A Retrospective Observational Study of Neurological Manifestations in COVID-19 (SON-CoV)

OBJECTIVES

Coronavirus disease 2019 (COVID-19) has neurologic manifestations associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to retrospectively analyze SARS COVID-19 patients with neurological manifestations and identify patterns of presentation including the site of neuroaxis involvement, neuroimaging, and associated systemic involvement.

METHODS AND SUBJECTS

This retrospective observational study was conducted at two tertiary care hospitals in western Rajasthan. Data on age, sex, presenting symptoms, and comorbidities (hypertension, diabetes, cardiac, cerebrovascular disease, and cancer) were collected from 28th February 2020 to 31st December 2020 through medical records, discharge summaries, and radiological studies. Verbal/written patient consent was obtained due to the prevailing COVID-19 norms at the time of the first wave. Major inclusion criteria were as follows: age >18 years, consent from patient/surrogate, positive RT-PCR report in case of active COVID cases, or positive COVID antibody test in case of post-COVID neurological sequelae. All neurological manifestations were reviewed by at least two neurologists and were divided into central nervous system (CNS) and peripheral nervous system (PNS) manifestations. Systemic features and their temporal relationship with neurological features were recorded. Various other specialized assessments and therapeutic interventions were conducted. Statistical analysis was performed using the SPSS software. A Chi-square test was performed to determine the association between variables. Student's t-test and one-way analysis of variance were used to determine differences in mean values. Statistical significance was set at p < 0.05.

RESULTS

The mean age was 57.32 years for the CNS group and 40 years for the PNS group (p = 0.025). Age was significantly lower in the PNS group than in the CNS group (p = 0.025). Anemia, leucocytosis, and elevated serum creatinine were more commonly seen in the CNS group, although the difference was not statistically significant. The most common CNS manifestations were stroke (41.8%), of which ischemic stroke constituted 83% of cases, followed by seizure (22%), encephalopathy (20.9%), headache (15.1%), and vertigo (3.8%). The most common PNS manifestation was neuropathy (57%), which included Guillain-Barré syndrome (GBS), critical illness neuropathy, and autonomic neuropathy Conclusion: CNS symptoms of COVID-19 are more common than PNS symptoms. Stroke is the most frequent (46%) COVID-CNS symptom, which occurs in people of age above 35 years and is associated with high mortality.

Evidence that bacterial cyanide oxygenase is a pterin-dependent hydroxylase

The soluble cell-free fraction (150,000g high-speed supernatants [HSS]) of Pseudomonas fluorescens NCIMB 11764 contains putative cyanide oxygenase (CNO) responsible for initiating cyanide oxidation and assimilation as a nitrogenous growth substrate. CNO activity, assayed either by cyanide-dependent O(2) or NADH uptake, or by conversion of radioactive K(14)CN to (14)CO(2), was detected at micromolar concentrations (apparent half-saturation constant, 4 microM). Results demonstrating that CNO requires a protein-enriched cell fraction and a low MW redox factor (<500 Da) for which reduced biopterin could substitute are presented. The properties of CNO are consistent with those of a pterin hydroxylase.

Beneficial effect of supplementation with copper sulfate on STZ-diabetic mice (IDDM)

Trace element status is known to be altered in the diabetic state. Current evidence suggests that reactive oxygen intermediates (ROI's) do participate in the destruction of pancreatic beta cells in STZ-induced Type 1 diabetes. The copper and zinc status of diabetic patients and their descendants was also found to have changed. The aim of this study was to evaluate the potential usefulness of copper sulfate in the treatment of STZ-induced type I diabetes. We used C57BL6 female mice, in whom copper sulfate treatment was started at 6 weeks of age followed by an IP injection of 40 mg/kg body weight of STZ for five consecutive days. Its effects were evaluated at 10 weeks of age. The treatment with copper sulfate significantly decreased blood glucose levels, levels of lipid peroxidation and mRNA expression of the enzyme iNOS and the cytokines IFN-gamma and IL-4. Histological analysis of the pancreas revealed that, three out of five animals in the copper sulfate treated groups showed absence of mononuclear cell infiltration and no change in the shape and size of islets as compared to pancreas of the STZ-induced diabetic group of animals. In conclusion, our observations indicate that copper sulfate treatment can exert beneficial effects in diabetes with preservation of beta-cell function in vivo. Copper sulfate could be exerting these beneficial effects either by acting directly by reducing free radicals or through reduction in glucose levels.

Immunobiology of CD28 expression on human neutrophils. I. CD28 regulates neutrophil migration by modulating CXCR-1 expression

CD28, described as a T cell costimulatory molecule so far, is expressed on human peripheral blood neutrophils, as shown by cell surface staining and immunoprecipitation with anti-CD28 monoclonal antibody, and by reverse transcription PCR. The phorbol 12-myristate 13-acetate-augmented expression of CD28 on these cells can be blocked by actinomycin D, an RNA transcription inhibitor, and staurosporin, a protein kinase inhibitor. Cross-linking of CD28 results in an early increase in IL-8 receptor A (IL-8RA or CXCR-1) expression and a concurrent increase in IL-8-induced chemotaxis. The expression of CXCR-1 is down-regulated by receptor internalization 3 h after CD28 cross-linking with concurrent decrease in IL-8-induced chemotactic migration. Thus, our results demonstrate for the first time that CD28 is expressed on human peripheral blood neutrophils and that CD28 may play an important role in the regulation of IL-8RA expression and migration of neutrophils in response to IL-8.

Combination of 4-hydroxyanisole and all-trans retinoic acid produces synergistic skin depigmentation in swine

A combination of 4-hydroxyanisole (4HA) and all-trans retinoic acid (TRA) was found to synergistically cause moderate to complete depigmentation of Yucatan swine skin. Two hyperpigmentation models were used: Natural dark-skinned swine, a potential model for melasma-like disorders, and ultraviolet light-stimulated hyperpigmentation, a model of solar lentigines. Test materials were applied twice daily, 5 d/week, to dorsal flank skin. Application sites were graded at weekly intervals for skin color using a 0 to 4 grading scale. After 8 weeks of treatment of naturally dark swine skin, a combination of 2% 4HA and 0.01% TRA produced grade 2 hypopigmentation (definite but moderate hypopigmentation). In contrast, 2% 4HA alone or 0.01% TRA alone did not produce significant hypopigmentation. After cessation of treatment, the 4HA/TRA-treated sites reverted to normal color within 7-12 weeks. The 4HA/TRA combination completely reversed the hyperpigmentation induced by ultraviolet light after 8 weeks of treatment. In vitro skin-penetration studies using hairless mouse and human skin show that skin penetration of 4HA was not significantly affected by adding 0.01% TRA. These data suggest that the observed synergy is not due to enhanced bioavailability of 4HA. We have demonstrated that combining low concentrations of 4HA and TRA results in effective skin lightening without causing irreversible depigmentation and with minimal local skin irritation.