Significant Clinical Symptoms Research Articles

Наднирникові гіперандрогенії: мультидисциплінарний підхід до вирішення проблеми

Поширеність та можливі наслідки гіперандрогенних станів у жінок репродуктивного віку обумовлюють важливість своєчасної диференційної діагностики гіпер­андрогеній. З урахуванням рівня розвитку радіологічних та лабораторних методів досліджень можлива постановка точного діагнозу, особливо при діагностиці гіперандрогеній наднирникового генезу, які часто перебігають без яскравої клінічної симптоматики, але супроводжуються порушеннями менструального циклу, безпліддям, невиношуванням вагітності.

Application of Auriculotherapy for Post-Burn Scar Syndrome in Young Adults with Major Burns.

A burn scar is a type of hypertrophic scar that can cause significant clinical symptoms, discomfort, and post-burn scar (PBS) syndrome in up to 77% of patients with burn injuries. Medication and rehabilitation are rarely effective at managing patient discomfort, and both laser and surgical interventions are postponed until the scar stabilizes and discomfort is tolerable. Objectives: The present study was conducted to investigate the effectiveness of auricular acupuncture among burn victims from the Formosa Color Dust Explosion in Taiwan. We enrolled 31 victims of the 2016 Formosa Color Dust Explosion who met the study inclusion criteria. The intervention involved placement of magnetic beads over the auricular Shenmen and Subcortex acupoints on one ear. Patients performed selfmassage five times per day, and both magnet beads were removed between the fifth and seventh days during the sessions. Several evaluation tools were used to assess clinical symptoms: the visual analogue scale for pain assessment, Burn Man Itch Scale for perceived patient itchiness, 5-D Pruritus Scale for sleep quality, and heart rate variability (HRV) for effects on the autonomic nervous system. The clinical symptoms were significantly decreased following the intervention, but the effect did not endure. The normal-to-normal heart rate interval, heart rate analysis abnormalities, and very low frequency heart rate were significantly decreased among patients with abnormal HRV (SD < 40) following treatment. Stimulation of the auricular Shenmen and Subcortex acupoints may effectively reduce pain, itchiness, and sleep disturbances among patients with PBS syndrome.

Fermented milk modulates immune systemic response and intestinal epithelial structure in Balb/c mice sensitized to bovine whey proteins

In epidemiological studies, cow’s milk protein allergy (CMPA) is the most prevalent allergy for infants or young children.This study was conducted to compare the effect of Soummam and Saifi fermented milks on mice sensiti-zed to whey protein (β –Lactoglobulin and α –Lactalbumin). During 28 days, the animals from the first and second lot received via an oral way the fer-mented milks. In a second period of time, mice from the first, second lots were sensitized via intraperitoneal way using β-Lg, mice from third and fourth lot were sensitized by α–Lactalbumin. The antigenecity was deter-mined by enzyme-linked immunosorbent assay (ELISA). Symptom scores were determined after in vivo challenge with β-Lg or α-Lac. Intestinal da-mage was evaluated by histological analysis. Analysis of the data revealed that the titers of anti-α-lactalbumin and anti-β-lactoglbulin IgG increased significantly in the positive control groups given Soummam and Saifi fer-mented milk (p &lt;0.001). Moreover, in fermented milk-treated mice, signifi-cant clinical symptoms were observed. Analysis of histological sections re-vealed that fermented milk doesn’t reduce the microscopic lesions induced by β-Lg or α-Lac sensitzation. This study indicated that the administration of Soummam fermented milk can modulate effectively the immune response and protect the intestinal epithelium integrity.

BK Polyomavirus-Biology, Genomic Variation and Diagnosis.

