Persistent immune abnormalities discriminate post-COVID syndrome from convalescence

BACKGROUND

Innate lymphoid cells (ILCs) are key organizers of tissue immune responses and regulate tissue development, repair, and pathology. Persistent clinical sequelae beyond 12 weeks following acute COVID-19 disease, named post-COVID syndrome (PCS), are increasingly recognized in convalescent individuals. ILCs have been associated with the severity of COVID-19 symptoms but their role in the development of PCS remains poorly defined.

METHODS AND RESULTS

Here, we used multiparametric immune phenotyping, finding expanded circulating ILC precursors (ILCPs) and concurrent decreased group 2 innate lymphoid cells (ILC2s) in PCS patients compared to well-matched convalescent control groups at > 3 months after infection or healthy controls. Patients with PCS showed elevated expression of chemokines and cytokines associated with trafficking of immune cells (CCL19/MIP-3b, FLT3-ligand), endothelial inflammation and repair (CXCL1, EGF, RANTES, IL-1RA, PDGF-AA).

CONCLUSION

These results define immunological parameters associated with PCS and might help find biomarkers and disease-relevant therapeutic strategies.

[Prognosis of patients with COVID-19 presenting acute ischaemic stroke and receiving interventional treatment]

Objetivo

Presentar nuestra experiencia y analizar el pronóstico de pacientes COVID-19 con ictus isquémico agudo por oclusión de grandes vasos tratados con neurointervencionismo (NIV) en la unidad de ictus.

Material y métodos

Se incluyeron todos los pacientes consecutivos con ictus isquémico agudo debido a oclusión de grandes vasos tratados por NIV en nuestra institución entre marzo y abril de 2020, durante el brote de COVID-19. Se realizó una comparación entre pacientes con COVID-19 y pacientes sin infección por coronavirus. Se comunican los resultados clínicos iniciales y a corto plazo.

Resultados

Del 1 de marzo al 30 de abril se realizaron 25 procedimientos de NIV por ictus isquémico agudo en nuestra institución. Ocho pacientes eran COVID-19 y 17 eran pacientes no COVID-19. La edad media de los pacientes con COVID-19 fue de 70,1 ± 12,23 años, y 7 fueron hombres (87,5%, p = 0,006). Mientras que todos los pacientes sin COVID procedían de urgencias, solo 5 pacientes con COVID-19 (62,5%) fueron atendidos desde urgencias por ictus (p = 0,01). Tres pacientes procedían de hospitalización. La tasa de mortalidad en pacientes sin COVID-19 fue del 5,8%, pero en pacientes con COVID-19 fue considerablemente alta (50%). Ningún parámetro analítico difirió entre ambos grupos. No se registraron hemorragias en esta serie.En comparación con el mismo período del año pasado, se observó una disminución de la actividad neurointervencionista del 39%.

Conclusiones

La mejor terapia médica y de NIV desembocó en malos resultados y una mortalidad dramática. La pandemia de COVID-19 dificultó significativamente el funcionamiento normal de los servicios de urgencias y la atención de estos pacientes con ictus.

Fear of heights in virtual reality saturates 20 to 40 m above ground

Recent epidemiological studies indicate that about one-third of the general population suffers from a more or less disabling height intolerance, with a relevant impact on quality of life in many of them. Acrophobia, the most severe form of visual height intolerance, has a life-time prevalence of around 5%. Although it is commonly believed that fear of heights should continuously aggravate with increasing elevation, this issue has not been systematically investigated yet. Here, we examined this topic using immersive virtual reality, an established tool in therapy for fear of heights, that allows to flexibly manipulate height stimuli. In a comprehensive cohort (including insusceptible subjects as well as subjects with height intolerance up to acrophobia) height intolerance severity was graded by an established metric scale (vHISS). Participants were randomly exposed to different virtual elevations using a head-mounted display. Behavioral responses to virtual height exposure were analogous to exposure in vivo. Participants exhibited increased anxiety and musculoskeletal stiffening with enhanced high-frequency body sway, to an extend that corresponded to the individual subjective height intolerance rating. For all behavioral responses, we observed a saturation above a certain altitude. Body sway and musculoskeletal stiffening became maximal at 20 m above ground, whereas anxiety saturated above 40 m. These results suggest that fear of heights is characterized by a nonlinear stimulus-response relationship and a dissociation between visual-height-induced bodily and emotional reactions.

