Nervous Symptoms Research Articles

Trend and co-occurrence network of COVID-19 symptoms through large-scale social media: Infoveillance Study.

For an emergent pandemic, such as COVID-19, the statistics of symptoms based on hospital data may be biased or delayed due to the high proportion of asymptomatic or mild-symptom infections who were not recorded in hospitals. Meanwhile, the difficulty of accessing large-scale clinical data also limits many researchers to conduct timely research. Given the wide coverage and promptness of social media, this study aimed to present an efficient workflow to track and visualize the dynamic characteristics and co-occurrences of symptoms for the pandemic from large-scale and long-term social media data. This retrospective study included 471,553,966 COVID-19-related tweets from February 1, 2020, to April 30, 2022. We curated a hierarchical symptom lexicon for social media containing 10 affected organs/systems, 257 symptoms, and 1808 synonyms. The dynamic characteristic of COVID-19 symptoms over time were analyzed from the perspectives of weekly new cases, overall distribution, and temporal prevalence of reported symptoms. The symptom evolutions between virus strains (Delta and Omicron) were investigated by comparing the symptom prevalence during their dominant periods. A co-occurrence symptom network was developed and visualized to investigate inner relationships among symptoms and affected body systems. This study identified 201 COVID-19 symptoms and grouped them into 10 affected body systems. The weekly quantity of self-reported symptoms has a high consistency (0.8528, P<.001) and one-week leading trend (0.8802, P<.001) with new COVID-19 infections. The frequency of symptoms showed dynamic changes as the pandemic progressed, from typical respiratory symptoms in the early stage to more musculoskeletal and nervous symptoms at later stages. We found the prevalence difference of symptoms between Delta period and Omicron period: less severe symptoms (coma and dyspnea), more flu-like symptoms (throat pain and nasal congestion), and less typical COVID symptoms (anosmia and taste altered) (All P<.001). Network analysis reveals the co-occurrences among symptoms and systems corresponding to specific disease progressions, including palpitation (cardiovascular) and dyspnea (respiratory), alopecia (musculoskeletal) and impotence (reproductive). This study identified more and milder COVID-19 symptoms than clinical research and characterize the dynamic symptom evolution based on 400 million tweets over 27 months. The symptom network reveals potential comorbidity risk and prognostic disease progressions. These demonstrate that the cooperation of social media and a well-designed workflow can depict a holistic picture of pandemic symptoms to complement clinical studies.

Multi-effective characteristics and advantages of acupuncture in COVID-19 treatment.

http://links.lww.com/AHM/A54.

Remedies for the housewife's nervousness: Life advice in Abraham Myerson's popular self-help texts, 1920-1930.

In 1920, the psychiatrist Abraham Myerson published a self-help book titled The Nervous Housewife. In his book, he argued that the living conditions in urban-industrial America were responsible for a significant increase in the number of housewives who suffered from nervous symptoms. He also warned that women were consequently becoming increasingly discontent with the role and were beginning to desire a life outside motherhood and housewifery. Accordingly, The Nervous Housewife offered housewives and their husbands directions on how to improve her living conditions. This would allow readers to manage and prevent the emergence of nervous symptoms so that women would continue to desire a life as housewife and mother. Throughout the 1920s, Myerson would continue to publish health advice for housewives on how they could manage and eliminate their nervous symptoms. This article analyzes how Myerson connected the everyday experiences and conditions of the housewife's life to her nervousness in his texts and reveals how his motivation was to keep women satisfied with what he deemed was their proper societal role, that of housewife and mother. In doing so, it will also compare his work to other self-help texts on nervousness to illuminate how his how-to guide was innovative, while examining both scholarly and popular reviews of his book to reveal what his peers and readers perceived as the benefits of his advice.

Predictive potential of somatic symptoms for the identification of subthreshold depression and major depressive disorder in primary care settings.