The BK polyomavirus (BKPyV), a representative of the family Polyomaviridae, is widespread in the human population. While the virus does not cause significant clinical symptoms in immunocompetent individuals, it is activated in cases of immune deficiency, both pharmacological and pathological. Infection with the BKPyV is of particular importance in recipients of kidney transplants or HSC transplantation, in which it can lead to the loss of the transplanted kidney or to haemorrhagic cystitis, respectively. Four main genotypes of the virus are distinguished on the basis of molecular differentiation. The most common genotype worldwide is genotype I, with a frequency of about 80%, followed by genotype IV (about 15%), while genotypes II and III are isolated only sporadically. The distribution of the molecular variants of the virus is associated with the region of origin. BKPyV subtype Ia is most common in Africa, Ib-1 in Southeast Asia, and Ib-2 in Europe, while Ic is the most common variant in Northeast Asia. The development of molecular methods has enabled significant improvement not only in BKPyV diagnostics, but in monitoring the effectiveness of treatment as well. Amplification of viral DNA from urine by PCR (Polymerase Chain Reaction) and qPCR Quantitative Polymerase Chain Reaction) is a non-invasive method that can be used to confirm the presence of the genetic material of the virus and to determine the viral load. Sequencing techniques together with bioinformatics tools and databases can be used to determine variants of the virus, analyse their circulation in populations, identify relationships between them, and investigate the directions of evolution of the virus.

Favipiravir and Hydroxychloroquine Combination Therapy in Patients with Moderate to Severe COVID-19 (FACCT Trial): An Open-Label, Multicenter, Randomized, Controlled Trial.

IntroductionAntiviral drugs have shown limited effectiveness in treating patients with coronavirus disease 2019 (COVID-19). We aimed to assess the effects of a favipiravir and hydroxychloroquine combination on treating moderate-to-severe COVID-19 patients.MethodsAn investigator-initiated, multicenter, open-label, randomized trial at nine hospitals. Eligible patients were adults with moderate-to-severe COVID-19 defined as oxygen saturation (SaO2) of ≤ 94% while breathing ambient air or significant clinical symptoms with chest x-ray changes requiring hospital admission. Randomization was in a 1:1 ratio to receive standard care (control group) or standard care plus favipiravir and hydroxychloroquine. The primary outcome was time to clinical improvement of two points (from the status at randomization) on a seven-category ordinal scale or live discharge from the hospital within 14 days. Analyses were done in an intention-to-treat population.ResultsFrom May 2020 to Jan 2021, 254 patients were enrolled; 129 were assigned to standard of care and 125 to the treatment. The mean age was 52 (± 13) years, and 103 (41%) were women. At randomization, six patients were on invasive mechanical ventilation, 229 (90.15%) were requiring supplemental oxygen only (with or without non-invasive ventilation), and 19 (7.48%) were receiving neither. The time to clinical improvement was not significantly different between the groups: median of 9 days in the treatment group and 7 days in the control group (HR: 0.845; 95% CI 0.617–1.157; p-value = 0.29). The 28-day mortality was not significantly different between the groups (7.63% treatment) vs. (10.32% control); p-value = 0.45. The most prevalent adverse events were headache, elevation in ALT, and the prolonged QTc interval in the treatment group.ConclusionThe combination of favipiravir and hydroxychloroquine did not result in a statistically significant clinical benefit in patients with moderate-to-severe COVID-19.Clinical Trial RegistrationClinicalTrials.gov (NCT04392973).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00496-6.

Review: The Nose as a Route for Therapy. Part 2 Immunotherapy.

The nose provides a route of access to the body for inhalants and fluids. Unsurprisingly it has a strong immune defense system, with involvement of innate (e.g., epithelial barrier, muco- ciliary clearance, nasal secretions with interferons, lysozyme, nitric oxide) and acquired (e.g., secreted immunoglobulins, lymphocytes) arms. The lattice network of dendritic cells surrounding the nostrils allows rapid uptake and sampling of molecules able to negotiate the epithelial barrier. Despite this many respiratory infections, including SARS-CoV2, are initiated through nasal mucosal contact, and the nasal mucosa is a significant “reservoir” for microbes including Streptococcus pneumoniae, Neisseria meningitidis and SARS -CoV-2. This review includes consideration of the augmentation of immune defense by the nasal application of interferons, then the reduction of unnecessary inflammation and infection by alteration of the nasal microbiome. The nasal mucosa and associated lymphoid tissue (nasopharynx-associated lymphoid tissue, NALT) provides an important site for vaccine delivery, with cold-adapted live influenza strains (LAIV), which replicate intranasally, resulting in an immune response without significant clinical symptoms, being the most successful thus far. Finally, the clever intranasal application of antibodies bispecific for allergens and Intercellular Adhesion Molecule 1 (ICAM-1) as a topical treatment for allergic and RV-induced rhinitis is explained.

