Chronic cough in post-COVID syndrome: Laryngeal electromyography findings in vagus nerve neuropathy.

BACKGROUND: Despite being a new entity, there is a large amount of information on the characteristics of SARS-CoV-2 infection and the symptoms of the acute phase; however, there are still many unknowns about the clinical features and pathophysiology of post-COVID syndrome. Refractory chronic cough is one of the most prevalent symptoms and carries both a medical problem and a social stigma. Many recent studies have highlighted the role of SARS-CoV-2 neurotropism, but no studies have demonstrated vagus nerve neuropathy as a cause of persistent chronic cough or other COVID-19 long-term effects. OBJECTIVE: The main objective was to assess the involvement of the vagus nerve neuropathy as a cause of chronic cough and other post-COVID syndrome symptoms. MATERIAL AND METHODS: This was a single-center observational study with prospective clinical data collected from 38 patients with chronic cough and post-COVID-19 syndrome. Clinical characteristics and laryngeal electromyographic findings were analyzed. RESULTS: Clinical data from 38 patients with chronic cough after 12 weeks of the acute phase of COVID-19 infection were analyzed. Of these patients, 81.6% suffered from other post-COVID conditions and, 73.6% reported fluctuating evolution of symptoms. Laryngeal electromyography (LEMG) of the thyroarytenoid (TA) muscles and cricothyroid (CT) muscles was pathological in 76.3% of the patients. Of the patients with abnormal LEMG, chronic denervation was the most frequent finding (82.8%), 10.3% presented acute denervation signs, and 6.9% presented myopathic pattern in LEMG. CONCLUSIONS: LEMG studies suggest the existence of postviral vagus nerve neuropathy after SARS-CoV-2 infection that could explain chronic cough in post-COVID syndrome.

Hallazgos electroencefalográficos compatibles con encefalopatía en pacientes ingresados por covid-19 / Electroencephalographic findings compatible with encephalopathy in patients admitted for COVID-19

RESUMEN INTRODUCCIÓN: La covid-19 afecta principalmente al aparato respiratorio, sin embargo, también se ha descrito afectación tanto directa como indirecta en el sistema nervioso central y periférico, lo cual ocasiona una gran variedad de manifestaciones neurológicas, siendo la encefalopatía una de las más frecuentemente observadas. OBJETIVO: Se busca mostrar la utilidad del video-electroencefalograma (vEEG) en el diagnóstico de encefalopatía en pacientes ingresados por covid-19, así como su valor para determinar el pronóstico de estos pacientes. MÉTODOS: Estudio observacional retrospectivo con 76 vEEG de 41 pacientes con covid-19 confirmada. Los estudios se han realizado entre los meses de marzo del 2020 y junio del 2021. Se estudió la gravedad de la enfermedad, así como sus características clínicas y neurológicas, el tratamiento farmacológico y los hallazgos electroencefalográficos según el grado de disfunción de la encefalopatía que desarrollaron estos pacientes. RESULTADOS: De los 41 pacientes, 12 (29 %) presentaron signos electroencefalográficos de disfunción cerebral leve, 15 (37 %) disfunción cerebral moderada y 14 (34 %) disfunción cerebral severa, los cuales se asociaron con una mayor mortalidad. CONCLUSIONES: En los 76 vEEG realizados a los 41 pacientes ingresados con encefalopatías asociadas con infección por covid-19, no se observó un patrón distinto a los descritos en encefalopatías de otras etiologías. El vEEG fue útil para confirmar la sospecha clínica de una disfunción cerebral en pacientes con encefalopatías asociadas con infección por covid-19 y para asignarle un grado de severidad, confirmando su beneficio como biomarcador diagnóstico y pronóstico.

ABSTRACT INTRODUCTION: COVID-19 mainly affects the respiratory system; however, both direct and indirect involvement of the central and peripheral nervous system has also been described, causing a wide variety of neurological manifestations, with encephalopathy being one of the most frequently observed neurological manifestations. OBJECTIVE: With this article we intend to show the usefulness of vEEG in the diagnosis of encephalopathy in patients referred for COVID-19 who develop this neurological complication, as well as its value in determining the prognosis of these patients. METHODS: Retrospective observational study with 76 video-electroencephalograms of 41 patients with confirmed COVID-19 infection. The studies were performed during the months of March 2020 through June 2021. Disease severity, clinical and neurological features, pharmacological treatment and electroencephalographic indings were studied according to the degree of encephalopathy dysfunction these patients developed. RESULTS: Of the 41 patients, 12 (29 %) presented electroencephalographic signs of mild cerebral dysfunction, 15 (37 %) moderate cerebral dysfunction, and 14 (34 %) severe cerebral dysfunction, which were associated with higher mortality. CONCLUSIONS: In the 76 vEEG performed in the 41 patients admitted with encephalopathies associated with COVID-19 infection, no pattern different from that described in encephalopathies of other etiologies was observed. The vEEG was useful to confirm the clinical suspicion of brain dysfunction in patients with encephalopathies associated with COVID-19 infection and to assign a degree of severity, confirming its benefit as a diagnostic and prognostic biomarker.

