Bell's palsy: a case report of unusual presentation in a patient with rhino-orbital cerebral mucormycosis

BACKGROUND

Mucormycosis is a fungal infection caused by the Mucorales order of fungi. This fungus is commonly found in soil and can cause disease in immunocompromised patients. On the other hand, Bell's palsy is an idiopathic condition that results in the sudden onset of unilateral facial muscle weakness, affecting the facial nerve.

CASE PRESENTATION

A 51-year-old Persian housewife with a history of poorly controlled diabetes mellitus presented with a splitting headache that had been ongoing for 1 week and an inability to close her left eye or make facial expressions on the left side of her face. The patient's vital signs were normal, but physical examination revealed a yellow-grey scar on the left side of her hard palate and Bell's palsy on the left side. A neurological examination showed that she could move both eyes but could not close her left eye, move up her left eyebrow, or smile. Further investigations were performed, including laboratory tests, radiologic imaging, and functional endoscopic sinus surgery. The patient underwent three rounds of debridement for bony erosion in the medial and posterior walls of the left maxillary sinus and the hard palate. Pathological examination confirmed mucormycosis infection in the hard palate and mucosa.

CONCLUSION

Fungal infection must be considered a potential diagnosis for immunocompromised adults who exhibit symptoms of Bell's palsy.

Heifers don't care: no evidence of negative impact on animal welfare of growing heifers when using virtual fences compared to physical fences for grazing

Virtual fencing (VF) represents a way to simplify traditional pasture management with its high labour and cost requirements for fencing and to make better use of the 'beneficial' agronomic and ecological effects of livestock grazing. In this study, the VF technology (® Nofence, AS, Batnfjordsøra Norway) was used with Fleckvieh heifers to investigate possible welfare impacts on the animals compared to conventionally fenced animals when they were trained to respond correctly to the system. The Nofence® collars (attached to the neck of the heifers) send acoustic signals as a warning when the animals approach the VF line, which was set up by GPS coordinates within the Nofence®-App, followed by an electric pulse when they do not stop or return. The heifers had no experience with VF prior to the study. Two treatments (VF versus physical fencing (PF)) were applied to six groups of four heifers each (three groups per treatment) over three 12-day time replicates. One VF line separated the pasture of the VF group into an accessible or non-accessible area. The control group had a PF line. Both groups were equipped with Nofence® collars (deactivated for the PF group). The trial took place on two adjacent paddocks of 1 000 m² each following a 12-day schedule which was divided into three sections: visual support of the VF line by a physical barrier (first 2 days), only virtual border without visual support, moving the VF line (on day 8). Each time replicate followed the next successively on different paddocks with two new groups of heifers, which were grazed 5 h daily. During the whole experiment, the behaviour of each of the four animals per group was continuously observed; 2 h a.m., 2 h p.m. Exclusion by the VF line was effective in our trial. None of the heifers crossed the virtual boundary, i.e. the time spent in exclusion zone was zero. The heifers received 2.70 ± 2.63 acoustic signals and 0.30 ± 0.36 electric pulses (mean ± SD) per heifer and hour during all time replicates. Main cattle behaviour on pasture was not affected by the fencing system. Live weight gain, herbage consumption and faecal cortisol metabolites also revealed no significant differences. The duration until the heifers restarted grazing after an electric pulse from the Nofence® collar was significantly shorter than after an electric pulse from the physical fence. We can summarise that in our study, cattle well-being on pasture was not negatively affected by VF compared to PF.

The effect of ascorbic acid and bio fertilizers on basil under drought stress

Evaluate the effect of ascorbic acid application and coexistence of Mycorrhiza fungus and Azospirillium on basil (Ocimum basilicum L.) under drought stress. This experiment was performed as a split factorial in a randomized complete block design with three replications in the crop year 2017-2018 in Shahriar, Iran. In this experiment, irrigation was the main factor in three levels, including drought stress based on 40-70-100 mm from the evaporation pan of class A. Biofertilizer including growth-promoting bacteria (Azospirillium) and mycorrhiza fungus in four levels, including a(Non-consumption) B (Seeds of growth-promoting bacteria (Azospirillium)) C (Consumption of mycorrhiza fungus as seeds) D (Concomitant use of growth-promoting bacteria Azospirillium with mycorrhiza fungi as seeds) and ascorbic acid in two levels of foliar application, including A (Absence Application of ascorbic acid) and B (Application of ascorbic acid (two days after irrigation treatment)) was considered as a factorial factor. The results showed that the highest biological yield was obtained in drought stress of 40 mm and application of biological fertilizers in the form of mycorrhiza application with an average of 3307.1 kg/ha, which was about 70% more than 100 mm evaporation stress and no application of biological fertilizer. The use of ascorbic acid under drought stress conditions improved by 10%, the essential oil using ascorbic acid evaporated under drought stress conditions of 100 mm. As a general conclusion, the use of ascorbic acid and Mycorrhiza + Azospirillium biological fertilizer improved the quantitative and qualitative characteristics of basil under drought stress.

