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5МЕДИЦИНСКИЕ НАУКИ
NEUROLOGICAL COMPLICATIONS OF SARS-COV-2 INFECTION IN GEORGIA
SH. V. VASHADZE
MD, PhD, ass. professor, Batumi State University after Shota Rustaveli
M. D. KEKENADZE
Ph.D. Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospital (UCLH), Queen Square, London, United Kingdom
S. G. BRUNJADZE
Batumi State University after Shota Rustaveli
D. V. KAJAIA
Clinical Director.Clinic Medical Center
Batumi State University after Shota Rustaveli, Georgia Shorena katamadze Medical Center
MARINA SHAVIAIDZE
MD, PhD, ass. Professor
Abstract
Objective: The main clinical symptoms of SARS-CoV2 infection are known to be fever, headache, cough, muscle aches, weakness, anosmia, and difficulty breathing, however plethora of neurological manifestations has been described. We have investigated neurological complications of Covid infection in Georgian patients.
Methods: We studied patients diagnosed with Covid infection at Batumi Medcenter Clinic from October 2020 to February 2022. A total of 544patients aged 18 to 87years, applied to the clinic, The Mini-Mental State was also used to diagnose dementia, BECK questionnaire was used to diagnose depression, according to which we identified mild, moderate, and severe depression.
Results: From 544 patients -148 (27.2)% of patients were diagnosed with acute Ischemic Cerebrovascular Syndrome, including vertebrobasilar artery syndrome, and transient ischemic attack (TIA), while Guillain-Barre syndrome was detected in 2 patients (0.74%). Dementia (of various degrees) was observed in 85 patients (31.48%). Depression was diagnosed in 235 (87.03%) patients.
Conclusion: According to our studies, neurological complications are quite common in patients after Covid infection, which is a serious problem and needs to be addressed in a timely manner.
Keywords: COVID -19, depression, Mini-Mental State
BACKGROUND
Scientists think that the number of people infected with COVID-19 in the world is higher than officially registered. The main clinical symptoms of SARS-CoV2 infection are known to be fever, headache, cough, muscle aches, weakness, anosmia, and difficulty breathing.1,2 researchers point to the most common neurological manifestations and symptoms of Covid-19: including dizziness: 16.8%, headache: 13.1%. Encephalopathy: 2.8%. According to Chinese scientists, 5.9% of patients with Covid-19 developed a stroke within 10 days of onset of symptoms. Stroke developed in elderly patients with cardiovascular disease who were admitted to the hospital due to severe pneumonia. The mechanism of stroke according to scientists is different: 1. It may be hypercoagulation of the blood, which may lead to a critical illness in the patient 2. It may be caused by cardioembolism, which is
ОФ "Международный научно-исследовательский центр "Endless Light in Science"
most likely caused by damage to the heart muscle by the virus. Importantly, the new coronavirus ACE2 receptor, the virus needs to enter the cell, is also found on the surface of blood vessels in the brain. Therefore, stroke associated with SARS-CoV2 may be directly related to infection. Patients with neurological complications of the central or peripheral system are more likely to be associated with virus invasion, inflammatory response, or immune changes in the nervous system.23
MATERIAL AND METHODS
Patients diagnosed with Covid infection at our clinic from October 2020 to February 2022, were studied. A total of 544 patients applied to the clinic, between the ages of 18 and 87 years, and 477 patients underwent inpatient treatment. Of these, 51% were male and 49% were female, 68 patients were treated at the Covid Hotel.81 patients died in the clinic, of which 31 were women and 50 were men. In all patients, a rapid antigen test or PCR test was used to determine the Sourse of the infection, which detects the presence of the virus in the nasopharyngeal smear; The patient was consulted by a doctor as soon as he entered the clinic, and he/she had radiological examinations, as well as diagnostic examinations after being recovered from Covid infection. The Mini-Mental State was also used to diagnose dementia and the BECK questionnaire was used to evaluate depression, according to which we identified mild, moderate, and severe depression. Pneumonia was confirmed in the majority of these patients - 540 (99.26%) patients. Among them with primary complaints: fever -450 (82.72%), shortness of breath and cough -484 (88.97%), headache -500 (91.91%), anosmia -530 (97.42), dizziness-155 (28.49), joint pain -257 (47.24%) Scheme 1. Primary complaints of the people with COVID-19?