The presence of heterogenous somatic symptoms frequently obscures the recognition of depression in primary care. We aimed to explore the association between somatic symptoms and subthreshold depression (SD) and Major Depressive Disorder (MDD), as well as to determine the predictive potential of somatic symptoms in identifying SD and MDD in primary care. Data were derived from the Depression Cohort in China study (ChiCTR registry number: 1900022145). The Patient Health Questionnaire-9 (PHQ-9) was used to assess SD by trained general practitioners (GPs), and the Mini International Neuropsychiatric Interview depression module was used to diagnose MDD by professional psychiatrists. Somatic symptoms were assessed using the 28-item Somatic Symptoms Inventory (SSI). In total of 4,139 participants aged 18-64 years recruited from 34 primary health care settings were included. The prevalence of all 28 somatic symptoms increased in a dose-dependent manner from non-depressed controls to SD, and to MDD (P for trend <0.001). Hierarchical clustering analysis grouped the 28 heterogeneous somatic symptoms into three clusters (Cluster 1: energy-related symptoms, Cluster 2: vegetative symptoms, and Cluster 3: muscle, joint, and central nervous symptoms). Following adjustment for potential confounders and the other two clusters of symptoms, per 1 increase of energy-related symptoms exhibited significant association with SD (OR = 1.24, 95% CI, 1.18-1.31) and MDD (OR = 1.50, 95% CI, 1.41-1.60) The predictive performance of energy-related symptoms in identifying individuals with SD (AUC = 0.715, 95% CI, 0.697-0.732) and MDD (AUC = 0.941, 95% CI, 0.926-0.963) was superior to the performance of total SSI and the other two clusters (P < 0.05). Somatic symptoms were associated with the presence of SD and MDD. In addition, somatic symptoms, notably those related to energy, showed good predictive potential in identifying SD and MDD in primary care. The clinical implication of the present study is that GPs should consider the closely related somatic symptoms for early recognition for depression in practice.

Health Conditions Associated with Alzheimer's Disease and Vascular Dementia.

We examined medical records to determine health conditions associated with dementia at varied intervals prior to dementia diagnosis in participants from the Baltimore Longitudinal Study of Aging (BLSA). Data were available for 347 Alzheimer's disease (AD), 76 vascular dementia (VaD), and 811 control participants without dementia. Logistic regressions were performed associating International Classification of Diseases, 9th Revision (ICD-9) health codes with dementia status across all time points, at 5 and 1 year(s) prior to dementia diagnosis, and at the year of diagnosis, controlling for age, sex, and follow-up length of the medical record. In AD, the earliest and most consistent associations across all time points included depression, erectile dysfunction, gait abnormalities, hearing loss, and nervous and musculoskeletal symptoms. Cardiomegaly, urinary incontinence, non-epithelial skin cancer, and pneumonia were not significant until 1 year before dementia diagnosis. In VaD, the earliest and most consistent associations across all time points included abnormal electrocardiogram (EKG), cardiac dysrhythmias, cerebrovascular disease, non-epithelial skin cancer, depression, and hearing loss. Atrial fibrillation, occlusion of cerebral arteries, essential tremor, and abnormal reflexes were not significant until 1 year before dementia diagnosis. These findings suggest that some health conditions are associated with future dementia beginning at least 5 years before dementia diagnosis and are consistently seen over time, while others only reach significance closer to the date of diagnosis. These results also show that there are both shared and distinctive health conditions associated with AD and VaD. These results reinforce the need for medical intervention and treatment to lessen the impact of health comorbidities in the aging population. ANN NEUROL 2023;93:805-818.

Characterization of new strains of Pseudorabies virus in Argentina: Detection of interspecies transmission.

