Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

Efecto de la deficiencia subclínica de zinc en corderos sobre parámetros bioquímicos, concentración tisular y balance de zinc

The objective of this trial was to study the effect of subclinical Zn deficiency in lambs on plasma levels of Zn and alkaline phosphatase (ALP), tissue Zn concentration and Zn balance. Ten lambs were randomly assigned to two groups: basal (B; 10 ppm of Zn) and supplemented with 30 ppm of Zn (Z). The trial lasted for 20 weeks. Blood samples were collected every 4 weeks by jugular venipuncture. In weeks 6 and 20, Zn balance was evaluated. At the end of the trial, samples of muscle, liver, pancreas, testis, kidney, lung, bone and wool were collected for Zn determination. Plasma Zn levels were significantly higher in the Z group (0.68 µg/ml) than in the B group (0.40 µg/ml), but ALP plasma levels did not differ between groups. In the first balance period, the percentage Zn retention in group B was higher (46.91 vs 26.07 %) but the amount retained was lower (1.66 vs 3.72 mg/day). The second balance period showed similar results. Bone Zn concentration was higher in Z group (P < 0.01), with a similar tendency in liver (P < 0.10). The rest of the parameters did not differ between treatments.Fil: Pechin, G.H. Universidad Nacional de La Pampa. Facultad de Ciencias Veterinarias. La Pampa, ArgentinaFil: Corbellini, C.N. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Mercedes (EEA). Buenos Aires, ArgentinaFil: Cseh, S.B. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Balcarce (EEA). Buenos Aires, ArgentinaFil: Stritzler, N.P. Universidad Nacional de La Pampa. Facultad de Agronomía. La Pampa, ArgentinaEl objetivo de este ensayo fue estudiar el efecto de la deficiencia subclínica de Zn en ovinos sobre los niveles plasmáticos de Zn y fosfatasa alcalina (FA), la concentración tisular y la retención del mineral. Diez corderos fueron asignados aleatoriamente a dos grupos: basal (B; 10 ppm de Zn) y suplementado con 30 ppm de Zn (Z). El ensayo se extendió por el término de 20 semanas, con sangrados cada 4 semanas. En las semanas 6 y 20 se evaluó el balance de Zn. Al final del trabajo, se recogieron muestras de músculo, hígado, páncreas, testículo, riñón, pulmón, hueso y lana. Los niveles de Zn plasmático fueron significativamente mayores en el grupo Z (0,68 µg/ml) que en el grupo B (0,40 µg/ml), pero los niveles de FA plasmática fueron similares. En el primer período de balance, la retención porcentual de Zn en grupo B fue mayor (46,91 vs 26,07 %), pero la cantidad retenida fue menor (1,66 vs 3,72 mg/día). El segundo período de balance presentó resultados similares. La concentración de Zn en hueso fue mayor en el grupo Z (P < 0,01), con una tendencia similar en hígado (P < 0,10). El resto de las variables no difirieron entre tratamientos

Enfermidades digitais em vacas de aptidão leiteira: associação com mastite clínica, metrites e aspectos epidemiológicos Foot diseases in dairy cows: association with clinical mastitis, metrites and predisposed factors

Utilizaram-se nesse estudo 5300 vacas de aptidão leiteira, provenientes de 80 propriedades rurais, que adotavam manejo intensivo ou semi-extensivo, com o objetivo de averiguar a existência de possível associação entre enfermidades digitais, mastite clínica e/ou metrite e identificar possíveis fatores de risco das enfermidades digitais. Em 325 (6,13%) vacas foram diagnosticados apenas enfermidades digitais, em 35 (0,66%) enfermidades digitais e mastite clínica, em 52 (0,98%) enfermidades digitais e metrite, em 28 (0,53%) enfermidades digitais, mastite clínica e metrite, em 128 (2,42%) apenas metrite, em 165 (3,11%) somente mastite clínica, e em 89 (1,68%) vacas metrite e mastite clínica. As mudanças bruscas na alimentação, o excesso de sujidades nas instalações, os pisos irregulares e abrasivos, a não utilização ou uso incorreto de pedilúvio, a falta de casqueamento preventivo, a ausência de quarentena, e a aquisição de animais sem a preocupação com o aspecto sanitário foram considerados os fatores de risco de maior ocorrência. Foi constatada diferença significativa entre a ocorrência de enfermidades digitais, mastite clínica e metrite, além de associação fraca entre tais enfermidades, concluindo-se que não houve relação expressiva entre enfermidades podais, mastite clínica e metrite em vacas lactantes.<br>With the objective to investigate a possible association between foot diseases, clinical mastitis and/or metritis and predisposing factors for foot diseases, 5300 dairy cows from 80 intensive and semi-intensive farms were used. In 325 (6.13%) cows only foot disease was diagnosed, in 35 (0.66%) foot disease and clinical mastitis, in 52 (0.98%) foot disease and metritis, in 28 (0.53%) foot disease, clinical mastitis and metritis, in 128 (2.42%) only metritis, in 165 (3.11%) only clinical mastitis, and in 89 (1.68%) cows metritis and clinical mastitis. Rapid changes in the diet, high exposure time of hoof horn to slurry and wet conditions, concrete floors, use of footbaths, low frequency of claw trimming, irregular quarantine, and no attention to health aspects during acquisition of the animals were considered as major risk factors for the occurrence of those diseases. The McNemar test for dependent samples showed significant statistical differences between the occurrence of foot disease, clinical mastitis and metritis, in spite of the poor association between those diseases. It was concluded that there was no expressive relationship between foot diseases, clinical mastitis and metritis in lactent cows

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

BackgroundNeurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.MethodsWe conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.ResultsWe included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.InterpretationNeurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.Thrombosis and Hemostasi