Parvimonas micra: A potential causative pathogen to consider when diagnosing odontogenic brain abscesses.

BACKGROUND: Brain abscess is a life-threatening entity which requires prompt and long-term antibiotic therapy, generally associated with surgical drainage, and eradicating the primary source of infection. Parvimonas micra (Pm) has only been reported once before as the lone infecting organism of an orally originated, solitary brain abscess. Diagnosing brain abscesses caused by this Gram-positive anaerobic coccus, constituent of the oral cavity flora, is challenging, and an optimal treatment regimen has not been well established. We report the diagnosis and successful treatment of a Pm caused odontogenic brain abscess. CASE DESCRIPTION: A 62-year-old immunocompetent male with a right-parietal brain abscess presented with headache and seizures. He was started on empirical antibiotic therapy and subsequently underwent surgical drainage. The only source of infection found was severe periodontitis with infected mandibular cysts. Thus, tooth extraction and cyst curettage were performed 1 week after brain surgery. Cultures of brain abscess fluid were negative, but amplification of bacterial 16S ribosomal RNA (rRNA) with polymerase chain reaction demonstrated Pm. After 3 weeks of intravenous ceftriaxone and metronidazole, the patient was switched to oral metronidazole and moxifloxacin for 6 weeks. CONCLUSIONS: This case highlights the potential risk of untreated dental infections causing brain abscesses. Pm should be considered as a possible pathogen of odontogenic brain abscesses despite its presence usually not being detected by standard bacterial cultures. Therefore, 16S rRNA gene sequencing analysis is strongly recommended for bacterial identification before defining brain abscesses as cryptogenic.

A randomized placebo controlled clinical trial to evaluate the efficacy and safety of minocycline in patients with Angelman syndrome (A-MANECE study).

BACKGROUND: Minocycline is an old tetracycline antibiotic that has shown antiinflammatory and antiapoptotic properties in different neurological disease mouse models. Previous single arm study in humans demonstrated benefits in individuals with Angelman Syndrome (AS); however, its efficacy in patients with Angelman Syndrome has not been assessed in a controlled trial. This was a randomized, double-blind, placebo-controlled, crossover trial in individuals with AS, aged 6 years to 30 years (n = 32, mean age 12 [SD 6·29] years). Participants were randomized to minocycline or placebo for 8 weeks and then switched to the other treatment (a subset of 22 patients) or to receive minocycline for up to 16 weeks (10 patients). After week 16, all patients entered a wash-out 8-week follow-up period. RESULTS: Thirty-six subjects were screened and 34 were randomized. Thirty two subjects (94·1%) completed at least the first period and all of them completed the full trial. Intention-to-treat analysis demonstrated the lack of significantly greater improvements in the primary outcome, mean changes in age equivalent of the development index of the Merrill-Palmer Revised Scale after minocycline compared with placebo (1·90 ± 3·16 and 2·00 ± 3·28, respectively, p = 0·937). Longer treatment duration up to 16 weeks did not result in better treatment outcomes (1·86 ± 3·35 for 8 weeks treatment vs 1·20 ± 5·53 for 16 weeks treatment, p = 0·667). Side effects were not significantly different during minocycline and placebo treatments. No serious adverse events occurred on minocycline. CONCLUSIONS: Minocycline treatment for up to 16 weeks in children and young adults with AS resulted in lack of significant improvements in development indexes compared to placebo treatment. Treatment with minocycline appears safe and well tolerated; even if it cannot be completely ruled out that longer trials might be required for a potential minocycline effect to be expressed, available results and lack of knowledge on the actual mechanism of action do not support this hypothesis. TRIAL REGISTRATION: European Clinical Trial database ( EudraCT 2013-002154-67 ), registered 16th September 2013; US Clinical trials database ( NCT02056665 ), registered 6th February 2014.