Aujeszky's disease is mainly a swine disease, still endemic worldwide. It can infect other mammalians, including human beings, and it is usually fatal with nervous symptoms. Ever since the disease was detected in 1988 in Argentina, many outbreaks have been reported involving both feral swine and dogs. At present, in Argentina, Pseudorabies virus (PRV) cases are sporadically reported; however, clinical cases are informed. This study aims to obtain information about the seroprevalence of PRV in wild boars and to isolate and characterize PRV from clinical samples. From 2018 to 2019, 78 wild boars' serum samples from Bahía de Samborombón natural reserve were analyzed for antibodies to PRV using a virus neutralization test. Clinical samples from 17 pigs, 2 wild boars, 1 dog, and 1 cat were collected from 2013 to 2019 for viral isolation and detection of the presence of the gD gene by PCR. For sequence analysis, the gC partial gene was amplified. Five strains were isolated from the dog, cat, and swine samples. The new PRV strains identified were confirmed by BLAST analysis, which revealed between 99.74% and 100% of similarity to the NIA-3 strain and phylogenetic analysis of the partial gene encoding the gC protein revealed that the PRV strains have divided into two main clades, clade 1 and clade 2. This report informed that most new cases of PRV were detected in the central regions of Argentina, where pig production is concentrated. The study in Bahía de Samborombón revealed a high percentage of detection but, the sampling is not representative of that of the rest of the country. Therefore, a systematic sampling effort of wild boar throughout the country should be included in the national program control. Although in Argentina only the inactivated Bartha vaccine is allowed, recombination risk should not be ignored if attenuated vaccines are incorporated into the National control plan. The two strains, one from the cat and one from the dog sample, are directly related to infected swine. The information about clinical cases and molecular characterization of new strains is important for a better understanding of the dynamics of PRV and to promote preventive measures.

Hypoglycemia In Non-Diabetic Patient: Report of Two Cases of Insulinoma

Background: Insulinoma is a B-cell tumor of the islets of the pancreas with an incidence of 4 per 1 million people per year, which produces excess insulin and can cause symptoms related to hypoglycemia at the level of the central nervous system or symptoms related to excess release of catecholamines. The presence of hypoglycemia, elevated insulin, proinsulin, and c-peptide levels suggest endogenous hyperinsulinism, which together with imaging findings suggestive of neuroendocrine tumor, allow establishing the diagnostic impression of Insulinoma. Case Report: Patients with neuroglycopenic symptoms, biochemical profile of hypoglycemia, endogenous hyperinsulinemia and radiological finding compatible with insulinoma are reported, who were treated by surgical resection of the tumor, with complete resolution of the initial symptoms. Conclusion: The clinical presentation, diagnosis and treatment of insulinoma represents a clinical challenge, since it is a rare pathology and the delay in diagnosis can have catastrophic consequences for the patient such as permanent brain damage and death.

Autonomic nervous system dysfunction in Prader-Willi syndrome.

Prader-Willi syndrome is a complex neurodevelopmental genetic disorder due to lack of paternal expression of critical imprinted genes in the 15q11.2-q13.1 chromosomal region, generally from a paternal deletion. Predominant features include infantile hypotonia, a poor suck with failure to thrive, craniofacial features, and developmental and behavioral problems including self-injury and childhood onset of obesity. In addition to severe obesity, patients with PWS present with other symptoms of autonomic nervous system dysfunction. We examined the features seen in Prader-Willi syndrome and searched the literature for evidence of autonomic nervous system involvement in this rare obesity-related disorder and illustrative findings possibly due to autonomic nervous system dysfunction. Additionally, we reviewed the literature in relation to childhood obesity syndromes and compared those syndromes to the syndromic obesity found in Prader-Willi syndrome. We report autonomic nervous system-related symptoms associated with childhood obesity impacting features seen in Prader-Willi syndrome and possibly other obesity-related genetic syndromes. We compiled evidence of both an autonomic route for the obesity seen in PWS and other autonomic nervous system-related dysfunctions. These include decreased salvation, sleep disordered breathing, increased pain and thermal threshold instability, delayed gastric emptying, altered blood pressure readings, and pupillary constriction responses as evidence of autonomic nervous system involvement. We summarized and illustrated findings of autonomic nervous system dysfunction in Prader-Willi syndrome and other obesity-related syndromes and genetic factors that may play a causative role in development.