From accurate diagnosis to targeted therapy: depression in general medical practice

Objective: to analyze the diagnostic significance of clinical and phenomenological characteristics of affective disorders in patients with chronic somatic pathology.Patients and methods. The analysis included the results of a clinical evaluation of 131 patients with chronic somatic pathology, including 96 patients suffering from cardiovascular diseases and 35 patients with cerebral small vessel disease. Clinical assessment included Primary care evaluation of mental disorders (PRIME-MD) and Hamilton Depression Rating Scale.Results and discussion. Despite the significant frequency and transparent clinical symptoms, general practitioners diagnosed mental disorders in only 30% of patients with depression. We observed a higher prevalence of somatic rather than psychological complaints during the clinical survey. According to the screening using PRIME-MD, 74% of patients were diagnosed with mood disorders, anxiety, and somatoform disorders. We also noted their significant comorbidity with a predominance of a depression and anxiety combination (p &lt; 0.001). Hypertensive patients had the highest depression prevalence (87%) and severity. Moderate depression was the most frequent diagnosis in the study participants, corresponding to major depressive disorder (61.5%).Conclusion. In general, the symptoms of anhedonia, depression, and anxiety were most pronounced in patients with affective disorders. The high prevalence of somatic symptoms complicates depression evaluation. It is possible to highlight depression and anhedonia as significant symptoms for the detection of depression in patients with somatic disorders.

Selective Anterior Fusion Surgery Does Not Influence Global Spinal Sagittal Alignment in Lenke Type 5 Adolescent Idiopathic Scoliosis Patients.

Retrospective comparative study. The aim of this study was to evaluate the changes in global spinal sagittal alignment (GSSA) following selective anterior spinal fusion (ASF) in patients with Lenke type 5 adolescent idiopathic scoliosis (AIS). Few studies have assessed the changes in postoperative GSSA, including cervical, thoracic, and lumbosacral sagittal alignment in AIS patients with major thoracolumbar/lumbar (TL/L) curve who underwent selective ASF. Fifty-two patients with Lenke type 5 AIS (two males and 50 females, mean age at surgery of 16.4 ± 3.1 years) were included in this study. The average final follow-up was 8.3 ± 3.1 years after surgery. The variations of outcome variables were analyzed in various spinal sagittal profiles using radiographic outcomes (pre-operation, immediate post-operation, and final follow-up). The clinical outcomes at the final follow-up were assessed using Scoliosis Research Society (SRS)-22 and Oswestry Disability Index (ODI) questionnaires. The mean Cobb angle of the main TL/L and minor thoracic curve was significantly improved after selective ASF, which was maintained up to the final follow-up. However, in all cases, the various sagittal parameters examined (sagittal vertical axis [SVA], C2-7 SVA, C2-7 lordosis, T1 slope, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope), did not significantly change in the immediate postoperative period, and all GSSA parameters were maintained up to the final follow-up. Furthermore, the magnitude of coronal curve correction and fused levels did not affect each GSSA parameter postoperatively. During the period up to the final follow-up, no significant clinical symptoms were observed. The final SRS-22 global score was 4.5 ± 0.3, and ODI scored 0.8 ± 2.4. Selective ASF did not influence various GSSA parameters postoperatively and could maintain excellent correction for coronal deformity with satisfactory final functional and clinical outcomes confirmed by long-term follow-up.Level of Evidence: 4.

