Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Multivariable risk scores for predicting short‐term outcomes for emergency department patients with unexplained syncope: A systematic review

ObjectivesEmergency department patients with unexplained syncope are at risk of experiencing an adverse event within 30 days. Our objective was to systematically review the accuracy of multivariate risk stratification scores for identifying adult syncope patients at high and low risk of an adverse event over the next 30 days.MethodsWe conducted a systematic review of electronic databases (MEDLINE, Cochrane, Embase and CINAHL) from database creation until May 2020. We sought studies evaluating prediction scores of adults presenting to an emergency department with syncope. We included studies that followed patients for up to 30 days to identify adverse events such as death, myocardial infarction, stroke, or cardiac surgery. We only included studies with a blinded comparison between baseline clinical features and adverse events. We calculated likelihood ratios and confidence intervals.ResultsWe screened 13,788 abstracts. We included 17 studies evaluating nine risk stratification scores on 24,234 patient visits, where 7.5% (95% CI 5.3-10%) experienced an adverse event. A Canadian Syncope Risk Score of 4 or more was associated with a high likelihood of an adverse event (LR score=4 or more 11 [95% CI 8.9-14). A Canadian Syncope Risk Score of 0 or less (LR Score = 0 or less 0.10 [95% CI 0.07-0.20]) was associated with a low likelihood of an adverse event. Other risk scores were not validated on an independent sample, had low positive likelihood ratios for identifying patients at high risk, or had high negative likelihood ratios for identifying patients at low risk.ConclusionMany risk stratification scores are not validated or not sufficiently accurate for clinical use. The Canadian Syncope Risk Score is an accurate validated prediction score for emergency department patients with unexplained syncope. Its impact on clinical decision making, admission rates, cost or outcomes of care is not known

Electromagnetic and Thermodynamic Analysis to Predict the Serious Life-threatening Implications of Future Massive Solar Energy Application

In this article, by an electromagnetic and thermodynamic analysis, it is finally predicted that future massive solar power application will pose a serious threat to life. To the eventual aim, it is first argued that life feeds on low entropy. Then, two physical theorems are proven, which clearly show the severe limitations in doing macroscopic work for future large-scale solar power use: First, low-density solar radiation limitation, and second, positive entropy generation limitation. These limitations force the observation that solar radiation must be extremely concentrated to produce a gigantic amount of work. Accordingly, some future practical implications of concentrated solar power use are considered. Combining these physical limitations with a discussion of the biophysical limit, some inferences are made leading to the final prediction above. In conclusion, for the preservation of life, it is proposed that present and future massive energy consumption must be strictly avoided