobalamin deficiency. References: 1. Watkins, D. & Rosenblatt, D. S. Inborn errors of cobalamin absorption and metabolism. American Journal of Medical Genetics 2011:157:33-44. 2. Gun Kang, M. et al. Job stress and cardiovascular risk factors in male workers. Preventive Medicine 2005;40:583-588. 3. Moustafa, A. et al. Homocysteine levels in schizophrenia and affective disorders-focus on cognition. Front Behav Neurosci 2014;8:343. 4. Li, T. et al. Serum Homocysteine Concentration Is Significantly Associated with Inflammatory/Immune Factors. PLOS ONE 2015;10:e0138099. 5. Juncal-Ruiz, M. et al. Comparison of the anti-inflammatory effect of aripiprazole and risperidone in 75 drug-naive first episode psychosis individuals: A 3 months randomized study. Schizophrenia Research 2018;202:226-233. Copyright © 2022

First episode psychosis related to COVID-19 infection

Introduction: During the course of COVID-19 pandemic, The respiratory system is the most commonly affected while many neuropsychiatric manifestations of the disease have been observed. Objective(s): Emphasize the importance of eliminating the diagnosis of covid 19 infection in a pandemic context face to first episode psychosis. Method(s): Presentation of case report Results: A 29-year-old woman unemployed married with no personal medical history and with psychiatric family history. She wasn't exposed to subject with covid 19 in her family circle. She was admitted in psychiatric care for acute behavioural disorders during five days. On physical examination: she was afebrile, eupneic and tachycardiac. Oxygen saturation was 96% and blood pressure was 100/50 mmHg. Specialized neurological examination was normal and cerebral CT scan was without abnormalities. At the psychiatric interview she was extremely agitated. She was distressed her speech was incoherent. She had auditory and visual hallucinations and a multi-thematic delirium. One day after her admission she died suddenly, the autopsy found positive RT PCR covid test and bilateral basal pneumonia. Conclusion(s): In individuals presenting with new-onset psychosis in areas endemic to COVID-19, consideration should be made for neuropsychiatric manifestations of Covid 19 from where the importance to push the explorations and to test the patients.

The double penalty of the coronavirus: Decidedly this virus has not yet revealed all its secrets!

Introduction: The direct and indirect effects of the COVID-19 pandemic on the mental health of the population have become a concern in the field of research in psychiatry. First psychotic episodes following infection with SARS cov2 have been reported. Objective(s): Through a clinical case, we will illustrate the association of psychiatric symptoms with SARS cov2 infection. Method(s): We discussed , through a clinical case, the association of psychiatric symptoms with infection by the coronavirus 19. Result(s): L.R, Tunisian 52-year-old, diabetic (type 2) women, with no personal or family psychiatric history and no toxic habits. she did not receive receive covid 19 vaccination. Twenty days before her admission to the psychiatry departement , she had fever, cough, myalgia, and anosmia .The diagnosis of a SARS COv2 infection was retained by her general practitioner. Two weeks later she suddenly presented a persecutory delirium, distressing auditory hallucinations, and attempted rat poison suicide. On admission, The patient had a delirium of persecution towards her entourage and an auditory hallucinatory syndrome with distressing content. She was put on 1 mg of Risperidone with restitution ad integrum after 7 days. COVID-19 serology test detected IgM antibodies which allowed us to conclude that the symptomatology was related to the infection by this virus. For the etiological research, we performed a serology that confirmed the recent exposure to SARS COV2 and. The diagnosis retained is a brief psychotic disorder post-Sars Cov2. Conclusion(s): The advanced hypothesis that infection with SARS CoV-2 could be the cause of the psychiatric manifestations remains unclear to this day.

Smelling different after COVID-19 ?

Introduction: Over the course of COVID 19 illness, olfactory dysfunction was largely described as hyposmia and anosmia. What about phantosmia? Objectives: In this study, we aimed to explore olfactory hallucinations among COVID 19 patients. Method(s): Our literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( phantosmia [MeSH terms]) OR (olfactory hallucinations[MeSH terms]) AND (COVID-19 [MeSH terms]). Result(s): Smell dysfonction is one of the most revealing sign of COVID 19 infection. However, other symptoms particularlty phantosmia tend to emerge later in the course of the disease. Female predominance was noted among patients sufferning from olfactory hallucinations regardless to their medical history. An unpleasant olfactory sensation was the most described sign. The occurene of phantosmia was also described in one case of women suffering from schizophrenia whom tested positive for COVID 19 infection. Conclusion(s): Olfactory hallucinations are more and more associated with COVID-19 disease regardless to psychiatric disorders. The pathological mechanism remains unclear and further studies are needed for a better comprehension and management.

Post-ictal psychosis syndrome : A case report

Introduction: Psychiatric comorbidity is prevalent among patients with epilepsy. Post-ictal psychosis syndrome (PIP) is a recent entity important to know. It belongs to the group of epileptic psychoses. The clinical presentation is often atypical, and symptoms are usually related to seizures. Objective(s): This work aimed to study the particularities of PIP. Method(s): It is a case report of PIP, involving a patient hospitalized in psychiatry department. Result(s): We report the case of a 45-year-old woman, with medical history of generalized epilepsy which was stabilized under antiepileptic treatment (phenobarbital 150 mg/day). The patient was hospitalized for psychomotor instability and inconsistent speech after having experienced a generalized tonicclonic seizure in the context of discontinuation of treatment. Psychiatric assessment revealed a hostility, a reluctance , a persecution delirium and auditory and visual hallucinations. A series of examinations have been carried out ;Neurological examination revealed no anomaly , a computed Tomography Scan of the Brain was normal. A lombar puncture was normal. A covid-19 infection was eliminated. The usual antiepileptic medication was reintroduced to the patient (Phenobarbital 150 mg/day), in association to benzodiazepines (clonazepam 4 mg/day). After 72 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days. A similar episode was reported two months earlier in the same circumstances with a similar symptomatology and a spontaneous resolution within 7 days. Conclusion(s): PPI syndrome, regardless of its good short-term prognosis, can potentially evolve into other psychiatric disorders of less good prognosis. Thus, this syndrome should be managed in collaboration with neurology and psychiatry.