Bilateral Facial Paralysis in an Atypical Clinical Onset of COVID-Associated Guillain-Barre Syndrome.

Coronavirus disease (COVID-19) has been associated with a diverse range of extrapulmonary manifestations since its global outbreak in 2019. One of its rare complications is Guillain-Barre Syndrome (GBS), a post-infectious neurological disorder that manifests with a characteristic ascending limb paralysis. Here, we describe the atypical case of a 42-year-old African American male who developed bilateral facial paralysis within five weeks of testing positive for COVID-19. Initial diagnostic imaging and blood studies were negative for acute pathology. Albuminocytological dissociation found in a subsequent analysis of the patient's cerebrospinal fluid and his appropriate therapeutic response to intravenous immunoglobulin (IVIg) indicated GBS as the most likely diagnosis.

The Effect of Sex on the Risk of Long-COVID and Cardiovascular Complications in Healthy Patients without Comorbidities: Data from a Polish Long-COVID Cardiovascular (PoLoCOV-CVD) Study.

Background: The prevalence of long-COVID (LC) presents a significant challenge to healthcare systems globally. There are still some discrepancies on the role of sex as an independent risk factor of LC complications. Thus, we aimed to determine the differences in clinical and cardiovascular complications between males and females without comorbidities after COVID-19. Methods: Clinical data on the course of the disease with the accompanying symptoms and post-COVID-19 symptoms were compiled from both male and female subjects with a minimum 12-week interval after COVID-19 recovery. Next, the patients were followed for 12 months. ECG, echocardiography, 24 h ECG monitoring, 24 h ambulatory blood pressure monitoring (ABPM), and selected biochemical tests were performed. LC was diagnosed based on the World Health Organization (WHO) definition. To reduce the impact of confounders, i.e., body mass index (BMI) and age, on the results of the study, the nearest neighbour (NN) propensity score matching (PSM) method with a 1:1 ratio was used. Results: The results were obtained following the removal of cases with comorbidities from the database consisting of 1237 males and 2192 females, and PSM of the new database included 886 cases (443 males and 443 females). At both the 3-month and 1-year post-recovery marks, females consistently reported a higher frequency of LC symptoms compared to males (p < 0.001 for both comparisons). Moreover, after 1 year of follow-up, females exhibited a higher prevalence of LC compared to males, with rates of 14% versus 8.3%, respectively (p = 0.013). The symptoms that significantly differed between females and males in the 12-month follow-up were hair loss (5.4 vs. 0.7%, p < 0.001), memory and concentration disturbances (8.4 vs. 4.3%, p = 0.013), and headaches (4.3 vs. 1.4%, p = 0.008). Females presented lower mean arterial pressure (MAP) [89 (83-95) mmHg versus (vs.) 94 (89-100); p < 0.001] and lower pulse pressure (PP) [46 (42-52) mmHg vs. 51 (48-57); p < 0.001] in 24 h ABPM and more elevated heart rates (HRs) in 24 h ECG monitoring as well as arrhythmia (p < 0.001 and p = 0.018, respectively). Males had a higher occurrence of ECG abnormalities such as QRS >= 120 ms, ST-T changes, T inversion, arrhythmia, and QRS fragmentation (27.3% vs. 19.2%; p = 0.004). No significant differences were observed between males and females concerning physical activity levels, stress, fatigue, alcohol consumption, and smoking habits. Conclusions: One year post-COVID-19 recovery, regardless of age and BMI, healthy females more often suffered from LC symptoms than males. They had lower MAP and PP in 24 h ABPM, more often had higher HRs and arrhythmia in 24 h ECG monitoring, and fewer ECG abnormalities than males.

The lingering symptoms of post-COVID-19 condition (long-COVID): a prospective cohort study.

