Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19 : Results of a retrospective multicenter neuroimaging-based study from three central European countries

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19.

MATERIALS AND METHODS

Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay.

RESULTS

442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH.

DISCUSSION

AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.

Combination of immunotherapies for severe allergic asthma

INTRODUCTION

Difficult-to-treat or severe persistent asthma accounts for 5-10% of the asthma population worldwide. However, this group of patients creates a higher burden on health systems due to their morbidity and need for long-term and additional treatment. Biological drugs constitute an alternative therapy in the treatment of patients with refractory asthma. In cases where inhalant allergy is part of the pathomechanism, allergen-specific immunotherapy (SIT) is a causative treatment option for allergic asthma. However, SIT is contraindicated for uncontrolled asthma and cannot be administered according to the guidelines. This is due to the risk of further worsening of uncontrolled asthma during treatment.

CASE STUDY

We herein report a case of a 67-year-old male with severe allergic asthma who was successfully treated with SIT after asthma control was achieved by using target treatments.

RESULTS

Complete control of asthma was achieved, and SIT with allergens from early flowering trees (birch-alder-hazel) was administered. Further, no asthmatic exacerbations or decrease in respiratory function occurred during the 15 months of treatment with mepoluzimab. He did not need any oral glucocorticosteroids.

CONCLUSION

The case report presented here suggests the effectiveness of an individualized approach and phenotype-specific treatment of patients who cannot receive allergen-specific immunotherapy due to the contraindication uncontrolled asthma and who receive SIT after asthma control is achieved by using target treatments.

Cross-Sectional Survey on the Dengue Knowledge, Attitudes and Preventive Practices Among Students and Staff of a Public University in Malaysia

Behavioural impact programmes are especially effective for dengue control and prevention. Universities are key settings for health promotion, so understanding factors that influence the practice of dengue prevention within a university community becomes important. This study aimed to examine the factors affecting dengue knowledge, attitude and preventive practices amongst students and staff of a public university. A cross-sectional survey study was conducted in Kuala Lumpur, Malaysia. A total of 372 students and staff of the NDUM were recruited by stratified sampling method. Data were collected via self-administered pre-tested structured questionnaires covering socio-demography and dengue KAP. Data were analysed descriptively. For bivariate analysis, Chi square test was applied. To explore the factors independently associated with the practice of dengue prevention, a logistic regression model was introduced. Overall, the participants had moderate dengue-related knowledge, good attitudes and good preventive practices. The majority had misconceptions about mosquito biting habits (83.8 %), seasonality of dengue epidemics (73.2 %), and mosquito breeding sites (70.3 %). Staff were more likely to have good dengue-related knowledge (p < 0.001) and attitudes (p = 0.008) than students. There was statistically significant positive association between the level of dengue knowledge and monthly average household income (p = 0.008), age (p < 0.001) and education (p < 0.001). Having good attitudes towards dengue was associated with being a non-Malay (p = 0.034), having higher monthly average household income (p = 0.047) and tertiary education (p < 0.001). In regression analysis, only dengue knowledge and dengue attitudes were significantly and positively associated with practice of dengue prevention. Dengue preventive strategies amongst university students and staff should focus on maintaining good dengue-related preventive practices. Educational campaigns should mainly target students, young staff members, and those with lower level of education and income.

Burnout and the Learning Environment of Anaesthetic Trainees

Burnout has a high prevalence among healthcare workers and is increasingly recognised as an environmental problem rather than reflecting a personal inability to cope with work stress. We distributed an electronic survey, which included the Maslach Burnout Inventory Health Services Survey and a previously validated learning environment instrument, to 281 Victorian anaesthetic trainees. The response rate was 50%. We found significantly raised rates of burnout in two of three subscales. Ninety-one respondents (67%) displayed evidence of burnout in at least one domain, with 67 (49%) reporting high emotional exhaustion and 57 (42%) reporting high depersonalisation. The clinical learning environment tool demonstrated a significant negative correlation with burnout (r=-0.56, P <0.001). Burnout was significantly more common than when previously measured in Victoria in 2008 (62% versus 38%). Trainees rated examination preparation the most stressful aspect of the training program. There is a high prevalence of burnout among Victorian anaesthetic trainees. We have shown a significant correlation exists between the clinical learning environment measure and the presence of burnout. This correlation supports the development of interventions to improve the clinical learning environment, as a means to improve trainee wellbeing and address the high prevalence of burnout.

