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6-month consequences of COVID-19 in patients discharged from hospital: a cohort study Among patients hospitalized with coronavirus disease 2019 (COVID-19) in Wuhan, China, symptoms of fatigue and muscle weakness, as well as sleep difficulties, were shown to persist in more than 1 in 4 patients after 6 months. In addition, more than 75% of patients reported at least 1 persistent symptom, according to study findings published last week in The Lancet. As cases of COVID-19 contin...ue to surge worldwide, researchers highlight that long-term health consequences remain largely unclear. The nation’s top infectious disease expert, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, noted during a keynote presentation at the American Heart Association’s Scientific Sessions 2020 that up to a third of people will live with symptoms, such as profound fatigue and shortness of breath, for weeks or months after contracting COVID-19. However, he said that long-term follow-up was still warranted to understand effects when the disease lingers. In the present study, the researchers sought to describe the long-term health consequences of patients with COVID-19 in Wuhan who had been discharged from Jin Yin-tan Hospital between January 7, 2020, and May 29, 2020 (n = 1733; median age, 57 years; 52% men). They also investigated associated risk factors, particularly disease severity. Based on findings derived from the follow-up study that was conducted from June 16 to September 3, 2020, fatigue and muscle weakness (63%) and sleep difficulties (26%) were the most common symptoms. Additional symptoms reported included anxiety and depression, present in 23% of patients. Notably, patients who presented with more severe illness during their hospital stay, scale 56, exhibited more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations. These patients also performed worse in the 6-minute walking test, with 29% unable to reach the lower distance limit of the normal range. The study additionally addressed a prominent concern among those who have already been infected with COVID-19. Among a group of 94 patients, levels of neutralizing antibodies fell by an average of 53% during the 6-month study period after their sickness peaked. These results support that those with severe disease need post-discharge care, concluded the study authors. Longer follow-up studies in a larger population are necessary to understand the full spectrum of health consequences from COVID-19. January 13, 2021 Matthew Gavidia

Multifocal microvascular injury in the brain and olfactory bulbs is a possible adverse outcome from COVID-19, new research suggests. Postmortem MRI brain scans of 13 patients who died from COVID-19 showed abnormalities in 10 of the participants. Of these, 9 showed punctate hyperintensities, "which represented areas of microvascular injury and fibrinogen leakage," the investigators report. ... Further analyses showed punctate hypointensities linked to congested blood vessels in 10 patients. These areas were "interpreted as microhemorrhages," the researchers note. However, they did not see any signs of an infection from the SARS-CoV-2 virus in the collected brain samples, suggesting that the damage was not caused by a direct viral attack.

COVID-19-associated ischemic strokes were more severe and more likely to result in severe disability, according to a study from the U.K. The data suggest that COVID-19 may influence the onset, characteristics, and outcomes of ischemic stroke. Study Synopsis and Perspective:...Continue reading

Most Hospitalized COVID Patients Have Neurologic Symptoms Severe complications seen in all stages of COVID-19, including recovery by Judy George, MedPage Today More than half of COVID-19 patients admitted to two hospitals in Spain developed some form of neurologic symptoms, a retrospective, observational study showed....Continue reading

Neurological complications of Covid-19 can include delirium, brain inflammation, stroke and nerve damage and possible risk of long term brain damage similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic.

Screening reduces risk of breast cancer death by 41% May 11, 2020 -- Mammography screening reduces the risk of dying of breast cancer by 41% within 10 years of diagnosis, according to a study published May 11 in Cancer. The study attributes most of the mortality reduction to the impact of screening rather than advances in breast cancer therapy. A team led by Stephen Duffy, PhD, and Dr. László Tabár examined a population of more than half a million women, covering approximatel...Continue reading