COVID19 : quel impact sur le suivi des patients vivant avec le VIH à l'hôpital ?

Introduction

La pandémie Covid-19 a gravement perturbé l'accès aux systèmes de santé. Cette étude a pour objectif d'évaluer l'impact de la crise de la Covid-19 sur le suivi ambulatoire hospitalier des personnes vivant avec le VIH (PVVIH) et de remettre dans le parcours de soins « les perdus de vue de la Covid-19 » une fois identifiés.

Matériels et méthodes

Grâce à une requête informatique du logiciel utilisé en ambulatoire (Diamm/G, Micro6) dans un service de maladies infectieuses, une liste de patients, venus consulter entre Mars 2019 et Mars 2020 puis sans nouveau RDV de consultation après Mars 2020, a été remise à chaque médecin pour qu'il y notifie une raison de non venue de chaque patient. A défaut, une recherche sur le logiciel Orbis et un courrier au médecin correspondant ont été fait. En dernier recours les patients étaient contactés par téléphone ou mail. Et si malgré cela, aucune réponse n'était apportée, le fichier INSEE était consulté afin de rechercher un éventuel décès. Les perdus de vue (PDV) ont été ainsi identifiés : les patients n'ayant pas de nouvelle consultation après Mars 2020 sans raison retrouvée.

Résultats

Sur les 2802 patients vivant avec le VIH (PVVIH) suivis jusqu'en Mars 2020, 544 (19 %) pts ne sont pas venus consulter après cette date : 235 (43 %) sont suivis en ville, 53 (10 %) sont suivis dans un autre hôpital, 34 (6 %) ont déménagé, 26 (5 %) sont décédés, 116 (21 %) sont revenus consulter en 2021 après avoir été contactés et 67 (12 %) sont des PDV. Les caractéristiques de ces PDV sont : 49 (73 %) hommes, âge médian 45.7 ans [25-80], 36 (54 %) étrangers dont 22 (33 %) originaires d'Afrique Subsaharienne, avec un mode de transmission hétérosexuelle chez 32 (48 %), homosexuelle chez 27 (40 %), par usage de drogue intraveineuse chez 3 (4 %), inconnue chez 5 (7 %), une médiane d'ancienneté VIH de 10.7 ans [1-33], une médiane de CD4 à 474/mm3 [23-1293], 17 (25 %) avaient une CV VIH > 50 cp/ml, un stade CDC A chez 55 (82 %) et C chez 12 (18 %). Des particularités ont été notées parmi ces PDV : 12 (14 %) avaient des problèmes d'observance, 17 (20 %) étaient en situation de précarité (logement, travail ou AME), 4 (5 %) présentaient des troubles psychiatriques et 8 (10 %) n'avaient consulté qu'une seule fois (2 arrivées récentes en France, 2 découvertes VIH, 1 sortie de prison, 2 patients suivis ailleurs avant). Les causes des 26 décès sont les suivantes : 11 cancers non classant SIDA, 3 décès liés à la COVID19, 2 pathologies cardio-vasculaires, 1 décès lié à une cirrhose décompensée, 1 décès lié à un SDRA et 8 décès sans cause retrouvée.

Conclusion

Les PDV représentent seulement 2 % (67/2802) de la file active des PVVIH avec une population représentative très hétérogène rendant complexe l'identification d'éventuels facteurs de risque telles que dysobservance et précarité. La pandémie COVID19 a surtout eu un impact sur la redistribution du suivi ville/hôpital et l'exode vers la Province. Cette enquête a reçu un accueil favorable des patients contactés qui se sentaient rassurés et a permis de remettre 4 % de patients de la file active dans le parcours de soin.