BACKGROUND: Longer-term symptoms (long COVID) may be present in seemingly recovered patients for several months and can be debilitating. AIM: To investigate the prevalence and type of symptoms in those with a prior COVID-19 diagnosis. METHODS: This prospective, longitudinal observational study commenced in July 2020 investigating the longer-term health impacts of COVID-19. Participants were recruited via public health units and media publicity. Surveys were completed upon enrolment, and at 1, 3, 6 and 12 months. Outcome measures included incidence of activity limitations and symptoms against health and vaccination status, age and gender. RESULTS: Overall, 339 participants were recruited. At 3 months after COVID-19, 66.8% reported symptoms, and 44.8% were still experiencing symptoms at 12 months. Fatigue was most common at every point (between 53.1% and 33.1%). Pain symptoms increased in relative prevalence over time, whereas respiratory/pulmonary-type symptoms decreased substantially after 3 months. Females and younger people were more likely to experience symptoms in the early stages of long COVID (P < 0.01) and those with more comorbidities in the latter stages (P < 0.001). Vaccination showed a statistically significant protective effect against symptoms (P < 0.01-0.001). CONCLUSION: Long-term COVID-19 symptoms exist among recovered patients up to 12 months after contracting the virus. Fatigue is a primary contributor, while chronic pain became more problematic after 6 months. Vaccination was a factor in preventing long-term symptoms and aiding faster recovery from symptoms. Further work exploring additional contributors to symptom prevalence would assist in developing appropriate follow-up care.

[Post-Covid osteomyelitis of the facial bones]. / Postkovidnyi osteomielit litsevykh kostei.

The pandemic of coronavirus infection existed from 2019 to 2023. The World Health Organization (WHO) has announced on May 5, 2023 that the pandemic had ended. However, it does not cease to have an adverse effect on the health of the world population. Necrotic lesions of the bones of the facial skeleton are now a characteristic sign of a severe coronavirus infection. We conducted a review of scientific publications that reflected the relationship between coronavirus and necrotic processes of the skull bones, methods of treatment, prevention and the latest developments in this direction. The purpose of this article is to review existing studies on Post-Covid osteomyelitis of facial bones, its impact, features of the clinical picture of this disease, analysis of methods and means of treatment of this group of patients. Analysis of literature data has shown that the search for an ideal dressing material continues, especially the developments of native developers stand emphasized. The advantages of modern materials over traditional ones have become unquestionable, but further research in this direction is required.

Vitamin D and COVID-19: An Update on Evidence and Potential Therapeutic Implications.

The COVID-19 pandemic created havoc in the whole world since 2019. It is an explosively spreading infectious disease in which the infectious agent enters the body through sneezing coughing touching etc. The primary site of infection is the respiratory system, and the various common symptoms are dry cough, fever, dyspnea, sore throat, nasal congestion, and loss of taste sensation. A majority of the patients experience diarrhea, vomiting, severe headache, and muscle pain. Many research have been undertaken to study the therapeutic implications of different elements in coronavirus infection. One such element of interest is vitamin D. There is evidence in the literature regarding the usefulness of vitamin D in severe acute respiratory distress syndrome (ARDS) and several respiratory diseases. As the site of infection in coronavirus infection is primarily the respiratory system, reviewing in detail the correlation of this vitamin with SARS-CoV-2 infection, is an area of keen interest. Thus, the aim of this article is to explore and describe in detail the relation between the two, with reference to levels of this vitamin in diagnosed subjects and a need for its supplementation in the management of coronavirus infection and also in the prevention of post-COVID-19 complications. The review concluded that Vitamin D has an immunomodulating function. Its deficiency may lead to severe respiratory illnesses including ARDS. Vitamin D levels affect the disease course in COVID-19 infection and proper blood concentration can reduce the severity of the symptoms as well as post-COVID-19 complications.

Comprehensive Risk Assessment of Infection Induced by SARS-CoV-2.

The pandemic COVID-19 (coronavirus disease 2019) is caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which devastated the global economy and healthcare system. The infection caused an unforeseen rise in COVID-19 patients and increased the mortality rate globally. This study gives an overall idea about host-pathogen interaction, immune responses to COVID-19, recovery status of infection, targeted organs and complications associated, and comparison of post-infection immunity in convalescent subjects and non-infected individuals. The emergence of the variants and episodes of COVID-19 infections made the situation worsen. The timely introduction of vaccines and precautionary measures helped control the infection's severity. Later, the population that recovered from COVID-19 grew significantly. However, understanding the impact of healthcare issues resulting after infection is paramount for improving an individual's health status. It is now recognised that COVID-19 infection affects multiple organs and exhibits a broad range of clinical manifestations. So, post COVID-19 infection creates a high risk in individuals with already prevailing health complications. The identification of post-COVID-19-related health issues and their appropriate management is of greater importance to improving patient's quality of life. The persistence, sequelae and other medical complications that normally last from weeks to months after the recovery of the initial infection are involved with COVID-19. A multi-disciplinary approach is necessary for the development of preventive measures, techniques for rehabilitation and strategies for clinical management when it comes to long-term care.