When doom is vincible but imperceptible

An eighty-year-old gentleman without any comorbidity or significant medical illness had presented with headache of recent onset. A detail clinical evaluation and imaging (MRI of brain) ruled out secondary cause of headache. A month later, he presented to emergency with altered sensorium and quadriparesis. Repeat brain imaging revealed bilateral subdural hemorrhage requiring emergent surgery. He was back to normalcy within few days postoperatively. A confession was obtained about his daily habit of induced vomiting after drinking large amount of water (kunjala kriya). The repeated habit of induced vomiting might have been responsible for the slowly evolving subdural hemorrhage. Interestingly, though he had significant clinical symptoms at the initial presentation, he had normal initial MRI of brain (the more sensitive imaging modality). Our case highlights the interesting neurophysiology of subdural hemorrhage and the importance of close monitoring of elderly patients of recent onset headache.

Development and Validation of a Clinical Symptom-based Scoring System for Diagnostic Evaluation of COVID-19 Patients Presenting to Outpatient Department in a Pandemic Situation

BackgroundPreventive strategies in the form of early identification and isolation of patients are the cornerstones in the control of COVID-19 pandemic. We have conducted this study to develop a clinical symptom-based scoring system (CSBSS) for the diagnostic evaluation of COVID-19. MethodsIn this study, 378 patients presenting to screening outpatient clinic with clinical suspicion of COVID-19 were evaluated for various clinical symptoms. Statistical associations between presenting symptoms and reverse transcription-polymerase chain reaction (RT-PCR) results were analysed to select statistically significant clinical symptoms to design a scoring formula. CSBSS was developed by evaluating clinical symptoms in 70% of the total patients. The cut-off score of the CSBSS was determined from ROC (receiver operating characteristics) curve analysis to obtain a cut-off for optimum sensitivity and specificity. Subsequently, developed CSBSS was validated in the external validation dataset comprising 30% of patients.ResultsClinical symptoms like fever >1000F, myalgia, headache, cough and loss of smell had significant association with RT-PCR result. The adjusted odds ratios (95% confidence interval [CI]) for loss of smell, fever >100°F, headache, cough and myalgia were 5.00 (1.78-13.99), 2.05 (1.36-3.07), 1.31 (0.67-2.59), 1.26 (0.70-2.26) and 1.18 (0.50-2.78), respectively. The ROC curve and area under the curve of development and validation datasets were similar.ConclusionThe presence of fever >100°F and loss of smell among suspected patients are important clinical predictors for the diagnosis of COVID-19. This newly developed CSBSS is a valid screening tool that can be useful in the diagnostic evaluation of patients with suspected COVID-19. This can be used for the risk stratification of the suspected patients before their RT-PCR results are generated.

Mending Broken Hearts

Mending Broken Hearts

Chronic Wasting Due to Liver and Rumen Flukes in Sheep.

Simple SummaryChronic wasting in sheep is often related to parasitic infections, especially to infections with several species of trematodes. Trematodes, or “flukes”, are endoparasites, which infect different organs of their hosts (often sheep, goats and cattle, but other grazing animals as well as carnivores and birds are also at risk of infection). The body of an adult fluke has two suckers for adhesion to the host’s internal organ surface and for feeding purposes. Flukes cause harm to the animals by subsisting on host body tissues or fluids such as blood, and by initiating mechanical damage that leads to impaired vital organ functions. The development of these parasites is dependent on the occurrence of intermediate hosts during the life cycle of the fluke species. These intermediate hosts are often invertebrate species such as various snails and ants. This manuscript provides an insight into the distribution, morphology, life cycle, pathology and clinical symptoms caused by infections of liver and rumen flukes in sheep. Furthermore, we address the diagnosis, treatment and prevention measures, as well as the current knowledge about genomic resources.Grazing sheep and goats are constantly exposed to helminth infections in many parts of the world, including several trematode species that causes a range of clinical diseases. The clinical picture of flukes is dependent upon the organs in which they develop and the tissues they damage within the respective organs. Accordingly, infections with the common liver fluke Fasciola hepatica, which, as juvenile worm migrates through the liver parenchyma for several weeks, may be associated with hepatic disorders such as impairment of carbohydrate, protein and fat metabolism, followed by chronic wasting. In contrast, the lancet fluke Dicrocoelium dendriticum, which does not exhibit tissue migration and thus does not lead to major tissue damage and bleeding, also does not lead to significant clinical symptoms. Rumen flukes such as Cotylophoron daubneyi cause catarrhal inflammation during their migration through the intestinal and abomasal epithelium during its juvenile stages. Depending on the infection intensity this may result in a range of clinical symptoms including diarrhoea, inappetence or emaciation. In this review, we aim to provide an update on the current knowledge on flukes particularly concerning the clinical relevance of the most important fluke species in sheep.