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Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises

Background

Deficiencies in non-technical skills (NTS) have been increasingly implicated in avoidable operating theatre errors. Accordingly, this study sought to characterize the impact of surgeon and anaesthetist non-technical skills on time to crisis resolution in a simulated operating theatre.

Methods

Non-technical skills were assessed during 26 simulated crises (haemorrhage and airway emergency) performed by surgical teams. Teams consisted of surgeons, anaesthetists and nurses. Behaviour was assessed by four trained raters using the Non-Technical Skills for Surgeons (NOTSS) and Anaesthetists' Non-Technical Skills (ANTS) rating scales before and during the crisis phase of each scenario. The primary endpoint was time to crisis resolution; secondary endpoints included NTS scores before and during the crisis. A cross-classified linear mixed-effects model was used for the final analysis.

Results

Thirteen different surgical teams were assessed. Higher NTS ratings resulted in significantly faster crisis resolution. For anaesthetists, every 1-point increase in ANTS score was associated with a decrease of 53·50 (95 per cent c.i. 31·13 to 75·87) s in time to crisis resolution (P < 0·001). Similarly, for surgeons, every 1-point increase in NOTSS score was associated with a decrease of 64·81 (26·01 to 103·60) s in time to crisis resolution in the haemorrhage scenario (P = 0·001); however, this did not apply to the difficult airway scenario. Non-technical skills scores were lower during the crisis phase of the scenarios than those measured before the crisis for both surgeons and anaesthetists.

Conclusion

A higher level of NTS of surgeons and anaesthetists led to quicker crisis resolution in a simulated operating theatre environment.

Drug-conjugated PLA-PEG-PLA copolymers: a novel approach for controlled delivery of hydrophilic drugs by micelle formation

A conjugate of the antihypertensive drug, lisinopril, with triblock poly(lactic acid)-poly(ethylene glycol)-poly(lactic acid) (PLA-PEG-PLA) copolymer was synthesized by the reaction of PLA-PEG-PLA copolymer with lisinopril in the presence of dicyclohexylcarbodiimide and dimethylaminopyridine. The conjugated copolymer was characterized in vitro by hydrogen nuclear magnetic resonance (HNMR), Fourier transform infrared (FTIR), differential scanning calorimetry (DSC) and gel permeation chromatography (GPC) techniques. Then, the lisinopril conjugated PLA-PEG-PLA were self-assembled into micelles in aqueous solution. The resulting micelles were characterized further by various techniques such as dynamic light scattering (DLS) and atomic force microscopy (AFM). The results revealed that the micelles formed by the lisinopril-conjugated PLA-PEG-PLA have spherical structure with the average size of 162 nm. The release behavior of conjugated copolymer, micelles and micelles physically loaded by lisinopril were compared in different media. In vitro release study showed that in contrast to physically loaded micelles, the release rate of micelles consisted of the conjugated copolymer was dependent on pH of media where it was higher at lower pH compared to the neutral medium. Another feature of the conjugated micelles was their more sustained release profile compared to the lisinopril-conjugated copolymer and physically loaded micelles.

Evolution of antimicrobial resistance and serotype distribution of Streptococcus pneumoniae isolated from children with invasive and noninvasive pneumococcal diseases in Algeria from 2005 to 2012

Pneumococcal infections are a major cause of morbidity and mortality in developing countries. The introduction of pneumococcal conjugate vaccines (PCVs) has dramatically reduced the incidence of pneumococcal diseases. PCVs are not currently being used in Algeria. We conducted a prospective study from 2005 to 2012 in Algeria to determine antimicrobial drug resistance and serotype distribution of Streptococcus pneumoniae from children with pneumococcal disease. Among 270 isolated strains from children, 97 (36%) were invasive disease; of these, 48% were not susceptible to penicillin and 53% not susceptible to erythromycin. A high rate of antimicrobial nonsusceptibility was observed in strains isolated from children with meningitis. The serotype distribution from pneumococci isolated from children with invasive infections was (by order of prevalence): 14, 1, 19F, 19A, 6B, 5, 3, 6A and 23F. Multidrug resistance was observed in serotypes 14, 19F, 19A and 6B. The vaccine coverage of serotypes isolated from children aged <5 years was 55.3% for PCV7, 71.1% for PCV10 and 86.8% for PCV13. Our results highlight the burden of pneumococcal disease in Algeria and the increasing S. pneumoniae antibiotic resistance. The current pneumococcal vaccines cover a high percentage of the circulating strains. Therefore, vaccination would reduce the incidence of pneumococcal disease in Algeria.