A Paleoarchean coastal hydrothermal field inhabited by diverse microbial communities: the Strelley Pool Formation, Pilbara Craton, Western Australia

The 3.4-Ga Strelley Pool Formation (SPF) at the informally named 'Waterfall Locality' in the Goldsworthy greenstone belt of the Pilbara Craton, Western Australia, provides deeper insights into ancient, shallow subaqueous to possibly subaerial ecosystems. Outcrops at this locality contain a thin (<3 m) unit of carbonaceous and non-carbonaceous cherts and silicified sandstones that were deposited in a shallow-water coastal environment, with hydrothermal activities, consistent with the previous studies. Carbonaceous, sulfide-rich massive black cherts with coniform structures up to 3 cm high are characterized by diverse rare earth elements (REE) signatures including enrichment of light [light rare earth elements (LREE)] or middle rare earth elements and by enrichment of heavy metals represented by Zn. The massive black cherts were likely deposited by mixing of hydrothermal and non-hydrothermal fluids. Coniform structures in the cherts are characterized by diffuse laminae composed of sulfide particles, suggesting that unlike stromatolites, they were formed dominantly through physico-chemical processes related to hydrothermal activity. The cherts yield microfossils identical to previously described carbonaceous films, small and large spheres, and lenticular microfossils. In addition, new morphological types such as clusters composed of large carbonaceous spheroids (20-40 μm across each) with fluffy or foam-like envelope are identified. Finely laminated carbonaceous cherts are devoid of heavy metals and characterized by the enrichment of LREE. This chert locally contains conical to domal structures characterized by truncation of laminae and trapping of detrital grains and is interpreted as siliceous stromatolite formed by very early or contemporaneous silicification of biomats with the contribution of silica-rich hydrothermal fluids. Biological affinities of described microfossils and microbes constructing siliceous stromatolites are under investigation. However, this study emphasizes how diverse the microbial community in Paleoarchean coastal hydrothermal environment was. We propose the diversity is at least partially due to the availability of various energy sources in this depositional environment including reducing chemicals and sunlight.

Expanding the Clinical Spectrum Associated With GLIS3 Mutations

CONTEXT

GLIS3 (GLI-similar 3) is a member of the GLI-similar zinc finger protein family encoding for a nuclear protein with 5 C2H2-type zinc finger domains. The protein is expressed early in embryogenesis and plays a critical role as both a repressor and activator of transcription. Human GLIS3 mutations are extremely rare.

OBJECTIVE

The purpose of this article was determine the phenotypic presentation of 12 patients with a variety of GLIS3 mutations.

METHODS

GLIS3 gene mutations were sought by PCR amplification and sequence analysis of exons 1 to 11. Clinical information was provided by the referring clinicians and subsequently using a questionnaire circulated to gain further information.

RESULTS

We report the first case of a patient with a compound heterozygous mutation in GLIS3 who did not present with congenital hypothyroidism. All patients presented with neonatal diabetes with a range of insulin sensitivities. Thyroid disease varied among patients. Hepatic and renal disease was common with liver dysfunction ranging from hepatitis to cirrhosis; cystic dysplasia was the most common renal manifestation. We describe new presenting features in patients with GLIS3 mutations, including craniosynostosis, hiatus hernia, atrial septal defect, splenic cyst, and choanal atresia and confirm further cases with sensorineural deafness and exocrine pancreatic insufficiency.

CONCLUSION

We report new findings within the GLIS3 phenotype, further extending the spectrum of abnormalities associated with GLIS3 mutations and providing novel insights into the role of GLIS3 in human physiological development. All but 2 of the patients within our cohort are still alive, and we describe the first patient to live to adulthood with a GLIS3 mutation, suggesting that even patients with a severe GLIS3 phenotype may have a longer life expectancy than originally described.

Household survey on Human Papilloma Virus vaccine awareness among women of reproductive age in Ibadan, Nigeria

BACKGROUND

Cervical cancer is the commonest female genital tract malignancy associated with high mortality in sub-Saharan Africa due to poor prevention plan. Human Papilloma Virus (HPV) is a necessary cause of cervical cancer, and the infection is vaccine preventable. Since the introduction of HPV vaccine, robust community surveys on awareness of the vaccine that capture end-users perspective is scarce. The aim of this study is to determine HPV vaccine awareness among women of reproductive age group.