Calcium, Phosphorus and Magnesium Abnormalities Associated with COVID-19 Infection, and Beyond.

The coronavirus disease (COVID-19) pandemic caused by the novel coronavirus SARS-CoV-2 has had a profound impact on global health, leading to a surge in research to better understand the pathophysiology of the disease. Among the various aspects under investigation, disruptions in mineral homeostasis have emerged as a critical area of interest. This review aims to provide an overview of the current evidence linking calcium, phosphorus and magnesium abnormalities with COVID-19 infection and explores the potential implications beyond the acute phase of the disease. Beyond the acute phase of COVID-19, evidence suggests a potential impact of these mineral abnormalities on long-term health outcomes. Persistent alterations in calcium, phosphorus and magnesium levels have been linked to increased cardiovascular risk, skeletal complications and metabolic disorders, warranting continuous monitoring and management in post-COVID-19 patients.

Post-COVID Fungal Osteomyelitis-Another Killer.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been sweeping across the globe as a pandemic. Based on a retrospective analysis of SARS data from worldwide, it is summarized that the fungal co-infections associated with global COVID-19 might be missed or misdiagnosed. Along with, we report case series of fungal infections in the maxilla and in the orbit, who were successfully treated for covid-19 and are on regular follow-up.

A Case Report on the Atypical Symptoms of the Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome: Could COVID-19 Be a Cause?

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare disorder with a spectrum of manifestations and overlapping osseous and cutaneous symptoms, shares pathogenesis with various autoimmune diseases. SARS-CoV-2 has been previously linked to various autoimmune diseases like Guillain-Barré syndrome (GBS), a multi-inflammatory syndrome in children (MIS-C), or rheumatoid arthritis, but there is no existing work showing a link between SAPHO syndrome and COVID-19 yet. Here, we present a case of a middle-aged Asian male who presented with minimum swelling of his right second toe, 21 days post-COVID. After a series of investigations, namely, MRI scans, 99mTc-methylene diphosphonate three-phase bone scan, and bone biopsy, followed by a positive culture and sensitivity test of the same toe, a trial of vancomycin was given to the patient to treat bacterial osteomyelitis. This resulted in no improvement, pointing toward a misdiagnosis. A conclusion of sterile osteomyelitis of his right second and third metatarsal heads and phalanges due to SAPHO syndrome, as a possible complication of SARS-CoV-2 infection, was made. There are a number of classification systems for diagnosing this syndrome, one of which was modified by Kahn and was used in our case. Atypical presentations of rare disorders like SAPHO syndrome and their relation to SARS-CoV-2 infection are still to be fully discovered and investigated. Their prevention, timely diagnosis, and management may help in alleviating the discomfort and fear associated with the unknown for the patients.

Cerebral Vasomotor Reactivity in COVID-19: A Narrative Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system but can also lead to neurological complications. Among COVID-19 patients, the endothelium is considered the Achilles heel. A variety of endothelial dysfunctions may result from SARS-CoV-2 infection and subsequent endotheliitis, such as altered vascular tone, oxidative stress, and cytokine storms. The cerebral hemodynamic impairment that is caused is associated with a higher probability of severe disease and poor outcomes in patients with COVID-19. This review summarizes the most relevant literature on the role of vasomotor reactivity (VMR) in COVID-19 patients. An overview of the research articles is presented. Most of the studies have supported the hypothesis that endothelial dysfunction and cerebral VMR impairment occur in COVID-19 patients. Researchers believe these alterations may be due to direct viral invasion of the brain or indirect effects, such as inflammation and cytokines. Recently, researchers have concluded that viruses such as the Human Herpes Virus 8 and the Hantavirus predominantly affect endothelial cells and, therefore, affect cerebral hemodynamics. Especially in COVID-19 patients, impaired VMR is associated with a higher risk of severe disease and poor outcomes. Using VMR, one can gain valuable insight into a patient's disease progression and make more informed decisions regarding appropriate treatment options. A new pandemic may develop with the COVID-19 virus or other viruses, making it essential that healthcare providers and researchers remain focused on developing new strategies for improving survival in such patients, particularly those with cerebrovascular risk factors.

