Neurological and Psychiatric Manifestations of Post-COVID-19 Conditions.

BACKGROUND: We aimed to investigate the factors associated with neurological manifestations of post-coronavirus disease 2019 (COVID-19) conditions. METHODS: We retrospectively collected data from 440 patients who visited our post-COVID-19 clinic more than 4 weeks after severe acute respiratory syndrome coronavirus 2 infection. We analyzed the prevalence of different neurological symptoms (brain fog, memory impairment, headache, and dizziness) and assessed the associated factors. RESULTS: Brain fog was the most common symptom, observed in 170 patients (38.6%), followed by headaches (n = 137, 31.1%), dizziness (n = 128, 29%), and memory impairment (n = 104, 23.6%). Brain fog was associated with hyposmia or hypogeusia (odds ratio [OR], 2.54; P < 0.001), Fatigue Severity Scale (FSS) (OR, 1.06; P < 0.001), and Hospital Anxiety and Depression Scale-Anxiety (OR, 1.09; P = 0.037). Memory impairment was associated with sleep problems (OR, 2.83; P < 0.001), FSS (OR, 1.05; P < 0.001), and age (OR, 1.02; P = 0.015). Headache was associated with sleep problems (OR, 2.28; P = 0.001), sex (OR, 1.68; P = 0.042), and FSS (OR, 1.04; P < 0.001). Dizziness was associated with sleep problems (OR, 2.88; P < 0.001), and FSS (OR, 1.04; P < 0.001). The incidence of brain fog (P < 0.001), memory impairment (P < 0.001), dizziness (P = 0.007), and headache (P = 0.045) accompanied by hyposmia and hypogeusia was higher in patients with the aforementioned symptoms than in those without. CONCLUSION: This study suggests that there is a relationship between neurological symptoms and other clinical factors, such as fatigue, depression, anxiety, hyposmia, and hypogeusia.

Cognitive impairments in patients with subacute coronavirus disease: Initial experiences in a post-coronavirus disease clinic.

Background: A significant number of patients experience persistent cognitive impairment after coronavirus disease (COVID-19). This study aimed to investigate the cognitive function of patients in the subacute phase of COVID-19 and to identify the clinical factors associated with cognitive sequelae. Materials and methods: Data from patients who visited the psychiatric department of our post-COVID clinic between March and May 2022 were analyzed. The results of neuropsychiatric function tests, including the digit span forward (attention/processing speed) and backward (working memory) tests, the trail making test part A (attention/processing speed) and part B (executive functioning), and the Stroop word color interference test (executive functioning), as well as clinical data from 40 patients in the subacute phase of COVID-19 were analyzed. We calculated the frequency of impairments in each cognitive measure, defined as a z-score of ≤-1.5 standard deviations below measure-specific age- and sex-adjusted norms. Results: Of the participants, 72.5% (n = 29) had impairments in at least one cognitive domain. Impairment in executive function was the most frequent (64.9%), followed by impairments in processing speed/attention (52.5%) and working memory (42.5%). Age was inversely correlated with T scores in all cognitive function tests. Conclusion: Regular examination of cognitive function is needed, especially in elderly individuals, regardless of the subjective symptom manifestations.

Persistent Symptoms After Acute COVID-19 Infection in Omicron Era.

BACKGROUND: We aim to compare the clinical characteristics and subjectively reported symptoms of the acute coronavirus disease (COVID) phase and those of the post-acute COVID phase to examine varying factors that affect the number of persistent symptoms and their categories. METHODS: We categorized 1,122 patients who visited the post coronavirus disease 2019 (COVID-19) clinic into two groups: "acute group" (< 4 weeks following diagnosis of COVID-19) and "post-acute group" (> 4 weeks following diagnosis of COVID-19). We statistically compared clinical characteristics between the two groups and determined which factors are associated with the number of persistent symptoms and their categories. RESULTS: The persistent symptoms of post COVID-19 conditions were classified into three categories as follows: Category A (the prevalence of symptoms is higher in the acute-visit group than in the post-acute-visit group), Category B (the prevalence of symptoms is not different between the two groups) and Category C (the prevalence of symptoms is higher in the post-acute-visit group than in the acute-visit group). Category A mainly included respiratory symptoms. Category B had generalized weakness, weight loss, cardiologic symptoms, hypogeusia, hyposmia, anxiety, and various gastrointestinal symptoms. Category C included fatigue, decreased attention, depression, blurred vision, hair loss, and sexual dysfunction. Anxiety, depression, fatigue and age were also associated with the number of symptoms and their categories, and anxiety is the most correlated factor (P < 0.001) among them. CONCLUSION: The persistent symptoms of post COVID-19 condition involve multi-organ and continue for four weeks or greater. Therefore, long-term observation and multidisciplinary interventions are essential for patients with post COVID-19 conditions.