Evaluation of fall risk factors for among hospitalized patients: systematic review and meta-analysis

Abstract Background Hospitals falls are an important challenge for healthcare systems. An early identification of patients at risk is critical, but no assessing tool has proven to be sufficiently predictive. This review aims at identifying factors associated with an increased risk of falls in hospitalized adults and at mapping them according to main international classification systems. Methods We carried out a systematic literature review and metanalysis to detect risk factors positively associated with the increase of falls in hospitals, searching litterature from January 2015 to March 2022. We included studies investigating falling risk factors in patients older than 16 years. Researchers independently assessed records’ eligibility and the methodological quality of included studies was assessed. When possible, data was processed using a random effects model and odds ratio (OR) with 95% confidence interval to quantify the effect. Risk factors were than classified according to ICF, ICD, and ATC classifications. Results We included 40 observational studies, enrolling 3,495,552 patients. Considering ICF-factors, mental and sensory functions-pain have a strong association with falls (OR = 3.311 and 2.149, respectively). ICD-factors associated with falls were mental and behavioural disorders (OR = 2.219), diseases of the nervous system (OR = 2.974), and symptoms, signs, and abnormal clinical and laboratory findings (OR = 2.665). Considering ATC-related factors, medications for alimentary tract and metabolism (OR = 1.978), and nervous system (OR = 1.779), showed a strong association with falls. Other factors were also associated with a moderately increased risk. Conclusions The comprehensive evidence-based assessment achieved with this meta-analysis alongside with the classification according to ICF, ICD and ATC systems provides a new standardized identification of the risk factors associated with an increase of falls in hospital. Key messages • Falls occurring in hospital are an important challenge for health care systems. Therefore the identification of risk factors associated to patients increased risk of fall is fundamental. • The comprehensive evidence-based assessment achieved with this meta-analysis provides a new standardized identification of the risk factors associated with an increase of falls for hospital.

Tissue Distribution of Parrot Bornavirus 4 (PaBV-4) in Experimentally Infected Young and Adult Cockatiels (Nymphicus hollandicus).

Proventricular dilatation disease (PDD) caused by parrot bornavirus (PaBV) infection is an often-fatal disease known to infect Psittaciformes. The impact of age at the time of PaBV infection on organ lesions and tissue distribution of virus antigen and RNA remains largely unclear. For this purpose, tissue sections of 11 cockatiels intravenously infected with PaBV-4 as adults or juveniles, respectively, were examined via histology, immunohistochemistry applying a phosphoprotein (P) antibody directed against the bornaviral phosphoprotein and in situ hybridisation to detect viral RNA in tissues. In both groups of adult- and juvenile-infected cockatiels, widespread tissue distribution of bornaviral antigen and RNA as well as histologic inflammatory lesions were demonstrated. The latter appeared more severe in the central nervous system in adults and in the proventriculus of juveniles, respectively. During the study, central nervous symptoms and signs of gastrointestinal affection were only demonstrated in adult birds. Our findings indicate a great role of the age at the time of infection in the development of histopathological lesions and clinical signs, and thus provide a better understanding of the pathogenesis, possible virus transmission routes, and the development of carrier birds posing a risk to psittacine collections.

Clinical genetics evaluation and testing of connective tissue disorders: a cross-sectional study

BackgroundHeritable connective tissue disorders (HCTDs) consist of heterogeneous syndromes. The diagnosis of HCTDs is aided by genomic biotechnologies (e.g., next-generation sequencing panels) facilitating the discovery of novel variants causing disease.MethodsDetailed clinical exam data and CLIA-approved genetic testing results from next generation sequencing of 74 genes known to play a role in HCTDs were manually reviewed and analyzed in one hundred consecutive, unrelated patients with phenotypic features indicative of a HCTD referred over a 3.5-year period (2016–2020) to a specialized academic genetics clinic. The prevalence of symptoms was evaluated in the context of genetic variants. We also determined if symptoms among different organ systems were related and performed latent class analysis to identify distinct groups of patients based on symptomatology.ResultsIn the cohort of 100 consecutive, unrelated individuals there were four pathogenic, six likely pathogenic and 35 classified potentially pathogenic variants of unknown clinical significance. Patients with potentially pathogenic variants exhibited similar symptom profiles when compared to patients with pathogenic/likely pathogenic variants in the same genes. Although results did not meet a multiple testing corrected threshold, patients with connective tissue symptoms had suggestive evidence of increased odds of having skin (odds ratio 2.18, 95% confidence interval 1.12 to 4.24) and eye symptoms (odds ratio 1.89, 95% confidence interval 0.98 to 3.66) requiring further studies. The best performing latent class analysis results were identified when dividing the dataset into three distinct groups based on age, gender and presence or absence of symptoms in the skeletal, connective tissue, nervous, gastrointestinal and cardiovascular systems. These distinct classes of patients included individuals with: (1) minimal skeletal symptoms, (2) more skeletal but fewer connective tissue, nervous or gastrointestinal symptoms and (3) more nervous system symptoms.ConclusionsWe used novel approaches to characterize phenotype-genotype relationships, including pinpointing potentially pathogenic variants, and detecting unique symptom profiles in patients with features of HCTDs. This study may guide future diagnosis and disease/organ system monitoring with continued improvement and surveillance by clinicians for patients and their families.