Solanum nigrum L. in COVID-19 and post-COVID complications: a propitious candidate.

COVID-19 is caused by severe acute respiratory syndrome coronavirus-2, SARS-CoV-2. COVID-19 has changed the world scenario and caused mortality around the globe. Patients who recovered from COVID-19 have shown neurological, psychological, renal, cardiovascular, pulmonary, and hematological complications. In some patients, complications lasted more than 6 months. However, significantly less attention has been given to post-COVID complications. Currently available drugs are used to tackle the complications, but new interventions must address the problem. Phytochemicals from natural sources have been evaluated in recent times to cure or alleviate COVID-19 symptoms. An edible plant, Solanum nigrum, could be therapeutic in treating COVID-19 as the AYUSH ministry of India prescribes it during the pandemic. S. nigrum demonstrates anti-inflammatory, immunomodulatory, and antiviral action to treat the SARS-CoV-2 infection and its post-complications. Different parts of the plant represent a reduction in proinflammatory cytokines and prevent multi-organ failure by protecting various organs (liver, kidney, heart, neuro, and lung). The review proposes the possible role of the plant S. nigrum in managing the symptoms of COVID-19 and its post-COVID complications based on in silico docking and pharmacological studies. Further systematic and experimental studies are required to validate our hypothesis.

COVID associated pulmonary mucormycosis: Outcomes of surgical therapy.

OBJECTIVES: This study aims at reporting the surgical outcomes of COVID associated pulmonary mucormycosis with special emphasis on surgical mortality. METHODS: This prospective observational study was conducted in a dedicated thoracic surgical unit in Gurugram, India over 18 months. An analysis of demography, peri-operative variables were carried out. Various parameters were analysed to assess the factors affecting mortality. RESULTS: Total of 44 patients with diagnosis of CAPM were managed during the study period. All were started on anti-fungal therapy. However, 33 patients (75%) were operated whereas rest 11 (25%) were not considered suitable for surgery. In the surgical cohort (n = 33), there were 20 males (60.6%) and 13 females (39.4%), with a mean age of 54.8 years (range, 33-72 years). The mean duration of the symptoms was 1.1 weeks. Non-anatomical wedge resection of lobe(s) was performed in 5 patients (15.1%), lobectomy/bi-lobectomy was required in 26 patients (78.9%) and left pneumonectomy in 2 patients (6%). There were 5 peri-operative deaths (15.1%), all due to fungal sepsis. ECOG scale > 2 (P ≤ 0.001), higher Charlson Comorbidity Index score > 2 (P = 0.04) and pneumonectomy (P = 0.02) were the predictors of mortality. On comparison with NCPM, there was no difference in the incidence of post-operative complications (P = 0.50) and the post-operative mortality (P = 0.69). CONCLUSION: Aggressive surgical resection with clear margins should be offered in CAPM, whenever feasible. Surgery for CAPM was not associated with higher post-operative complications including mortality compared to Non-COVID Pulmonary Mucormycosis.

Predictors of Long COVID in Patients without Comorbidities: Data from the Polish Long-COVID Cardiovascular (PoLoCOV-CVD) Study.