ROP-ESAT6-CFP10 as Tuberculosis-Specific Antigen in Interferon Gamma Release Assay.

OBJECTIVE: The ROP-ESAT6-CFP10 antigen (Changzhou Niujin Shisong Biotech [CBI], China) was recently developed using recombinant overlapping peptide (ROP) technology. We used ROP-ESAT6-CFP10 as a tuberculosis (TB)-specific antigen and compared it with existing interferon-gamma release assays (IGRAs). METHODS: Healthy volunteers and patients who were diagnosed with TB within a one-year period were enrolled. Samples were tested with QuantiFERON-TB Gold (QFT; QIAGEN Sciences Inc., USA), T-SPOT.TB (Oxford Immunotec, UK), and ELISpot using ROP-ESAT6-CFP10 as a TB-specific antigen (ROP-TB). For ROP-TB, two concentrations (1 µg and 5 µg) of ROP-ESAT6-CFP10 were used as TB-specific antigens. Agreement between assays was evaluated. RESULTS: A total of 35 TB patients and 20 healthy volunteers were evaluated. Agreement between T-SPOT.TB and ROP-TB 1 µg, QFT and ROP-TB 1 µg, and ROP-TB 1 µg and ROP-TB 5 µg/mL were 79.1% (kappa=0.483), 76.7% (kappa=0.557), and 95.3% (kappa=0.894), respectively. The median number of spots between the T-SPOT.TB and ROP-TB assays in the TB patients had no significant difference. CONCLUSIONS: ELISpot using newly developed ROP-ESAT6-CFP10 showed good agreement with T-SPOT.TB and QFT. Since ROP technology can lower the manufacturing cost, ROP-ESAT6-CFP10 might work as a good source of TB-specific antigen for IGRAs.

Peripheral neuropathy after extra-corporeal membrane oxygenation therapy in children: A case report.

RATIONALE: In recent years, the use of extracorporeal membrane oxygenation (ECMO) treatment for pediatric patients with cardiorespiratory failure has increased, with emphasis being given to the prevention of complications in ECMO-treated patients. Several studies have reported ECMO-related central nervous system complications, such as intracranial hemorrhage, cerebral infarction, and seizure. However, few cases of peripheral nerve injury have been reported in ECMO-treated adults; there have also been no reported cases of peripheral nerve injury in the pediatric population. PATIENT CONCERNS: Two pediatric patients aged 16 and 6 experienced motor weakness in the extremities after the insertion of ECMO equipment. DIAGNOSES: They were diagnosed with peripheral nerve injuries through an electrodiagnostic study that showed femoral/sciatic neuropathies and brachial plexopathy. Arteriography and doppler sonography was performed to find the cause of peripheral nerve injury, and this may be the results of vascular compromise and compressive injuries, respectively. INTERVENTIONS: Surgical embolectomy was performed to remove thrombus in one patient. Two patients received orthosis, and physical therapy and occupational therapy were performed to prevent contracture and improve strength and functional use. OUTCOMES: Two pediatric patients showed a gradual improvement in motor power and function. LESSONS: Through this case report, we present rare ECMO-related complications and emphasize the importance of early diagnosis and monitoring of peripheral nerve injury in ECMO-treated children.

Comparison of the clinical characteristics and mortality of adults infected with human coronaviruses 229E and OC43.

The purpose of the study was to compare clinical characteristics and mortality among adults infected with human coronaviruses (HCoV) 229E and OC43. We conducted a retrospective cohort study of adults (≥ 18 years) admitted to the ward of a university teaching hospital for suspected viral infection from October 2012 to December 2017. Multiplex real-time polymerase chain reaction (PCR) was used to test for respiratory viruses. Multivariate logistic regression was used to compare mortality among patients with HCoV 229E and HCoV OC43 infections. The main outcome was 30-day all-cause mortality. Of 8071 patients tested, 1689 were found to have a respiratory virus infection. Of these patients, 133 had HCoV infection, including 12 mixed infections, 44 HCoV 229E infections, and 77 HCoV OC43 infections. HCoV 229E infections peaked in January and February, while HCoV OC43 infections occurred throughout the year. The 30-day all-cause mortality was 25.0% among patients with HCoV 229E infection, and 9.1% among patients with HCoV OC43 infection (adjusted odds ratio: 3.58, 95% confidence interval: 1.19-10.75). Infections with HCoVs 229E and OC43 appear to have different seasonal patterns, and HCoV 229E might be more virulent than HCoV OC43.