PLA-PEG-PLA copolymer-based polymersomes as nanocarriers for delivery of hydrophilic and hydrophobic drugs: preparation and evaluation with atorvastatin and lisinopril

Tri-block poly(lactide)-poly(ethylene glycol)-poly(lactide) (PLA-PEG-PLA) copolymers were synthesized and used to prepare polymersomes loaded separately by the hydrophobic and hydrophilic model drugs, atorvastatin and lisinopril, respectively. The resulting nanostructures were characterized by various techniques such as FTIR, DSC, PCS and AFM. The polymersomes exhibited high encapsulation efficiencies of almost 78% and 70.8% for atorvastatin and lisinopril, respectively. Investigation on FTIR and DSC results revealed that such a high encapsulation efficiency is due to strong interaction between atorvastatin and the copolymer. The impact of drug/copolymer ratio and copolymer composition on drug-loading efficiency and drug release behavior were also studied. The results showed that in case of lisinopril, polymersomes exhibited a triphasic drug release, while for atorvastatin a biphasic release profile was obtained. Overall, the results indicated that PLA-PEG-PLA polymersomes can be considered as a promising carrier for both hydrophilic and hydrophobic drugs.

Effect of lullaby and classical music on physiologic stability of hospitalized preterm infants: a randomized trial

BACKGROUND

Music is considered a subset of developmental supportive care. It may act as a suitable auditory stimulant in preterm infants. Also, it may reduce stress responses in autonomic, motor and state systems.

OBJECTIVE

To assess and compare the influence of lullaby and classical music on physiologic parameters.

METHOD

This is a randomized clinical trial with cross-over design. A total of 25 stable preterm infants with birth weight of 1000-2500 grams were studied for six consecutive days. Each infant was exposed to three phases: lullaby music, classical music, and no music (control) for two days each. The sequence of these phases was assigned randomly to each subject. Babies were continuously monitored for heart rate, respiratory rate, and oxygen saturation and changes between phases were analyzed.

RESULT

Lullaby reduced heart rate (p < 0.001) and respiratory rate (p = 0.004). These effects extended in the period after the exposure (p < .001 and p = 0.001, respectively). Classical music reduced heart rate (p = 0.018). The effects of classical music disappeared once the music stopped. Oxygen saturation did not change during intervention.

CONCLUSION

Music can affect vital signs of preterm infants; this effect can possibly be related to the reduction of stress during hospitalization. The implications of these findings on clinical and developmental outcomes need further study.

Prevalence of dentine hypersensitivity among adult patients attending a dental hospital clinic in Turkey

OBJECTIVES

The aim of this study is to determine the prevalence of dentine hypersensitivity (DH) and to examine some associated factors such as the initiating stimuli among adult patients attending the Restorative Clinic of the Kirikkale University Dental Faculty, Turkey.

METHODS

Questionnaires for 1169 patients, 678 men and 491 women, were completed and necessary clinical examinations performed during a one-year period and patients who were diagnosed with DH were questioned further about their occupation and smoking habits. Patients with at least two different quadrants which had sensitive teeth with sound exposed cervical dentine on the facial surface, were included in the study. The amount of cervical lesions, buccal gingival recession and initiating factors associated with the sensitive teeth were also recorded.

RESULTS

Of the 1169 patients examined, 89 were diagnosed as having dentine hypersensitivity, giving a prevalence of 7.6%. The commonest teeth affected were the upper premolars and the commonest initiating factor was cold drinks.

CONCLUSIONS

The prevalence of dentine hypersensitivity in a postgraduate clinic in Turkey was 7.6%. The commonest teeth affected were the upper premolar and the commonest initiating factor was cold drinks.

Efficacy and morbidity following PCNL in patients with renal anomalies: the outcome from a randomized study comparing different imaging modalities for assessment

AIM

The aim of this paper was to assess outcome of totally tubeless percutaneous nephrolithotomy (TPCNL) performing with and without preoperative computed tomography (CT) scan, in anomalous kidneys.

METHODS

A total of 50 patients with renal anomaly were randomly divided into two groups. Exclusion criteria was stone size >3.5 cm. Twenty six had malrotation, 21 had horseshoe kidney and 3 had ectopic pelvic kidneys. For 25 patients, TPCNL was performed with preoperative CT scan and in the remnant only intravenous urography and renal ultrasonography were done, preoperatively. The incidence of complications and outcomes were compared between two groups in a 1 month period.