Favipiravir and Hydroxychloroquine Combination Therapy in Patients with Moderate to Severe COVID-19 (FACCT): An Open-Label, Multicentre, Randomised, Controlled Trial

Background: No antiviral drug has been proven effective for the treatment of patients with moderate-to-severe coronavirus disease 2019 (COVID-19). Favipiravir and hydroxychloroquine were introduced as potential antiviral agents to treat patients with COVID-19.Methods: We conducted an investigator-initiated, multicentre, open-label, randomised trial involving hospitalised patients with confirmed moderate-to-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at nine hospitals in Saudi Arabia. Eligible patients were adult with moderate-to-severe COVID-19 defined as oxygen saturation (Sao2) of 94% or less while breathing ambient air or significant clinical symptoms with chest X-ray changes requiring hospital admission. Randomisation was in a 1:1 ratio to receive standard care (control group) or standard care plus favipiravir and hydroxychloroquine. The favipiravir loading dose was 1800 mg twice daily on day 1, then 800mg twice daily for nine days and hydroxychloroquine as 400mg twice daily, followed by 200mg twice daily for days 2-5. The primary outcome was time to clinical improvement of two points (from the status at randomisation) on a seven-category ordinal scale or live discharge from the hospital within 14 days. Analyses were done in an intention-to-treat population of patients to assess the primary and secondary endpoints. The trial is registered at ClinicalTrials.gov (NCT04392973).Findings: From May 2020 to Jan 2021, 254 patients were enrolled; 129 were assigned to standard of care and 125 patients to the combination of favipiravir and hydroxychloroquine. The mean age was 52·65 ±13·06 years, 59·4% were men, and 229 (90·15%) required supplemental oxygen at randomisation (with or without non-invasive ventilation). The time to clinical improvement was not significantly different between the two groups; median of 9 days (95%CI: 8, 12) in the treatment group and 7 days (95%CI: 6, 10) in the control group (HR:0·845; 95% CI 0·617 to 1·157; p-value = 0·29). The median duration of hospitalisation among patients discharged on or before day 14 was 9 days (95%CI: 8, 12) for the treatment group and 8 days (95%CI: 7, 10) for the control group with a p-value of 0·42. The 28-day mortality was not significantly different between the two groups, 9 (7·63%) in the treatment group vs 13 (10·32%) in the control group; p-value=0·45. The most prevalent adverse events were headache, elevation in ALT, and the prolonged QTc interval in the treatment group.Interpretation: The combination of favipiravir and hydroxychloroquine did not result in a statistically significant clinical benefit in patients with moderate-to-severe COVID-19. No new safety signals were recognised for both medications.Trial Registration: This trial is registered with ClinicalTrials.gov, Identifier: NCT04392973, May 19, 2020.Funding Statement: King Abdullah International Medical Research Center, Saudi Arabia.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: This trial was approved by the Saudi Food and Drug Authority (SFDA). Ethical approval was obtained from the Institutional Review Board (IRB) at the Ministry of National Guard-Health Affairs (MNGHA) and Ministry of Health (MOH). The trial was overseen by an independent data and safety monitoring board (DSMB). The trial was done according to the Declaration of Helsinki principles and the International Conference on Harmonization-Good Clinical Practice guidelines.