Cluster Analysis of the Child Behavior Checklist 1.5-5 for Preschool Children Diagnosed With a Mental Disorder.

Research on the relationship between the Child Behavior Checklist (CBCL) and Diagnostic and Statistical Manual for Mental Disorder diagnoses for preschool children is scarce. Cluster analysis can be useful for investigating characteristics of a clinical group by using CBCL subscales and classifying subtypes of a Diagnostic and Statistical Manual for Mental Disorder diagnosis group. This study conducted a cluster analysis of the CBCL 1.5-5 for preschool children diagnosed with a mental disorder. Participants were 333 children (255 males and 78 females) aged 1.5 to 5 years who were diagnosed with a mental disorder. The CBCL 1.5-5 and Bayley Scales of Infant Development II were used as assessment instruments. Three clusters were extracted and then compared with CBCL 1.5-5 profiles of each Diagnostic and Statistical Manual for Mental Disorder-5 subject group to determine their clusters. Cluster 1 was named "intellectual disorder cluster." Cluster 2 was referred to as "other mental disorders cluster," and Cluster 3 was called "autism spectrum disorder cluster." When differences in profiles of behavior problems distinguished by CBCL 1.5-5 scales were examined among different clusters, discriminant validity was found to be high.

A Validation Study of the Korean Child Behavior Checklist 1.5-5 in the Diagnosis of Autism Spectrum Disorder and Non-Autism Spectrum Disorder.

OBJECTIVES: The purpose of this study was to analyze the discriminant validity and the clinical cut off scores of the Child Behavior Checklist 1.5-5 (CBCL 1.5-5) in the diagnosis of autism spectrum disorder (ASD) and non-ASD. METHODS: In total, 104 ASD and 441 non-ASD infants were included in the study. T-test, discriminant analysis, receiver operating characteristic (ROC) curve analysis, and odds ratio analysis were performed on the data. RESULTS: The discriminant validity was confirmed by mean differences and discriminant analysis on the subscales of Emotionally reactive, Somatic complaints, Withdrawn, Sleep problems, Attention problems, Aggressive behavior, Internalizing problems, Externalizing problems, and Total problems, along with the Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scales between the two groups. ROC analysis showed that the following subscales significantly separated ASD from normal infants: Emotionally reactive, Somatic complaints, Withdrawn, Sleep problems, Attention problems, Aggressive behavior, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems. Moreover, the clinical cut off score criteria adopted in the Korean-CBCL 1.5-5 were shown to be valid for the subscales Withdrawn, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems. CONCLUSION: The subscales of Withdrawn, Internalizing problems, Externalizing problems, Total problems, and DSM pervasive developmental problems significantly discriminated infants with ASD.

The Mediating Effects of Self-Esteem and Optimism on the Relationship between Quality of Life and Depressive Symptoms of Breast Cancer Patients.

OBJECTIVE: This study investigated the mediating effects of the internal psychological factors of self-esteem and optimism on the relationship between breast cancer patients' quality of life in terms of symptoms and functioning and depressive symptoms. METHODS: The study centered on 384 breast cancer patients who had within a 24-month period received diagnosis of 0-4 stage cancer and had medical treatment. To achieve the study's purpose, the study made use of EORTC QLQ BR23, CES-D, and the Self-Esteem and Optimism Scales. RESULTS: Findings revealed that breast cancer patients' quality of life was negatively impacted by self-esteem and optimism, and that self-esteem and optimism impacted negatively on depressive symptoms. Analyses showed that when breast cancer patients' quality of life affects depressive symptoms, the full mediation effect of self-esteem was statistically significant. Also, findings revealed there to be a significant partial mediation effect due to optimism. CONCLUSION: Study findings demonstrated that enhancing self-esteem is crucial in the psychological intervention of depressive symptoms because self-esteem functioned as the main causal factor accounting for all variation when breast cancer patients' quality of life affected depressive symptoms. In addition, results suggested that optimism is also vital to psychological intervention because it functioned as partial cause of heightened depressive symptoms when breast cancer patients' quality of life affected depressive symptoms.

