Surveillance Study of Acute Neurological Manifestations among 439 Egyptian Patients with COVID-19 in Assiut and Aswan University Hospitals

  1. Eman M. Khedr
  2. Noha Abo-Elfetoh
  3. Enas Deaf
  4. Hebatallah M. Hassan
  5. Mariam T. Amin
  6. Radwa K. Soliman
  7. Alaa A. Attia
  8. Amro A. Zarzour
  9. Mohamed Zain
  10. Aliae Mohamed-Hussein
  11. Maiada K. Hashem
  12. Sahar M. Hassany
  13. Ahmed Aly
  14. Ahmed Shoyb
  15. Mostafa Saber

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Abstract

<b><i>Background:</i></b> COVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study, we estimate the frequency of such complications among hospital inpatients with COVID-19 in Assiut and Aswan university hospitals. <b><i>Materials and Methods:</i></b> We screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory tests, CT/MRI of the chest and brain, and neurophysiology study were performed for each patient if indicated. <b><i>Results:</i></b> 439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these, 117 had acute neurological disease and the remainder had nonspecific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke and the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of multiple sclerosis (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31) and the others had Guillain-Barré syndrome (4), peripheral neuropathy (3), myasthenia gravis (MG, 2), or myositis (2). Fever, respiratory symptoms, and headache were the most common general symptoms. Hypertension, diabetes mellitus, and ischemic heart disease were the most common comorbidities in patients with CNS affection. <b><i>Conclusion:</i></b> In COVID-19, both the CNS and PNS are affected. Stroke was the most common complication for CNS, and anosmia and/or ageusia were common for PNS diseases. However, there were 6 cases of encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG, and 2 cases of myositis.

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    SciScore for 10.1101/2020.10.28.20221879: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Written informed consent was obtained from each patient /or relative and Local Ethical Committee of Assiut University hospital approved the study Diagnosis and Evidence of COVID-19: Reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard diagnostic procedure for confirming SARS-CoV-2 virus infection.
    IACUC: Written informed consent was obtained from each patient /or relative and Local Ethical Committee of Assiut University hospital approved the study Diagnosis and Evidence of COVID-19: Reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard diagnostic procedure for confirming SARS-CoV-2 virus infection.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Definition of major neurological diseases: Statistical analysis: The collected data was revised, coded, tabulated and introduced to a PC using Statistical package for Social Science (SPSS 25).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1159/000513647
  3. Version published to 10.1101/2020.10.28.20221879v1 on medRxiv