Serum Alpha-(1, 3)-Fucosyltransferase IV, Copper, and Zinc Levels in Patients with Colorectal Cancer and Healthy Controls

Background: Colorectal cancer (CRC) has no significant clinical symptoms at the early stages, and the molecular differences in the serum of the patients and healthy subjects could be assessed to identify the biological markers that indicate the detection of this cancer at the levels of the biological system. Objectives: The present study aimed to assess the concentrations of the alpha-(1, 3)-fucosyltransferase IV (FUT4) enzyme and copper (Cu) and zinc (Zn) as biological elements. Methods: This case-control study was conducted on 40 patients with CRC, including 20 men and 20 women. A metal-free sterile tube was used to collect five milliliters of venous blood. The enzyme-linked immunosorbent assay (ELISA) based on the Biotin double-antibody sandwich technology was used to measure the human FUT4 in the sera. In addition, plasma zinc and copper values were determined using Zist Chem Diagnostics kits. Results: The mean FUT4 levels in the CRC patients was slightly higher than the control group (P = 0.17), and the mean serum copper and zinc levels of these patients were lower than the control group with a significance difference in this regard (P &lt; 0.001). In addition, the AUC of FUT4, copper, and zinc was 0.58, 0.80, and 0.77, respectively. Conclusions: According to the results, the altered levels of FUT4, copper, and zinc in the serum of the CRC patients compared to the healthy controls could be an indicator associated with the CRC disease course. Furthermore, the unusual changes in the FUT4, copper, and zinc levels may signify CRC development, which plays a key role in the diagnosis and monitoring of this cancer.

Anxiety level and clinical course of patients with sickle cell disease during the COVID-19 outbreak

ObjectivesBesides infectious pneumonia and death risks, the COVID-19 pandemic has prompted negative psychological impacts on communities, especially on people with chronic diseases. We aimed to evaluate COVID-19 and sickle cell disease (SCD)-related experiences, and the clinical course during the outbreak, to measure anxiety levels of adolescent and young adult patients with homozygous SCD, to analyze the correlations between their COVID-19 experiences and anxiety levels and painful episodes. MethodsIn this cross-sectional study, 47 patients aged between 14 and 24 years responded to a descriptive instrument and the State-Trait Anxiety Inventory. Clinical features requiring hospitalization for the same period (between March 10 and May 10) of two sequential years were compared. ResultsSixty-six percent of the patients had at least one negative COVID-19 experience of dizziness, sleep disturbance, tonic immobility, appetite loss or nausea/abdominal distress. The number of negative COVID-19 experiences was correlated with the state anxiety score, the trait anxiety score, and the number of painful episodes (ρ=0.552, P<0.001; ρ=0.529, P<0.001; ρ=0.448, P=0.002, respectively). Both median state anxiety and trait anxiety scores were below the cut-off scores indicating significant clinical symptoms. The number of hospitalizations requiring vaso-occlusive crisis management and blood/exchange transfusion were similar for the same period of two sequential years, 2019 and 2020. ConclusionThese descriptive and correlation findings are the first reported on COVID-19-related anxiety in SCD patients. To develop screening and support strategies for mental health needs in pandemic times, further SCD studies should be conducted.

Analyzing genetic mutations of porcine reproductive and respiratory syndrome virus strains by serial passages in cell line from field wild strain