Titrating Optimal Dose of Osmotic-Controlled Release Oral Delivery (OROS)-Methylphenidate and Its Efficacy and Safety in Korean Children with ADHD: A Multisite Open Labeled Study.

OBJECTIVE: This study was aimed to determine effectiveness and tolerability of Osmotic-controlled Release Oral delivery (OROS) methylphenidate (MPH) and its optimal dose administered openly over a period of up to 12 weeks in drug naïve Korean children with ADHD. METHODS: Subjects (n=143), ages 6 to 18-years, with a clinical diagnosis of any subtype of ADHD were recruited from 7 medical centers in Korea. An individualized dose of OROS-MPH was determined for each subject depending on the response criteria. The subjects were assessed with several symptom rating scales in week 1, 3, 6, 9 and 12. RESULTS: 77 of 116 subjects (66.4%) achieved the criteria for response and the average of optimal daily dose for response was to 30.05±12.52 mg per day (0.90±0.31 mg/kg/d) at the end of the study. Optimal dose was not significantly different between ADHD subtypes, whereas, significant higher dose was needed in older aged groups than younger groups. The average of optimal daily dose for response for the subjects aged above 12 years old was 46.38±15.52 per day (0.81±0.28 mg/kg/d) compared to younger groups (p<0.01). No serious adverse effects were reported and the dose did not have a significant effect on adverse effects. CONCLUSION: Optimal mean dose of OROS-MPH was significantly different by age groups. Higher dose was needed in older aged groups than younger groups. Effectiveness and tolerability of OROS-MPH in symptoms of ADHD is sustained for up to 12 weeks.

Variability of response time as a predictor of methylphenidate treatment response in korean children with attention deficit hyperactivity disorder.

PURPOSE: Methylphenidate (MPH) is an effective medication for the treatment of attention deficit hyperactivity disorder (ADHD). However, about 30% of patients do not respond to or are unable to tolerate MPH. Based on previous findings, we hypothesized that great variability in response time (RT) among Korean children with ADHD on a computerized continuous performance attention test would be related to poor MPH treatment response. MATERIALS AND METHODS: Children (ages 6-18 years) with ADHD were recruited for a prospective 12-week, open-labeled, multicenter study to examine optimal dosage of OROS methylphenidate. Of the 144 subjects selected, 28 dropped out due to adverse events, medication noncompliance, or follow-up loss, and an additional 26 subjects with comorbid disorders were excluded from statistical analyses. We defined 'responders' as subjects who received a score of less than 18 on the attention deficit hyperactivity disorder rating scale (ARS; Korean version, K-ARS) and a score of 1 or 2 on the Clinical Global Impression-Improvement scale (CGI-I). RT variability was assessed with the ADHD diagnostic system (ADS). RESULTS: Fifty-nine (67%) subjects responded to MPH treatment. The non-responders showed greater RT variability at baseline (Mann Whitney U = 577.0, p < 0.01). Baseline RT variability was a significant predictor of MPH response (Nagelkerke R(2) = 0.136, p < 0.01). It predicted 94.9% of responder, 17.2% of non-responder and 69.3% of overall group. CONCLUSION: High RT variability may predict poor response to MPH treatment in children with ADHD.

Effects of methylphenidate on quantitative EEG of boys with attention-deficit hyperactivity disorder in continuous performance test.

The purpose of this study was to investigate the effects of methylphenidate, a psychostimulant, on quantitative electroencephalography (QEEG) during the continuous performance test (CPT) in boys with attention-deficit hyperactivity disorder (ADHD). The QEEG was obtained from 20 boys with ADHD. The amplitudes of 4 bands (alpha, beta, delta, and theta) in the QEEG, as well as the theta /beta ratio, before and after the administration of methylphenidate were compared during both the resting and CPT states. Methylphenidate induced a significant increase of alpha activities in both the right and left frontal and occipital areas, an increase of beta activities in almost all areas except for the temporal region, a decrease of theta activities in both the occipital and right temporo-parietal areas, a mild decrease of delta activities in the occipito-parietal areas, and an increase of the theta/beta ratio in the right frontal and parieto-occipital, and left temporal areas during the CPT state. No significant QEEG changes were induced by the administration of methylphenidate in the resting state. These data suggest that methylphenidate has greater electrophysiological influences on the cerebral topographical activities during the performance of attentional tasks, as compared to the resting state, in boys with ADHD.