Cerebrovascular events, notably acute ischemic strokes (AIS), have been reported in the setting of novel coronavirus disease (COVID-19) infection. Commonly regarded as cryptogenic, to date, the etiology is thought to be multifactorial and remains obscure; it is linked either to a direct viral invasion or to an indirect virus-induced prothrombotic state, with or without the presence of conventional cerebrovascular risk factors. In addition, patients are at a greater risk of developing long-term negative sequelae, i.e., long-COVID-related neurological problems, when compared to non-COVID-19 stroke patients. Central to the underlying neurobiology of stroke recovery in the context of COVID-19 infection is reduced angiotensin-converting enzyme 2 (ACE2) expression, which is known to lead to thrombo-inflammation and ACE2/angiotensin-(1–7)/mitochondrial assembly receptor (MasR) (ACE2/Ang-(1-7)/MasR) axis inhibition. Moreover, after AIS, the activated nucleotide-binding oligomerization domain (NOD)-like receptor (NLR) family pyrin domain-containing 3 (NLRP3) inflammasome may heighten the production of numerous proinflammatory cytokines, mediating neuro-glial cell dysfunction, ultimately leading to nerve-cell death. Therefore, potential neuroprotective therapies targeting the molecular mechanisms of the aforementioned mediators may help to inform rehabilitation strategies to improve brain reorganization (i.e., neuro-gliogenesis and synaptogenesis) and secondary prevention among AIS patients with or without COVID-19. Therefore, this narrative review aims to evaluate the mediating role of the ACE2/Ang- (1-7)/MasR axis and NLRP3 inflammasome in COVID-19-mediated AIS, as well as the prospects of these neuroinflammation mediators for brain repair and in secondary prevention strategies against AIS in stroke rehabilitation.

Background: Hospital-based stroke rehabilitation for stroke survivors in developing countries may be limited by staffing ratios and length of stay that could hamper recovery potential. Thus, a home-based, gamified rehabilitation system (i.e., IntelliRehab) was tested for its ability to increase cerebral blood flow (CBF), and the secondary impact of changes on the upper limb motor function and functional outcomes. Objective: To explore the effect of IntelliRehab on CBF in chronic stroke patients and its correlation with the upper limb motor function. Methods: Two-dimensional pulsed Arterial Spin Labelling (2D-pASL) was used to obtain CBF images of stable, chronic stroke subjects (n = 8) over 3-months intervention period. CBF alterations were mapped, and the detected differences were marked as regions of interest. Motor functions represented by Fugl-Meyer Upper Extremity Assessment (FMA) and Stroke Impact Scale (SIS) were used to assess the primary and secondary outcomes, respectively. Results: Regional CBF were significantly increased in right inferior temporal gyrus and left superior temporal white matter after 1-month (p = 0.044) and 3-months (p = 0.01) of rehabilitation, respectively. However, regional CBF in left middle fronto-orbital gyrus significantly declined after 1-month of rehabilitation (p = 0.012). Moreover, SIS-Q7 and FMA scores significantly increased after 1-month and 3-months of rehabilitation. There were no significant correlations, however, between CBF changes and upper limb motor function. Conclusions: Participants demonstrated improved motor functions, supporting the benefit of using IntelliRehab as a tool for home-based rehabilitation. However, within-participant improvements may have limited potential that suggests the need for a timely administration of IntelliRehab to get the maximum capacity of improvement.

Background: This study explores the impact of noise-induced hearing loss (NIHL) on the microstructural integrity of white matter tracts in the brain, focusing on areas involved in speech processing. While the primary impact of hearing loss occurs in the inner ear, these changes can extend to the central auditory pathways and have broader effects on brain function. Our research aimed to uncover the neural mechanisms underlying hearing loss-related deficits in speech perception and cognition among NIHL patients. Methods: The study included two groups: nine bilateral NIHL patients and nine individuals with normal hearing. Advanced diffusion tensor imaging techniques were employed to assess changes in the white matter tracts. Regions of interest (ROIs), including the auditory cortex, cingulum, arcuate fasciculus, and longitudinal fasciculus, were examined. Fractional anisotropy (FA) values from these ROIs were extracted for analysis. Results: Our findings indicated significant reductions in FA values in NIHL patients, particularly in the left cingulum, right cingulum, and left inferior longitudinal fasciculus. Notably, no significant changes were observed in the auditory cortex, arcuate fasciculus, superior longitudinal fasciculus, middle longitudinal fasciculus, and right inferior longitudinal fasciculus, suggesting differential impacts of NIHL on various white matter tracts. Conclusions: The study's findings highlight the importance of considering association fibres related to speech processing in treating NIHL, as the broader neural network beyond primary auditory structures is significantly impacted. This research contributes to understanding the neurological impact of NIHL and underscores the need for comprehensive approaches in addressing this condition.

Background : The mental health status among the house officers (HOs) in Malaysia is at an alarming level in which nearly one-third of the HOs are suffering depression and anxiety during their housemanship. This study aims to identify the work-related stress (WRS) domains which affect the mental health of the HOs in Malaysia from the view of the resigned HOs. Method : The questionnaire used in this study is the UK Health and Safety Executive (HSE) Management Standards Indicator Tool. A total of 30 respondents consisting of resigned HOs from hospitals all over Malaysia participated in this study. Results : Most of the respondents (63.3%) are female and nearly half of the respondents (46.7%) are married. Majority of respondents (60.0%) had a duration of 1-4 months of working experience as HOs before developing mental health outcomes leading to resignation, in which most respondents (56.7%) are being diagnosed with both depression and anxiety. The mean score for the resigned HOs is 2.36±0.54 indicating high stress level perceived during their housemanship period. For the WRS domains, Control has the lowest mean score of 1.66±0.39 indicating Control has the highest level of WRS perceived by the resigned HOs during their housemanship. Conclusion: This study demonstrated high prevalence of WRS among the HOs. The management of the hospital should be more aware and take prompt interventions such as early detection and monitoring on the mental wellbeing of the HOs, promote constructive working environment, encourage proper task delegations and consider their opinions for any changes in the system.

This study investigates the impact of Noise-Induced Hearing Loss (NIHL) on the structural integrity of white matter pathways in the brain, specifically focusing on association fibers and the cerebellum. Utilising Diffusion Tensor Imaging (DTI) technique, this study examines changes in white matter integrity that may underlie cognitive and perceptual deficits associated with NIHL. Findings suggest alterations in the association fibers and cerebellum, indicating potential disruptions and neuroplasticity changes in auditory processing and cognitive functions. This research contributes to understanding the neurobiological effects of NIHL, offering insights for therapeutic strategies targeting auditory rehabilitation and cognitive impairment.