In this study, we compared the genetic mutation and virulence of the attenuated PRRSV strains obtained by 95 serial passages in Marc-145 cells with the parental virulent strain (designated as BG81) isolated in Vietnam. Results showed that there were marked changes in virulence: pigs inoculated with BG81 exhibited high fever ( 41◦C), which lasted for 12 days, and presented typical clinical symptoms of PRRSV; otherwise, pigs inoculated with BG895 (from passage 95), maintained mean rectal temperature from 39,5oC to 39,9oC, did not develop any significant clinical symptoms. Whole genomes of the attenuated strains were significantly different, but their sequence lengths were conserved, i.e., 15,321 nucleotides. The attenuated strain from passage 95 (BG895) contained 38 nucleotide substitutions that resulted in 14 amino acid changes. Most of these changes (about 65%) occurred before passage 50. The 14 amino acid changes were distributed in Nsp1, Nsp4, Nsp9, Nsp10, GP2, E, GP3, GP4, GP5 and N. Specially, there were two single substitutes within a codon in ORF3, corresponding to parallel mutation at position F143L. However, structural protein (M) and eight non-structural proteins (Nsp2, Nsp3, Nsp5, Nsp6, Nsp7, Nsp8, Nsp11 and Nsp12) among the 19 PRRSV proteins, remained conserved, without any mutations and supposed for consideration as irrelative to the attenuation process. It is interesting that in the gene coding for the smallest structural protein (E protein), there was the highest mutation rate among all of the structural genes analyzed, and genetically, seemed to be a highly variable region. These changes may provide the molecular bases for the observation of the attenuated phenotype in pigs. Thus, our variation results obtained between the attenuated BG895 and the parental virulent BG81 strains provide appropriate molecular data for potential use to test and control the masterseed strain in production of a PRRSV vaccine in Vietnam.

Peripheral nerve conduction study in early cognitive impairment of Alzheimer's disease

AbstractBackgroundMild cognitive impairment (MCI) individuals are at a higher risk to develop dementia, especially due to Alzheimer’s disease (AD). Dyskinesia, such as facial expressions, gait and postural changes, retardation and tremor, occurs even before significant clinical symptoms of AD. Besides, elders with central nervous degenerative diseases are more likely to have peripheral neuropathy. However, few studies have been devoted to exploring the relationship between peripheral nerve function and early cognitive impairment. The aim of this study was to compare MCI individuals with the normal population for peripheral nerve conduction, and to assess its relationship with cognitive function in elderly population living in Shanghai.Method74 MCI and 82 healthy controls (HC) underwent a peripheral nerve conduction examination and a neuropsychological evaluation. In order to minimized the effect of somatic diseases on peripheral nerve function, all the participants had no diabetes, thyroid dysfunction, Parkinson's disease and peripheral neuropathy. Nicolet EDX was used to assess peripheral nerve conduction of upper and lower limb, including median and sural sensory and median and peroneal motor nerve action potential amplitudes and velocities. Then we compared the peripheral nerve conduction results between two different cognitive groups. Furthermore, we also investigated the relationship between the peripheral nerve conduction and cognitive function.ResultBetween the two groups, MCI was older than HC (70.36±7.38 vs 68.04±6.27, p=0.07) although there was no significant difference. MCI group had less years of education (10.05±3.58 vs 11.45±2.57, p=0.009) and more depressive symptoms (3.65±4.37 vs 2.70±4.17, p=0.044), but no difference was found in gender. Median and peroneal motor nerve velocities were found slower in MCI group compared to HC group (54.51±4.18 vs 47.13±5.90, p=0.011; 56.36±4.72 vs 49.29±5.65, p=0.023). Both median (p=0.005) and peroneal (p=0.003) motor nerve velocities were correlated with MoCA. Furthermore, linear regression revealed that, after taking age, gender, education, depression and body mass index (BMI) into account as covariates, median motor nerve velocity was associated with MoCA (p=0.019).ConclusionOur study found that peripheral motor nerve velocity may be correlated with early cognitive impairment of AD, suggesting a new, possible research direction of early identification markers for AD.