METHODS

This was a household survey that used multi-stage random sampling conducted amongst 1002 women aged 18-49 years from August to September 2012 in Mokola area, Ibadan, south western Nigeria. A self-administered pre-tested questionnaire was used for data collection. Descriptive, bivariate and multivariable analyses were performed, and statistical significance was set at 95% confidence level.

RESULTS

The mean age was 29.8 +/- 8.2 years and 49.9% had female children. Only 4.6% had heard of HPV vaccine. A significantly higher odds of HPV vaccine awareness was found among highly skilled women, those initiating sexual intercourse at older ages; women with multiple sexual partners and those aware that cervical cancer is preventable.

CONCLUSION

The awareness of HPV vaccine is low. Policies and programs that will improve awareness utilising culturally sensitive messages are imperative.

Markel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumour of the skin with high rate of local recurrence and distant metastatic potential leading to poor outcomes. Merkel cells are normally found as innervated clusters of cells around hair follicles in the basal layer of the epidermis and are thought to function as touch receptors. Here, we describe a case of MCC in a 71-year-old female and provide an up-to-date review of the literature pertinent to the management of MCC. KEYWORDS: merkell cell carcinoma, diagnosis, imunohistochemistry, management.

Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumour of the skin with high rate of local recurrence and distant metastatic potential leading to poor outcomes. Merkel cells are normally found as innervated clusters of cells around hair follicles in the basal layer of the epidermis and are thought to function as touch receptors. Here, we describe a case of MCC in a 71-year-old female and provide an up-to-date review of the literature pertinent to the management of MCC.

Abdominal wall pseudohernia following video-assisted thoracoscopy and pleural biopsy

A rare case of pseudohernia of the abdominal wall following video-assisted thoracoscopy (VAT) and pleural biopsy in a 61-year-old male is presented. The patient presented with a recurrent pleural effusion following fractured ribs after a road traffic accident. Computerised tomography (CT) showed thickened pleura, which was biopsied using VAT. Access to the pleural cavity was obtained with two laparoscopic ports inserted at the 8th intercostal space on the posterior chest wall. Following the procedure, the patient experienced sharp pain over the right hypochondrium, which was followed by the development of a diffuse bulge associated with the loss of skin sensation. Ultrasound and CT disclosed no musculofascial defect. Electromyography showed denervation changes affecting the muscles innervated by the 8th intercostal nerve. With expectant treatment over a year, cutaneous sensation recovered partially; however, the size of the pseudohernia remained unchanged. To the authors' knowledge, this is the first report of a pseudohernia in the English literature following VAT and pleural biopsy.

Behcet's Disease : report of a case and review of the literature

Behcet's disease (BD) is an autoimmune disease of unknown aetiology with multisystem involvement presenting with relapsing orogenital ulcers and uveitis, involvement of central nervous system, joints, lungs, gastrointestinal tract and major blood vessels leading to myriads of presentations, which requires a multidisciplinary approach for satisfactory outcome. We describe a patient with BD, highlight its pathophysiology and management aspects, and present review of pertinent literature.

The alpha isoform of protein kinase C is involved in signaling the response of desmosomes to wounding in cultured epithelial cells

Initiation of reepithelialization upon wounding is still poorly understood. To enhance this understanding, we focus here on changes in the adhesive state of desmosomes of cultured Madin-Darby canine kidney cells in response to wounding of confluent cell sheets. Previous results show that desmosomal adhesion in Madin-Darby canine kidney cells changes from a calcium-dependent state to calcium independence in confluent cell sheets. We show that this change, which requires culture confluence to develop, is rapidly reversed upon wounding of confluent cell sheets. Moreover, the change to calcium dependence in wound edge cells is propagated to cells hundreds of micrometers away from the wound edge. Rapid transition from calcium independence to calcium dependence also occurs when cells are treated with phorbol esters that activate PKC. PKC inhibitors, including the conventional isoform inhibitor Gö6976, cause rapid transition from calcium dependence to calcium independence, even in subconfluent cells. The cellular location of the alpha isoform of PKC correlates with the calcium dependence of desmosomes. Upon monolayer wounding, PKCalpha translocates rapidly to the cell periphery, becomes Triton X-100 insoluble, and also becomes concentrated in lamellipodia. The PKCalpha translocation upon wounding precedes both the increase in PKC activity in the membrane fraction and the reversion of desmosomes to calcium dependence. Specific depletion of PKCalpha with an antisense oligonucleotide increases the number of cells with calcium-independent desmosomes. These results show that PKCalpha participates in a novel signaling pathway that modulates desmosomal adhesion in response to wounding.