A novel SCN9A gene variant identified in a Chinese girl with paroxysmal extreme pain disorder (PEPD): a rare case report

BackgroundParoxysmal extreme pain disorder (PEPD) is a rare autosomal dominant hereditary disease, characterized by paroxysmal burning pain in the rectum, eyes or mandible and autonomic nervous symptoms, including skin redness and bradycardia. PEPD is a sodium channel dysfunctional disorder caused by SCN9A gene variants. It occurs mainly in Caucasians and only one case has been reported in the Chinese population. Here, we report the second PEPD case in a Chinese indivisual.Case presentationA 2 years and 6 months old girl initially presented with non-epileptic tonic seizures at 7 days after birth. Her clinical symptoms in order of presentation were non-epileptic tonic seizures, harlequin color change and pain. Genetic analysis showed the patient carried a heterozygous variant c.4384T>A (p.F1462I) in the SCN9A gene, which was speculated to cause PEPD symptoms. After administrating carbamazepine, the symptoms were relieved and the patient's condition improved. However, the patient’s mother, who carries the same SCN9A variant as her daughter, only showed bradycardia and sinus arrest but no PEPD-related pain.ConclusionsThis is the second PEPD case reported in the Chinese population. With the discovery of a novel variant in SCN9A, we expanded the genotype spectrum of PEPD. This is the first case suggesting that the clinical presentations of SCN9A-associated PEPD may show inter familial phenotypic diversity. In the future of clinical diagnosis, patients with triggered non-epileptic tonic seizures or pain and harlequin color change should be considered for PEPD and proper and prompt treatment should be given.

Adult Presentation of X-Linked Hypophosphatemia

Adult X-linked hypophosphatemia (XLH) patients present with specific symptoms, including enthesopathies (e.g., ossification of longitudinal ligaments (OPLL), osteophytes around large joints, and enthesopathy in the Achilles tendons), early osteoarthritis, the development of severe secondary and tertiary hyperparathyroidism (SHPT/THPT), and the subsequent progression of chronic kidney disease (CKD). In addition, these patients exhibit the typical phenotypes of osteomalacia, such as pseudofracture and fracture in weight-bearing bones, odontitis, and tooth abscesses. The mechanism underlying enthesopathy development is unknown; however, a common underlying mechanism among XLH and autosomal recessive hypophosphatemic rickets (ARHR1/2) due to mutations in PHEX, DMP1, and ENPP1 is assumed. Clarification of the pathogenesis and drug discovery for this complication is an urgent issue, as many adult XLH patients suffer subsequent debilitating nervous symptoms or impingement syndrome, and existing treatments are ineffective. Severe SHPT and THPT are associated with conventional therapy, including active vitamin D and phosphate supplementation, and complicated and careful adjustment of dosages by experienced clinicians is required to avoid SHPT/THPT. Burosumab is a very effective therapy without risk for the development of SHPT/THPT. However, indications for this drug should be carefully considered, along with cost-effectiveness, guidelines or recommendations, and the health care system of each country.