Background: The SARS-CoV-2 pandemic has become an enormous worldwide challenge over the last two years. However, little is still known about the risk of Long COVID (LC) in patients without comorbidities. Thus, we aimed to assess the predictors of LC in patients without comorbidities. Methods: Patients' information, the course of the disease with symptoms, and post-COVID-19 complaints were collected within 4−12 weeks after COVID-19 recovery. Next, the patients were followed for at least 3 months. ECG, 24-h ECG monitoring, 24-h blood pressure (BP) monitoring, echocardiography, and selected biochemical tests were performed. LC was recognized based on the WHO definition. Results: We identified 701 consecutive patients, 488 of whom completed a 3-month follow-up (63% women). Comparisons were made between the LC group (n = 218) and patients without any symptoms after SARS-CoV-2 recovery (non-LC group) (n = 270). Patients with a severe course of acute-phase COVID-19 developed LC complications more often (34% vs. 19%, p < 0.0001). The persistent symptoms were observed in 45% of LC patients. The LC group also had significantly more symptoms during the acute phase of COVID-19, and they suffered significantly more often from dyspnoea (48 vs. 33%), fatigue (72 vs. 63%), chest pain (50 vs. 36%), leg muscle pain (41 vs. 32%), headache (66 vs. 52%), arthralgia (44 vs. 25%), and chills (34 vs. 25%). In LC patients, significant differences regarding sex and body mass index were observed­woman: 69% vs. 56% (p = 0.003), and BMI: 28 [24−31] vs. 26 kg/m2 [23−30] (p < 0.001), respectively. The number of symptoms in the acute phase was significantly greater in the LC group than in the control group (5 [2−8] vs. 2 [1−5], p = 0.0001). The LC group also had a higher 24-h heart rate (77 [72−83] vs. 75 [70−81], p = 0.021) at admission to the outpatient clinic. Multivariate regression analysis showed that LC patients had a higher BMI (odds ratio (OR): 1.06, 95% confidence intervals [CI]: 1.02−1.10, p = 0.007), almost twice as often had a severe course of COVID-19 (OR: 1.74, CI: 1.07−2.81, p = 0.025), and presented with joint pain in the acute phase (OR: 1.90, CI: 1.23−2.95, p = 0.004). Conclusions: A severe course of COVID-19, BMI, and arthralgia are independently associated with the risk of Long COVID in healthy individuals.

Post-COVID-19 pulmonary cavitation and tension pneumothorax in a non-ventilated patient.

Cavitation and pneumothorax are independently associated with high morbidity and mortality in coronavirus disease-2019 (COVID-19). While spontaneous (non-traumatic) pneumothorax formation has commonly been observed among mechanically ventilated COVID-19 patients, there are few rare reports of COVID-19 associated pneumothorax without any history of barotrauma and other conventional risk factors. Here, we report a unique case of post-COVID-19 cavitation and tension pneumothorax which was further complicated by hydropneumothorax formation in a young patient who suffered severe COVID-19 pneumonia 4 weeks back. As the patient was devoid of any conventional risk factors, we believe that persistent inflammatory alveolar damage even after clinical recovery from COVID-19 played a key role in pulmonary cavitation followed by pneumothorax formation. With prompt clinical and radiological recognition of these fatal, yet treatable complications of COVID-19 pneumonia, the patient was saved and had an uneventful recovery.

Long-Term Cardiovascular Effects of COVID-19: Emerging Data Relevant to the Cardiovascular Clinician.

PURPOSE OF REVIEW: COVID-19 is now a global pandemic and the illness affects multiple organ systems, including the cardiovascular system. Long-term cardiovascular consequences of COVID-19 are not yet fully characterized. This review seeks to consolidate available data on long-term cardiovascular complications of COVID-19 infection. RECENT FINDINGS: Acute cardiovascular complications of COVID-19 infection include myocarditis, pericarditis, acute coronary syndrome, heart failure, pulmonary hypertension, right ventricular dysfunction, and arrhythmia. Long-term follow-up shows increased incidence of arrhythmia, heart failure, acute coronary syndrome, right ventricular dysfunction, myocardial fibrosis, hypertension, and diabetes mellitus. There is increased mortality in COVID-19 patients after hospital discharge, and initial myocardial injury is associated with increased mortality. Emerging data demonstrates increased incidence of cardiovascular illness and structural changes in recovered COVID-19 patients. Future research will be important in understanding the clinical significance of these structural abnormalities, and to determine the effect of vaccines on preventing long-term cardiovascular complications.

Therapeutics for COVID-19 and post COVID-19 complications: An update.