Buoyancy-driven, rapid exhumation of ultrahigh-pressure metamorphosed continental crust

Preservation of ultrahigh-pressure (UHP) minerals formed at depths of 90-125 km require unusual conditions. Our subduction model involves underflow of a salient (250 +/- 150 km wide, 90-125 km long) of continental crust embedded in cold, largely oceanic crust-capped lithosphere; loss of leading portions of the high-density oceanic lithosphere by slab break-off, as increasing volumes of microcontinental material enter the subduction zone; buoyancy-driven return toward midcrustal levels of a thin (2-15 km thick), low-density slice; finally, uplift, backfolding, normal faulting, and exposure of the UHP terrane. Sustained over approximately 20 million years, rapid ( approximately 5 mm/year) exhumation of the thin-aspect ratio UHP sialic sheet caught between cooler hanging-wall plate and refrigerating, downgoing lithosphere allows withdrawal of heat along both its upper and lower surfaces. The intracratonal position of most UHP complexes reflects consumption of an intervening ocean basin and introduction of a sialic promontory into the subduction zone. UHP metamorphic terranes consist chiefly of transformed, yet relatively low-density continental crust compared with displaced mantle material-otherwise such complexes could not return to shallow depths. Relatively rare metabasaltic, metagabbroic, and metacherty lithologies retain traces of phases characteristic of UHP conditions because they are massive, virtually impervious to fluids, and nearly anhydrous. In contrast, H2O-rich quartzofeldspathic, gneissose/schistose, more permeable metasedimentary and metagranitic units have backreacted thoroughly, so coesite and other UHP silicates are exceedingly rare. Because of the initial presence of biogenic carbon, and its especially sluggish transformation rate, UHP paragneisses contain the most abundantly preserved crustal diamonds.

Comparison of topical and oral acyclovir in early herpes zoster ophthalmicus

Poor systemic absorption has limited the efficacy of early oral acyclovir in herpes zoster ophthalmicus (HZO). Aqueous humour levels are substantially higher if the drug is administered topically to the eye. A multicentre open randomised study was performed to compare the ocular prophylactic effects of topical and oral acyclovir. Fifty-seven patients with HZO within 72 hours of the onset of rash received either topical acyclovir ointment or 800 mg oral acyclovir, both 5 times daily for 7 days, and were followed for 12 months. Patients receiving ointment were significantly more likely to have ocular complications (p < 0.02) and anterior uveitis was significantly more frequent (p < 0.01) and severe (p < 0.01). Corneal hypoaesthesia was significantly more frequently (p < 0.05) and severe (p < 0.02) at 1 month. From 2 weeks patients receiving ointment were more likely to have pain and at all times their pain was more severe, but these differences were not statistically significant. In spite of its apparently better penetration topical acyclovir appears to have no prophylactic value in the management of early HZO.

Characterization of complementary DNA encoding the rat neuromedin U precursor

Neuromedin U (NmU), a peptide originally isolated from porcine spinal cord, is known for its ability to stimulate uterine smooth muscle contraction and to cause selective vasoconstriction. It was subsequently isolated from a number of species. Among the species studied, the five amino acids at the C-terminus of the peptide are totally conserved, suggesting that this region is of major importance. We have cloned and sequenced the cDNA encoding the rat NmU precursor protein using the anchor polymerase chain reaction technique. Sequence analysis revealed that NmU is synthesized as a 174-amino acid precursor. Like the precursors of most other small regulatory peptides, it has a hydrophobic signal peptide and a number of paired dibasic amino acids, which may serve as signals for enzymatic cleavage, to release NmU and a series of other peptides. These predicted flanking peptides of NmU show no significant homology with entries in the protein databases searched, and the cDNA likewise shows no homology with entries in the GenBank database. Northern blot analysis using total RNA extracted from different rat tissues shows high levels of NmU mRNA in the ileum, thyroid, and anterior pituitary. Southern blot analysis of rat genomic DNA demonstrates that NmU is a single copy gene.