Scorpion envenomation in buffalo calf - Case report

Scorpion bit a three-month-old male buffalo calf of college sub-center in evening hours followed by rapid onset of clinical signs. Acute signs with lateral recumbency, paddling of legs, bellowing, nystagmus, frequent urination was observed in a calf. Clinical examination revealed subnormal body temperature (97.9oF), tachycardia (88/minute) and tachypnea (40/minute) with hyperemic conjunctival mucous membranes. Haematology showed severe leukocytosis (17.65x103/μl) while biochemistry showed slightly elevated serum total bilirubin (0.79 mg/dl) with normal blood urea nitrogen (25 mg/dl) and creatinine (1.4 mg/dl) values. Centrifugation of both whole blood sample in EDTA vial and clot activator tube showed haemolysed plasma and serum. Based on the evidence of scorpion bite, buffalo calf was treated symptomatically with Inj. Dextrose 5% 1 lit iv, Inj. Dexamethasone 0.04 mg/kg iv, Inj. Diazepam 1 mg/kg iv and Inj. Chlorpheniramine maleate 0.2 mg/kg im. Clinical signs of pain, nystagmus, bellowing, and excitation were subsided within half hour post-treatment while vital parameters were restored to normal after 12 h. A second treatment comprising of 1 liter Dextrose 5% 12 h later was followed by appreciable clinical improvement with resumption of normal suckling, feeding, and watering in treated calf. In conclusion, scorpion bite in bovines can be treated symptomatically with fluids, steroids, anti-allergic drugs, and sedatives in severe cases of nervous excitatory symptoms.

Effect of Movement Games on Physical Fitness of Children with Intellectual Disabilities

Research purpose. The study was aimed at investigating the effect of the proposed technology using movement games on the physical and psychomotor fitness of young schoolchildren with intellectual disabilities. &#x0D; Materials and Methods. Fourty children from an orphan asylum in Smila, Cherkasy region (Ukraine) participated in the study. All children were divided into two groups: control and experimental; all of them had been diagnosed with moderate-grade oligophrenia and were 2nd and 3rd graders (age 9–12 years). The control group consisted of 22 pupils, including 11 boys and 11 girls. The experimental group consisted of 18 pupils, including 9 boys and 9 girls. The following research methods were used to solve the problems set in the paper: analysis and generalization of information from special scientific literature, pedagogical research methods, method of comparison and similitude, psychoemotional state and psychomotor development research methods, methods of mathematical statistics. &#x0D; Results. The study results set forth in the paper will allow stating the fact that lessons with the use of movement games have a positive effect on the physical and psychomotor fitness of young schoolchildren with intellectual disabilities, which ensures their social adaptation in the context of growth. &#x0D; Conclusions. Increasing the time spent on playing games not only in classes but also in extracurricular activities had a positive effect that found expression in the improvement of the children’s health and psychoemotional condition, which is the main component of the behavior of a child with mental disabilities. It can be stated that, after using the proposed movement games, the indicators of the pupils’ psychomotor and mental condition, memory, perception of reality and attention improved in the positive dynamics of their physical fitness. It was found that the number of nervous breakdowns, depressive states and symptoms of stress decreased during the selected movement games.

Risk assessment of glyphosate and malathion pollution and their potential impact on Oreochromis niloticus: role of organic selenium supplementation

A field survey was conducted on five fish farms to trace glyphosate and malathion pollution with some physicochemical parameters. A precise half-life time, LC50-96h, of these agrochemicals on Oreochromis niloticus, as well as chronic exposure with organic selenium (OS) supplementation, were experimentally investigated. Oreochromis niloticus was subjected to the following: (negative control); (2 mg L−1 glyphosate); (0.5 mg L−1 malathion); (glyphosate 1.6 mg L−1 and 0.3 mg L−1 malathion); (glyphosate 2 mg L−1 and OS 0.8 g kg−1 diet); (malathion 0.5 mg L−1 and OS 0.8 g kg−1 diet) and (glyphosate 1.6 mg L−1; malathion 0.3 mg L−1 and OS 0.8 g kg−1 diet). Furthermore, data from the analyzed pond revealed a medium risk quotient (RQ) for both agrochemicals. The detected agrochemicals were related to their application, and vegetation type surrounding the farms, also their biodegradation was correlated to water pH, temperature, and salinity. Glyphosate and malathion had half-lives of 2.8 and 2.3 days and LC50-96h of 2.331 and 0.738 mg L−1, respectively. The severest nervous symptoms; increased oxidative stress markers, as well as high bacterial count in the livers and kidneys of fish challenged with Aeromonas hydrophila, were observed in the combined exposure, followed by a single exposure to malathion and then glyphosate. Organic selenium mitigated these impacts.