Evaluation of three methodologies to estimate the VO2max in people of different ages

Aging and gender are factors that affect the variation of physical work capacity. The present paper highlights the importance of the metabolism used by ergonomics to establish the appropriate limits of loads at work. This study compares the aerobic capacity of people from 20 to 71 years old split in 5 different groups. The laboratory experiment tested 33 volunteers (19 women and 14 men). A submaximal step test was used to measure the VO(2) using a portable breath by breath metabolic system and a telemetric heart rate monitor. Three methods to estimate the VO(2max) were compared: 1) a direct measurement of VO(2), 2) estimation by heart rate, and 3) a step test method using predetermined charts. Significant difference was encountered among the estimation methods as well as among the age ranges (F(2,92)=6.43, p<0.05 y F(4,92)=7.18, p<0.05 respectively). The method of direct measurement and the method of predetermined charts were different for the estimation of the VO(2max) with a confidence level of 95%. The method of predetermined charts is better adapted for males and people younger than 30 years. The estimation through non invasive heart rate apparatus was a good appraiser of the maximal oxygen consumption considering both genders and all the age groups.

Restoration of enamel and dentin erosion due to gastroesophageal reflux disease: a case report

Gastroesophageal reflux disease (GERD) is a condition where acid contents of the stomach are regurgitated into the oral cavity, which results in continual exposure of the teeth to these acids. Knowledge of the relationship between GERD and dental erosion enables the appropriate diagnosis and treatment of the underlying medical condition as well as the affected teeth. This article details a case report where severe dental erosion was present due to GERD. After management of the disease, treatment (i.e., diagnosis, treatment planning, and restoration) of the eroded dentition is described.

Attitudes toward physician-nurse collaboration: a cross-cultural study of male and female physicians and nurses in the United States and Mexico

BACKGROUND

Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior.

OBJECTIVES

The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures.

METHOD

The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered to 639 physicians and nurses in the United States (n = 267) and Mexico (n = 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design.

RESULTS

Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed.

CONCLUSIONS

Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.

Onychomycosis in children: treatment with bifonazole-urea

We assessed the safety and efficacy of a two-phase topical treatment with bifonazole-urea ointment in children with onychomycosis. Twenty-five children younger than 16 years old with proved onychomycosis were included in the study. Bifonazole-urea ointment was administered under occlusion until the nontraumatic removal of the nail was achieved. Bifonazole cream was then applied for 4 weeks and a follow-up visit 4 weeks after cessation of medication was scheduled. During the study, periodic clinical and mycologic evaluations were carried out. Of the 25 patients included, 17 were cured (68%), 6 improved, and 2 failed treatment. The main etiologic agent isolated was Trichophyton rubrum (92%). Two patients had minor side effects, both during the occlusive phase, one each with mild pain and a probable dermatitis from the adhesive strips. Treatment was not discontinued in both of these cases. We concluded that a two-phase treatment with bifonazole-urea is effective and safe, and represents a new therapeutic choice for onychomycosis in children.

Occluding junctions and cytoskeletal components in a cultured transporting epithelium

MDCK cells form uninterrupted monolayers and make occluding junctions similar to those of natural epithelia. This aricle explores the relationship between these junctions and the cytoskeleton by combining studies on the distribution of microfilaments and microtubules with the effect of drugs, such as colchicines and cytochalasin B, on the degree of tightness of the occluding junctions. To study the degree of tightness, monolayers were prepared by plating MDCK cells on mylon disks coated with collagen. Disks were mounted as flat sheets between two Lucite chambers, and the sealing capacity of the junctions was evaluated by measuring the electrical resistance across the monolayers. Equivalent monolayers on coverslips were used to study the distribution of microtubules and microfilaments by indirect immunofluorescence staining with antibodies against tubulin and actin. This was done both on complete cells and on cytoskeleton preparations in which the cell membranes had been solubilized before fixation. Staining with antiactin shows a reticular pattern of very fine filaments that spread radially toward the periphery where they form a continuous cortical ring underlying the plasma membrane. Staining with antitubulin depicts fibers that extend radially to form a network that occupies the cytoplasm up to the edges of the cell. Colchicine causes a profound disruption of microtubules but only a 27 percent decrease in the electrical resistance of the resting monolayers. Cytochalasin B, when present for prolonged periods, disrupts the cytoplasmic microfilaments and abolishes the electrical resistance. The cortical ring of filaments remains in place but appears fragmented with time. We find that removal of extracellular Ca(++), which causes the tight junctions to open, also causes the microfilaments and microtubules to retract toward the center of the cells. The process of junction opening and fiber retraction is reversed by the restoration of Ca(++). Colchicine has no effect on either the opening or reversal processes, but cytochalasin B inhibits the resealing of the junctions by disorganizing the filaments in the ring and at the apical border of the cells. These cytochalasin B effects are fully reversible. The correlation among cell shape, cytoskeletal patterns, and electrical resistance in the EGTA-opened and resealed monolayers suggests that microfilaments, through their association with plasma membrane components, play a role in positioning the junctional strands and influence the degree of sealing of the occluding junctions.

[Norwegian scabies caused by Sarcoptes scabiei variety hominis]

A rare case of Norwegian scabies in a 16 years old female patient is reported. There also was Silver Roussel's syndrome and cellular immunologic deficiency. The case was confirmed at the biopsy, direct examination and immunologic examinations. Clinically, by erythema and adherent, abundant, whitish desquamation. The treatment resulted in a full recovery.