stroke diagnosis
cerebrovascular severe ischemic attack,
Gien - Barre syndrome
RESULTS
Among 544 patients 7% (N38) was diagnosed with stroke (ischemic and hemorrhagic) Within two weeks to three months after the Covid infection, 270 patients with neurological complaints reapplied to the clinic. Among them N148 (54,81)% of patients were diagnosed with acute Ischemic Cerebrovascular Syndrome, including vertebrobasilar artery syndrome and transient ischemic attack (TIA), while Guillain-Barre syndrome was detected in N2 patients (0.74%).Dementia of various degrees was observed in N85 patients (31.48%). Mild dementia in 63 (74.11%), moderate dementia in 20 (23.52%) and severe dementia in 2 (2.35%) patients.
Depression was diagnosed in 235 (87.03%) patients, mild in 170 (72.34%), moderate in 50 (27.27%) and severe in 15 (6.38%) patients.
Scheme 2. Degree of depression in patients after post-Covid infection
Symptoms of the emotional disregulation: boredom, anxiety, anger, mood swings, feelings of helplessness, and irritability were expressed in 230 (97.87%) patients. Behavioral disorders: crying, relationships issues with others, and some denial of self-responsibility was observed in 145 (61.70%) patients.Self-criticism, concentration difficulty, memory problems, and suicidal ideation was observed in 55 (23.40%) of the examined patients. Low energy, feeling of chronic fatigue, excessive daytime sleepiness or insomnia, weight gain or loss, lack of motivation, strange pains, and attempts to suppress these pains was observed in 135 (57.44%) patients.
According to our data, patients developed ischemic stroke in the background of Covid infection from the age of 40 to 80. A case of ischemic stroke developed at a young age is noteworthy, although these patients had no somatic pathology. All patients had high D-dimer (10-15 times higher than normal), and C-reactive protein, three patients were diagnosed with middle cerebral artery thrombosis. Almost all patients had headaches.
DISSCUSION
Almost half (270 patients) returned to the clinic after two weeks to three months after the Covid infection, and most of them (185 patients) had neurological complications. Most had central nervous system complications, with only two having peripheral nervous system complications. 235 out of 270 patients had varying symptoms of depression, and one quarter (85 patients) had varying stages of dementia. It is noteworthy that the level of D-dimer is elevated in patients with covid-19 (increased risk of stroke). Consequently, the number of patients with cerebrovascular disease increased. However, it should also be noted that almost all patients admitted to our clinic, regardless of age, were treated with anticoagulants, which (in our opinion) significantly reduced the risk of stroke and cardiovascular complications. The level of D-dimer in patients was systematically monitored by family physicians.
In addition, it should be noted that depression develops in the background of Covid-19 pneumonia and hypoxia. Hypoxia itself affects the brain and other organs, constant stress, uncertainty, fear of the future, loss of loved ones, economic hardship, prolonged lockdowns, and closure affect the mood of patients. That is why the state should do everything possible to inform patients and provide them with qualified assistance to avoid increased suicidal tendencies. The rate of increased post - Covid dementia is also noteworthy. According to our studies, cognitive impairment is quite common in patients after transmission of Covid infection, which is a serious problem and needs to be addressed in a timely manner.
CONCLUSION
For many years, many countries have been seriously preparing to solve dementia problem, our studies highlighted that we need to develop a state program to help such patients and their relatives. Covid 19 has caused a pandemic, so we need to pay attention to patients whose first sign of the disease may be a neurological manifestation, or neurological complication. Diagnosis of the disease at an early stage is important for its proper management and prevention.
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