MRI Shows Brain Abnormalities in Some COVID-19 Patients Evidence continues to increase on the neurological impacts of COVID-19 infection. Research released Friday showed nearly half of all patients positive for COVID-19 who were admitted to the intensive care unit (ICU) showed brain abnormalities on MRI scans. A study conducted by a team led by Naci Kocer, M.D., professor of neuroradiology at Istanbul University-Cerrahpasa in Turkey, revealed that 44 percent of COVID-19-posit...ive patients being treated in the ICU demonstrated neurological symptoms. These findings underscore the clinical symptoms already identified in these patients. Current evidence has revealed that 6 percent of patients experience acute stroke and 15 percent develop an altered mental status. Cytokine storm syndrome can also be involved. Recent evidence highlights a relatively high percentage (36 percent) of central nervous system symptoms, including headache, altered mental status, acute cerebrovascular disease, and epilepsy in patients with COVID-19, the team wrote. The rate of neurological symptoms is higher in patients with more severe respiratory diseases status. To determine the neurological impacts, the team conducted brain MRI exams on COVID-19-positive ICU patients who were hospitalized in eight institutions two academic and six academic-affiliated. Overall, 235 individuals were receiving care in the ICU. Fifty (21 percent) developed neurological symptoms, and brain MRI was performed in 27 patients (54 percent). Of those patients imaged, 12 (44 percent) had acute findings on MRI. Ten patients had COVID-19-related neuroimaging findings cortical FLAIR signal abnormalities, including increased cortical diffusion weighted signal with corresponding low ADC values (seven cases), subtle leptomeningeal enhancement (five cases), and punctate cortical blooming artifact (three cases). These abnormalities were involved in various areas: frontal lobe (4), parietal lobe (3), occipital lobe (4), temporal lobe (1), insular cortex (3), and cingulate gyrus (3). COVID-19 with its neurotropic potential may result in infectious or autoimmune encephalitis, the team wrote. Certain viral and autoimmune encephalitis can have specific pattern of involvement that is helpful to establish a differential list, however non-specific imaging pattern in our series hinders achieving a specific diagnosis based on MRI. See more

Silent brain infarcts found in 3% of AFib patients, tied to cognitive decline Patients with atrial fibrillation, even those on oral anticoagulant therapy, developed clinically silent brain infarctions at a striking rate of close to 3% per year, according to results from SWISS-AF, a prospective of study of 1,227 Swiss patients followed with serial MR brain scans over a 2 year period. The results also showed that these brain infarctions which occurred in 68 (5.5%) of the atri...Continue reading

Coronavirus Hijacks the Body From Head to Toe, Perplexing Doctors BY By Betsy McKay and Daniela Hernandez PD 7 May 2020...Continue reading

Neurologic Disease Eventually Affects Half of Women and One-Third of Men Neurology Reviews. 2018 December;26(12):63 Around one-half of women and one-third of men will develop dementia, stroke, or parkinsonism during their lifetime, according to a study published online ahead of print October 2 in the Journal of Neurology, Neurosurgery & Psychiatry.... The population-based Rotterdam study involved 12,102 individuals (57.7% women) who were ages 45 or older and free of neurologic disease at baseline. Researchers found that a 45-year-old woman had a 48.2% overall remaining lifetime risk of developing dementia, stroke, or parkinsonism, while a 45-year-old man had a 36.3% lifetime risk. There are currently no disease-modifying drugs available for dementia and most causes of parkinsonism, and prevention of stroke is hampered by suboptimal adherence to effective preventive strategies or unmet guideline thresholds, the authors wrote. Yet a delay in onset of these common neurologic diseases by merely a few years could reduce the population burden of these diseases substantially. Women age 45 had a significantly higher lifetime risk than men of developing dementia (31.4% vs 18.6%, respectively) and stroke (21.6% vs 19.3%), but the risk of parkinsonism was similar between the sexes. Women also had a significantly greater lifetime risk of developing more than one neurologic disease, compared with men (4% vs 3.1%), largely because of the overlap between dementia and stroke. At age 45, women had the greatest risk of dementia, but as men and women aged, their remaining lifetime risk of dementia increased relative to other neurologic diseases. After age 85, 66.6% of first diagnoses in women and 55.6% in men were dementia. By comparison, first manifestation of stroke was the greatest threat to men age 45. Men also were at a significantly higher risk for stroke at a younger agebefore age 75than were women (8.4% vs 5.8%, respectively). In the case of parkinsonism, the lifetime risk peaked earlier than it did for dementia and stroke and was relatively low after age 85, with no significant differences in risk between men and women. The authors considered what effect a delay in disease onset and occurrence might have on remaining lifetime risk for neurologic disease. They found that a one-, two-, or three-year delay in the onset of all neurologic disease was associated with a 20% reduction in lifetime risk in individuals age 45 or older, and a greater than 50% reduction in risk in the oldest. A three-year delay in the onset of dementia reduced the lifetime risk by 15% for men and women age 45 and conveyed a 30% reduction in risk to those age 45 or older. Suggested Reading Licher S, Darweesh SKL, Wolters FJ, et al. Lifetime risk of common neurological diseases in the elderly population. J Neurol Neurosurg Psychiatry. 2018 Oct 2 [Epub ahead of print].

Radical surgery for some prostate cancers adds three years to life In men with localized prostate cancer discovered because they had symptoms, radical prostate surgery leads to an average of three extra years of life compared to a watchful waiting approach, researchers say. The benefit of surgery was most pronounced in men who were under age 65 when their tumor was diagnosed, a new, long-term Scandinavian study found. The results, published in The New England Journal of Med...Continue reading