Since its inception in late December 2020 in China, novel coronavirus has affected the global socio-economic aspect. Currently, the world is seeking safe and effective treatment measures against COVID-19 to eradicate it. Many established drug molecules are tested against SARS-CoV-2 as a part of drug repurposing where some are proved effective for symptomatic relief while some are ineffective. Drug repurposing is a practical strategy for rapidly developing antiviral agents. Many drugs are presently being repurposed utilizing basic understanding of disease pathogenesis and drug pharmacodynamics, as well as computational methods. In the present situation, drug repurposing could be viewed as a new treatment option for COVID-19. Several new drug molecules and biologics are engineered against SARS-CoV-2 and are under different stages of clinical development. A few biologics drug products are approved by USFDA for emergency use in the covid management. Due to continuous mutation, many of the approved vaccines are not much efficacious to render the individual immune against opportunistic infection of SARS-CoV-2 mutants. Hence, there is a strong need for the cogent therapeutic agent for covid management. In this review, a consolidated summary of the therapeutic developments against SARS-CoV-2 are depicted along with an overview of effective management of post COVID-19 complications.

Mechanisms of the Effects of Short-Term Inhalations of Xe and O2 Gas Mixture in the Rehabilitation of Post-COVID Ventilation Failure.

The article presents a theoretical rationale and a clinical case of relief of post-COVID ventilation failure by inhalation of Xe and O2 gas mixture. Pneumonitis of coronavirus etiology transforms saturated phospholipids of surfactant into a solid-ordered phase, which disrupts surface tension, alveolar pneumatization, and alveolar-capillary gas exchange. Using molecular modeling (B3LYP/lanl2dz; GAUSSIAN09), we demonstrated that Xe atom due to the van der Waals dispersion interaction increases the distance between the phospholipid acyl chains providing a phase transition from the solid-ordered to liquid phase and restored the surface-active monolayer surfactant film. A clinical case confirmed that short-term inhalations of the Xe and O2 gas mixture relieved manifestations of ventilation insufficiency and increased SpO2 and pneumatization of the terminal parts of the lungs.

Role of ACE2-Ang (1-7)-Mas axis in post-COVID-19 complications and its dietary modulation.

Severe acute respiratory syndrome-coronavirus-2 (COVID-19) virus uses Angiotensin-Converting Enzyme 2 (ACE2) as a gateway for their entry into the human body. The ACE2 with cleaved products have emerged as major contributing factors to multiple physiological functions and pathogenic complications leading to the clinical consequences of the COVID-19 infection Decreased ACE2 expression restricts the viral entry into the human cells and reduces the viral load. COVID-19 infection reduces the ACE2 expression and induces post-COVID-19 complications like pneumonia and lung injury. The modulation of the ACE2-Ang (1-7)-Mas (AAM) axis is also being explored as a modality to treat post-COVID-19 complications. Evidence indicates that specific food components may modulate the AAM axis. The variations in the susceptibility to COVID-19 infection and the post-COVID its complications are being correlated with varied dietary habits. Some of the food substances have emerged to have supportive roles in treating post-COVID-19 complications and are being considered as adjuvants to the COVID-19 therapy. It is possible that some of their active ingredients may emerge as the direct treatment for the COVID-19.

Multiple Sclerosis Following SARS-CoV-2 Infection: A Case Report and Literature Review.

Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory coronavirus 2 (SARS-CoV-2). Apart from respiratory manifestations, COVID-19 can affect the nervous system due to its neurotropic features. Neurological manifestations and complications include headache, polyneuropathies, cerebrovascular accidents, seizures, encephalopathy, and demyelinating disease. We describe a case of multiple sclerosis, a demyelinating disease following COVID-19 infection, rarely reported in the literature. A 47-year-old female presented with fatigue, blurry vision, numbness, and signs of upper motor neuron lesions that had occurred three weeks after COVID-19 infection. Magnetic resonance imaging of the brain revealed demyelinating lesions in the periventricular area of both hemispheres, suggesting a demyelinating disease. A provisional diagnosis of multiple sclerosis was made. Her condition improved after the commencement of methylprednisolone.