Neurological diseases caused by coronavirus infection of the respiratory airways

Infections of the central nervous system (CNS) infections are critical problems for public health. They are caused by several different organisms, including the respiratory coronaviruses (CoVs). CoVs usually infect the upper respiratory tract causing the common cold. However, in infants, and in elderly and immunocompromised persons, they can also affect the lower respiratory tract causing pneumonia and various syndromes of respiratory distress. CoVs also have neuroinvasive capabilities because they can spread from the respiratory tract to the CNS. Once infection begins in the CNS cells, it can cause various CNS problems such as status epilepticus, encephalitis, and long‐term neurological disease. This neuroinvasive properties of CoVs may damage the CNS as a result of misdirected host immune response, which could be associated with autoimmunity in susceptible individuals (virus‐induced neuro‐immunopathology) or associated with viral replication directly causing damage to the CNS cells (virus‐induced neuropathology). In December 2019, a new disease named COVID‐19 emerged which is caused by CoVs. The significant clinical symptoms of COVID‐19 are related to the respiratory system, but they can also affect the CNS, causing acute cerebrovascular and intracranial infections. We describe the possible invasion routes of coronavirus in this review article, and look for the most recent findings associated with the neurological complications in the recently published literature.

Clinical Symptoms of Arboviruses in Mexico.

Arboviruses such as Chikungunya (CHIKV), Dengue (DENV), and Zika virus (ZIKV) have emerged as a significant public health concern in Mexico. The existing literature lacks evidence regarding the dispersion of arboviruses, thereby limiting public health policy’s ability to integrate the diagnosis, management, and prevention. This study seeks to reveal the clinical symptoms of CHIK, DENV, and ZIKV by age group, region, sex, and time across Mexico. The confirmed cases of CHIKV, DENV, and ZIKV were compiled from January 2012 to March 2020. Demographic characteristics analyzed significant clinical symptoms of confirmed cases. Multinomial logistic regression was used to assess the association between clinical symptoms and geographical regions. Females and individuals aged 15 and older had higher rates of reported significant symptoms across all three arboviruses. DENV showed a temporal variation of symptoms by regions 3 and 5, whereas ZIKV presented temporal variables in regions 2 and 4. This study revealed unique and overlapping symptoms between CHIKV, DENV, and ZIKV. However, the differentiation of CHIKV, DENV, and ZIKV is difficult, and diagnostic facilities are not available in rural areas. There is a need for adequately trained healthcare staff alongside well-equipped lab facilities, including hematological tests and imaging facilities.

The origin and past demography of murine astrovirus 1 in laboratory mice.

Astroviruses are non-enveloped, positive-sense, ssRNA viruses and often associated with gastrointestinal diseases. Murine astrovirus (MuAstV) was first confirmed in a laboratory mouse colony in 2011. Although infected mice do not present significant clinical symptoms, the virus might interfere with research results. A recent surveillance has shown that MuAstV is highly prevalent in laboratory mice. The aims of the present study were to identify and characterize MuAstV strains as well as to investigate the prevalence rate of viral RNA in laboratory mice in Taiwan, and to estimate the origin and past population demography of MuAstVs. Based on molecular surveillance, MuAstV RNA was detected in 45.7 % of laboratory mice (48/105) from seven of nine colonies. Three fully sequenced MuAstV strains, MuAstV TW1, TW2 and TW3, exhibited 89.1-94.4 % and 89.1-90.0 % nucleotide identities with the reference strains MuAstV STL1 and STL2, respectively. Phylogenetic analyses of the partial regions of the RNA-dependent RNA polymerase (RdRp) and capsid protein (CP) genes of 18 Taiwan strains along with other astroviruses revealed that there are three distinct lineages of mouse astrovirus, MuAstV1, MuAstV2 and mouse astrovirus JF755422. The mutation rates of MuAstV1 were 2.6×10-4 and 6.2×10-4 substitutions/site/year for the RdRp and CP regions, respectively. Based on the above molecular clock, the colonization of MuAstV1 in laboratory mice was between 1897 and 1912, in good agreement with the establishment of 'modern' laboratory mouse facilities. Since its initial infection, the population size of MuAstV1 has increased 15-60-fold, probably consistent with the increased use of laboratory mice. In conclusion, MuAstV1 has been associated with modern laboratory mice since the beginning, and its influence on research results may require further investigation.