RFLP for the human apolipoprotein B gene: II;EcoRI

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RFLP for the human apolipoprotein B gene: III;EcoRV

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RFLP for the human apolipoprotein B gene: I;BamHI

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RFLP for the human apolipoprotein B gene: IV;MspI

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RFLP for the human apolipoprotein B gene: V;XbaI

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Possible applications of recombinant DNA technology to the diagnosis and study of variants of alpha 1-antitrypsin

We describe the basic principles of recombinant DNA technology and how this methodology has been used to isolate and characterise cloned genes coding for alpha 1-antitrypsin. We show how these probes can be used for diagnosis and to study molecular variants of alpha 1-antitrypsin which may predispose individuals to develop lung disease.

Characterisation of mRNAs encoding the precursor for human apolipoprotein CI

cDNA clones encoding human apolipoprotein CI have been isolated from an adult liver cDNA library. Apo CI mRNA was shown to have two species of approximately 580 and 560 bases by RNA blot hybridisation. The intracellular precursor of apo CI was inferred from the cDNA sequence to be an 83 amino acid polypeptide consisting of the 57 residue mature protein and an additional 26 residue amino terminal signal peptide. The 5' untranslated regions of the messages are 63 and 40 bases as determined by primer extension and the 3' untranslated region 111 bases. A polyadenylation signal is situated 10 bases 3' of the poly(A) tall. The mRNA level of apo CI in human liver was significantly greater than that of apo All and apo E.

The isolation of a clone for human alpha 1-antitrypsin and the detection of alpha 1-antitrypsin in mRNA from liver and leukocytes

A recombinant clone containing an insert complementary to alpha 1-antitrypsin (alpha 1-AT) mRNA has been isolated from a human adult liver cDNA library. The clone was selected by direct screening of recombinants with a synthetic oligodeoxynucleotide 17 bases in length corresponding to the known partial DNA sequence of the gene. The insert size of the clone is 250 base pairs. The DNA sequence of the clone has been determined and agrees with the published partial DNA sequence. There is one nucleotide difference from the published sequence, causing a single amino acid change at position 376 where aspartate replaces glutamate. The clone has been used to detect alpha 1-AT mRNA sequences in human liver and in a mixed leukocyte population containing monocytes and lymphocytes. A single mRNA approximately 1,400 nucleotides in length is observed in both leukocytes and liver. Leukocytes contain only 0.15% as much alpha 1-AT mRNA as liver.

[Monitoring therapy by analysis of the drug concentration of saliva]

The distribution of a drug between blood and saliva depends on its physicochemical properties, e.g. binding to plasma proteins, apparent dissociation constant and lipid solubility. The clinical value of measuring salivary drug concentrations in therapeutic drug monitoring is demonstrated using anticonvulsant therapy in children as an example. For carbamazepine and phenytoin there is a close and constant saliva/serum ratio over a wide range of concentrations, which is influenced by the salivary flow rate only to an insignificant degree. Salivary concentrations of carbamazepine account for about 40%, of phenytoin for about 10% of the serum concentrations. In contrast, salivary levels of primidone and phenobarbital are significantly influenced by the rate of saliva flow. In resting saliva primidone levels slightly exceed those in serum and fall significantly below the corresponding serum values during forced stimulation of salivary flow. For phenobarbital in resting saliva the mean saliva/serum ratio is 0.3 and increases significantly during forced stimulation. Provided the conditions of sample collection are standardized saliva is suitable for monitoring primidone and phenobarbital therapy, too.

School achievement and behaviour of children who were small-for-dates at birth

School-teachers were asked to assess the school achievement and behaviour of 45 children who had been small-for-dates (SFD) at birth, and of 19 control children who had had a normal birthweight. The SFD children were divided into groups according to the stage in gestation at which slow head-growth began. Those whose head growth had slowed before 26 weeks gestation achieved less well at school than those who had had no evidence of slow intra-uterine head-growth. Their teachers also thought they were less able to concentrate. Boys (but not girls) whose head growth had slowed between 27 and 34 weeks gestation also had problems at school. The authors conclude that school achievement and behaviour of children who were small-for-dates at birth is related to the severity of slow growth before birth, the sex of the child and the social class of the parents.