Herpesvirus and neurological manifestations in patients with severe coronavirus disease.

BackgroundCertain clinical manifestations of coronavirus disease (COVID-19) mimic those associated with human herpesvirus (HHV) infection. In this study, we estimated the prevalence of herpesvirus in patients with COVID-19 and determined if coinfection is associated with poorer outcomes and neurological symptoms.MethodsWe analyzed samples of 53 patients diagnosed with COVID-19. The samples were evaluated for the presence of alphaherpesviruses, betaherpesviruses, and gammaherpesviruses, and the viral loads were quantified using quantitative polymerase chain reaction (qPCR) method.ResultsAmong the patients, in 79.2% had detection at least one type of herpesvirus. HHV-6 (47.2%), cytomegalovirus (43.3%), and HHV-7 (39.6%) showed the highest detection rates. Patients with a high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) load were more likely to show herpes simplex virus 1 detection (p = 0.037). Among patients coinfected with SARS-CoV-2 and HHVs, 26.4% showed central nervous system-associated neurological symptoms and herpetic manifestations. A statistically significant association was observed between neurological changes and HHV-6 detection (p = 0.034).ConclusionsThe findings showed a high prevalence of herpesvirus in patients with COVID-19. Furthermore, even though SARS-CoV-2 and HHV coinfection was not associated with poorer outcomes, the findings demonstrated the association between neurological symptoms and HHV-6 detection.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12985-022-01828-9.

Itraconazole Contaminated with Rilmazafone in Japan: A Retrospective Analysis Using the Japanese Adverse Drug Event Report Database.

BackgroundIn early December 2020, the antifungal medication, itraconazole (ITCZ), was mistakenly contaminated with rilmazafone in Japan. Healthcare professionals reported adverse drug reaction reports associated with ITCZ and included central nervous system-depression symptoms such as dizziness, lightheadedness, loss of consciousness, and intense drowsiness.ObjectiveWe examined ITCZ-associated suspicious cases using the Japanese Adverse Drug Event Report (JADER) database to determine the impact of adverse drug reaction reporting on post-marketing safety measures.MethodsAdverse drug reaction reports in which the suspicious or concomitant medication was ITCZ or fluconazole (FLCZ) were extracted from the JADER dataset. The number of adverse drug reaction reports associated with central nervous system-depression adverse drug reactions were counted, and chronological changes were compared with ITCZ and FLCZ.ResultsOf the 713,893 adverse drug reaction reports in the JADER database, 5048 cases were associated with ITCZ and 6007 cases with FLCZ. When ITCZ contamination occurred, the number of adverse drug reaction reports associated with ITCZ increased rapidly, while those with FLCZ did not. In addition, the proportion of central nervous system-depression adverse drug reactions increased only in the ITCZ-associated report.ConclusionsAn incident of ITCZ contamination with rilmazafone was detected on the JADER retrospectively. This case highlights the importance of spontaneous adverse drug reaction reporting, even if the causal relationship between the drug and adverse drug reaction is unknown.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-022-00306-6.