RESULTS

In the group with preoperative CT scan, the mean (SD) stone size was 2.9 (0.75) vs. 2.7 (0.95) cm2. Between the two groups, there were not statistical differences in the mean (SD) analgesic requirement, hemoglobin drop, operation time, hospital stay, and return to normal activity. They were 7.5 (1.7) vs. 6.1 (1.9) mg of morphine, 1.20 (0.36) vs. 1.52 (0.27) mg/dl, 64 (13.2) vs. 59 (13.3) minutes, 1.9 (0.4) vs. 1.7 (0.45) and 12.4(2.9) vs. 10 (3.5) days, respectively. Only 2 patients required blood transfusion and one patient had postoperative pneumothorax in the group with CT while in the other group, three patients required postoperative transfusion and one showed postoperative fever. A successful outcome at the first attempt was 88% in group with CT vs. 80% in the other group.

CONCLUSION

It seems that TPCNL could be done with safety in renal anomalies by omitting preoperative CT scan.

Cauda equina cavernous angioma presenting as acute low back pain and sciatica. A report of two cases and literature review

Spinal cavernous angiomas are rare vascular lesions occurring mainly in the vertebral bodies extending secondary into the extradural space. Only 3% of these lesions are intradural, usually localized within the spinal cord. Rarely, cavernous angioma has been reported to occur in the cauda equina. We describe clinical, diagnostic imaging, and surgical procedures of two cases of cavernous angioma of the cauda equina who presented with acute back pain and sciatica. The relevant literature is also reviewed.

Fruit and vegetable intake and bone health in women aged 45 years and over: a systematic review

High fruit and vegetable intake may be associated with improved bone status among women aged ≥ 45 years. This is the first systematic review that specifically assessed this association and identified research gaps. The benefits of fruit and vegetables (F&V) on bone health remain unclear. Further studies are needed.

INTRODUCTION

F&V have several components that are beneficial to bones. Some studies report that high F&V intake is associated with improved bone status in middle aged and aged women; however, findings are inconsistent. The objective was to systematically review observational and interventional studies that investigated the effects of F&V intake on incidence of osteoporotic fractures, bone mineral density (BMD), and bone turnover markers (BTM) in women aged ≥ 45 years and to identify potential research gaps.

METHODS

Electronic databases were searched, and peer-reviewed manuscripts published in English, with F&V intake as a main dietary exposure, were included. Data selection, extraction, and evaluation of risk of bias were performed independently by two reviewers.

RESULTS

Eight studies were included. One cohort study reported cross-sectional as well as longitudinal data. There was significant between-study heterogeneity in design, definition, and amount of F&V intake, outcomes, analyses, and reporting of results. Two studies had low, two had moderate, and four had high risk of bias. Among reports with low or moderate risk of bias, two cross-sectional analyses reported positive associations between F&V intake and BMD of the forearm, lumbar spine, or total hip, whereas one randomized controlled trial and two prospective cohort analyses reported no effects. One trial reported no associations between F&V and BTM.

CONCLUSIONS

Based on limited evidence, the benefits of F&V on bone health remain unclear for women aged ≥ 45 years. Further studies with low risk of bias are needed.

Preparation and in vitro evaluation of carrier erythrocytes for RES-targeted delivery of interferon-alpha 2b

Carrier erythrocytes is one of the most promising systemic drug delivery systems investigated in recent decades. In this study, human erythrocytes have been loaded with interferon-alpha 2b (IFN) with the aim to benefit the reticuloendothelial system (RES) targeting potential of the carrier cells. Hypotonic preswelling method was used for drug loading in erythrocytes and the entire loading procedure was evaluated and validated. The loaded amount, entrapment efficiency and cell recovery of the loading procedure were 2906.33+/-588.35IU/0.1ml, 14.53+/-2.94%, and 83.61+/-0.49%, respectively, all being practically feasible. The carrier erythrocytes were characterized in vitro in terms of their drug release kinetics, hematological indices, particle size distribution, SEM analysis, and osmotic and turbulence fragility. IFN release from carrier cells was a relatively rapid process in comparison to the cell lysis kinetics, which is unusual considering the whole body of data published on this delivery system and other protein drugs, so far. All the tested in vitro characteristics showed significant, sometimes notable changes upon drug loading procedure, both with and without the drug.