Clinical characteristics of IgE-mediated cow's milk protein allergy in children

Objective: To analyze the clinical features of IgE-mediated cow's milk protein allergy (CMPA) in children aged 0-5 years. Methods: This cross-sectional study collected the data on children diagnosed with CMPA in the Department of Allergy at the Children's Hospital of the Capital Institute of Pediatrics from October 2019 to November 2020 and improved peripheral blood routine,total IgE defection, milk specific IgE (sIgE) defection,SPT and milk component defection,diagnosis of severe anaphylaxis based on clinical manifestations. Rank-sum test and chi-square test are used for statistical analysis of clinical characteristics between groups. Results: A total of 106 children (67 boys and 39 girls) were enrolled with the age of 15 (8, 34) months, including 42 cases (≤ 1 year of age), 39 cases (>1-<3 years of age) and 25 cases(≥3 years of age), the onset age of 6 (5, 8) months. Among them, 95 cases (89.6%) were reacted after consuming milk or its products, 42 cases (39.6%) had reaction due to skin contact and 11 cases (10.4%) reacted after exclusive breastfeeding. The onset time of milk product consumption was 45 (1, 120) min, skin contact pathway was 10 (5, 30) min and symptoms in breastfeeding pathway was 121 (61, 180) min. There was statistical difference among the time of symptoms (χ2=77.01, P<0.001).The cutaneous reaction was most common (100 cases, 94.3%), followed by digestive (20 cases, 18.9%) and respiratory (16 cases, 15.1%), and the nervous symptoms (1 case, 0.9%) were uncommon and 24 cases (22.6%) had at least one episode of anaphylaxis. There were 87 cases (82.1%) also diagnosed with other food allergies, 94 cases (88.7%) with previous eczema, 57 cases (53.8%) with history of rhinitis, and 23 cases (21.7%) with history of wheezing. The total IgE level was 191.01 (64.71, 506.80) kU/L, and the cow's milk sIgE level was 3.03 (1.11, 15.24) kU/L. The maximum diameter of the wheal in SPT was 8.2 (4.0, 12.0) mm. Component resolved diagnosis showed that 77 cases (81.9%) were sensitized to at least one out of 4 main components, including casein, α lactalbumin, β lactoglobulin and bovine serum albumin.The possibility of anaphylaxis in children with milk sIgE grade Ⅳ-Ⅵ was higher than that in children with grade 0-Ⅲ (57.7% (15/26) vs. 12.5% (10/80), OR=9.545, 95%CI 3.435-26.523). Children with milk SPT ≥+++ had a higher probability of anaphylaxis than those with milk SPT ≤++ (34.4% (11/32) vs. 11.5% (3/26), OR=4.016, 95%CI 0.983-16.400). Anaphylaxis were more common in α lactalbumin positive children than in negative children (34.3% (13/38) vs. 14.2% (8/56), χ2=1.23，P=0.042). Conclusions: CMPA in children has early onset and diversified clinical manifestations, which are mainly cutaneous symptoms. Most children are sensitized to at least one allergen component. Serum sIgE level, SPT reaction and allergen components play important roles in the diagnosis and evaluation of CMPA, and higher milk sIgE level may predict a higher risk of anaphylaxis.

Brain-Specific Increase in Leukotriene Signaling Accompanies Chronic Neuroinflammation and Cognitive Impairment in a Model of Gulf War Illness.

Persistent cognitive impairment is a primary central nervous system-related symptom in veterans afflicted with chronic Gulf War Illness (GWI). Previous studies in a rat model have revealed that cognitive dysfunction in chronic GWI is associated with neuroinflammation, typified by astrocyte hypertrophy, activated microglia, and enhanced proinflammatory cytokine levels. Studies in a mouse model of GWI have also shown upregulation of several phospholipids that serve as reservoirs of arachidonic acid, a precursor of leukotrienes (LTs). However, it is unknown whether altered LT signaling is a component of chronic neuroinflammatory conditions in GWI. Therefore, this study investigated changes in LT signaling in the brain of rats displaying significant cognitive impairments six months after exposure to GWI-related chemicals and moderate stress. The concentration of cysteinyl LTs (CysLTs), LTB4, and 5-Lipoxygenase (5-LOX), the synthesizing enzyme of LTs, were evaluated. CysLT and LTB4 concentrations were elevated in the hippocampus and the cerebral cortex, along with enhanced 5-LOX expression in neurons and microglia. Such changes were also associated with increased proinflammatory cytokine levels in the hippocampus and the cerebral cortex. Enhanced CysLT and LTB4 levels in the brain could also be gleaned from their concentrations in brain-derived extracellular vesicles in the circulating blood. The circulating blood in GWI rats displayed elevated proinflammatory cytokines with no alterations in CysLT and LTB4 concentrations. The results provide new evidence that a brain-specific increase in LT signaling is another adverse alteration that potentially contributes to the maintenance of chronic neuroinflammation in GWI. Therefore, drugs capable of modulating LT signaling may reduce neuroinflammation and improve cognitive function in GWI. Additional findings demonstrate that altered LT levels in the brain could be tracked efficiently by analyzing brain-derived EVs in the circulating blood.