Highlights • Whether frailty is a potential cardiovascular risk factor is currently poorly understood. • In this meta-analysis frailty was associated with a higher prevalence and incidence of CVD. • ...Interventional studies are needed to test if improving frail and prefrail status can reduce CV risk and outcomes.
Background
The ongoing SARS-CoV-2 pandemic, which is dramatically spreading worldwide, is well known for its respiratory sequelae. Besides cases of Guillain-Barré Syndrome, encephalitis, hyposmia, ...the whole range of neurological complications due to SARSCoV-2 is still not well known.
Methods and findings
Herein, we report a new case of COVID-19, associated with mononeuropathy with reversible conduction block (CB). After SARS-CoV-2 infection, the patient developed acute weakness of left peroneal muscles. He underwent an endovenous immunoglobulin treatment, and symptoms improved. Two electroneurographic exam (before and after treatment), showed a reversible CB on left peroneal nerve. Dosage of serum antiganglioside antibodies showed anti-GM1 IgM positivity.
Conclusions
The present case gives new informations about reversible CB neuropathy as an acute presentation of SARS-CoV-2. Besides, antiganglioside antibodies evaluation could be useful to understand etiology of the increasing number of neurological manifestations related to SARS-CoV-2.
In the additive manufacturing laser powder bed fusion (L-PBF) process, the optimization of the print process parameters and the development of conduction zones in the laser power (P) and scanning ...speed (V) parameter spaces are critical to meeting production quality, productivity, and volume goals. In this paper, we propose the use of a machine learning approach during the process parameter development to predict the melt pool dimensions as a function of the P/V combination. This approach turns out to be useful in speeding up the identification of the printability map of the material and defining the conduction zone during the development phase. Moreover, a machine learning method allows for an accurate investigation of the most promising configurations in the P-V space, facilitating the optimization and identification of the P-V set with the highest productivity. This approach is validated by an experimental campaign carried out on samples of Inconel 718, and the effects of some additional parameters, such as the layer thickness (in the range of 30 to 90 microns) and the preheating temperature of the building platform, are evaluated. More specifically, the experimental data have been used to train supervised machine learning models for regression using the KNIME Analytics Platform (version 4.7.7). An AutoML (node for regression) tool is used to identify the most appropriate model based on the evaluation of R2 and MAE scores. The gradient boosted tree model also performs best compared to Rosenthal’s analytical model.
Paraneoplastic syndromes are often a diagnostic challenge to doctors and may have a heterogeneous presentation, including humoral hypercalcemia of malignancy (HHM), most commonly caused by squamous ...cell cancer and renal, ovarian, endometrial, and breast cancer. Chronic inflammatory demyelinating polyneuropathy (CIDP) has been described in patients affected by several types of cancer, especially hematologic malignancies, and a possible paraneoplastic pathogenesis of this neurological disease has been suggested. This report describes a 56-year-old man with a history of CIDP diagnosed 3 months earlier and persistently elevated aminotransferases for 18 months who was admitted to our internal medicine unit with abdominal pain, fatigue, and severe hypercalcemia with low serum intact parathyroid hormone. Parathyroid hormone-related protein (PTH-rP) was markedly high. Liver imaging showed a large hepatic mass in the right lobe, and percutaneous ultrasound-guided biopsy revealed histopathological findings consistent with a combined hepatocholangiocarcinoma (CHCC). We supposed that both HHM and CIDP could represent a paraneoplastic manifestation of CHCC.
Insulinoma is an insulin-producing pancreatic neuroendocrine tumor that can be malignant in about 10% of cases. Locoregional invasion, lymph node metastases, or remote metastases are the main ...criteria of malignant insulinoma. Its incidence in patients with pre-existing diabetes mellitus (DM) is exceptionally rare. In this report, we describe a 66-year-old man with long-standing type 2 DM who presented with recurrent episodes of diaphoresis due to severe hypoglycemia despite the withdrawal of insulin therapy, hypercalcitoninemia, and biochemical and radiological findings suggestive of metastatic malignant insulinoma. Unfortunately, after few days of diazoxide treatment, edema, hypotension, oliguria, and water retention were observed, patient’s clinical status deteriorated rapidly, and he died in our department from acute renal failure.
Fever of unknown origin (FUO) can be an unusual first clinical manifestation of pheochromocytoma. Pheochromocytomas are tumors that may produce a variety of substances in addition to catecholamines. ...To date, several cases of IL-6-producing pheochromocytomas have been reported. This report describes a 45-year-old woman with pheochromocytoma who was admitted with FUO, normal blood pressure levels, microcytic and hypochromic anemia, thrombocytosis, hyperfibrinogenemia, hypoalbuminemia, and normal levels of urine and plasma metanephrines. After adrenalectomy, fever and all inflammatory findings disappeared.
The aims of this study were to assess the efficacy and safety of botulinum toxin (BoTox) injection in the cricopharyngeus muscle (CP) and CP myotomy in patients with oropharyngeal dysphagia (OPD) and ...to identify factors predicting the outcome of these treatments. The study involved patients with persistent OPD despite 2–6 months of rehabilitation, who all underwent clinical evaluation, esophageal manometry, upper gastrointestinal endoscopy, and videofluoroscopy (VFS). Patients received 5–10 BoTox units injections in the CP, identified by electromyography. Surgical myotomy of the upper esophageal sphincter was performed when dysphagia persisted after two BoTox injections. After treatment, patients were reevaluated with clinical interviews and VFS. The study population included 21 patients (15 mean and 6 women; median age, 68 years), classified into three groups, based on the etiology of their OPD: eight (38%) had central nervous system abnormalities, five (24%) had peripheral nerve disease, and eight (38%) were classified as idiopathic. The median time since the onset of dysphagia was 18 months. Thirteen of 21 patients (62%) needed supplemental/total gastrostomy feeding, and 5 of 21 (24%) had tracheostomy. One patient died, on posttreatment day 7, due to massive aspiration. No other BoTox-related complications were observed. After BoTox injection, dysphagia improved in 9 of 21 (43%) patients. Severely altered VFS findings and CP incoordination or low activity predicted BoTox failure at multivariate analysis. Dysphagia improved in 8 of 11 (72.7%) patients who failed to respond to BoTox and underwent myotomy. A mild impairment of VFS findings and a higher pressure of pharyngeal contractions best predicted response to BoTox with or without myotomy. BoTox injection can be used as the first therapeutic option in patients with OPD: it is safe and simple and relieves dysphagia in 43% of cases. If BoTox fails, CP myotomy can be offered to patients with preserved oral and tongue activity at VFS and an intact bolus propulsion ability on manometry.
•There is the need to better understand the humoral immunity response to mRNA vaccines against SARS-CoV-2 in a real world setting.•In response to BNT162b2 we observed that at peak immunity anti-SP ...IgG titer range was wide, spanning more than two orders of magnitude.•Anti-spike IgG declined over time to reach a residual value of about 18% at 28 weeks.•Our results support the use of booster doses.
Adverse drug reaction is defined by the World Health Organization as any response to a drug that is noxious and unintended and occurs at a dose normally used in man. Older people are at elevated risk ...of adverse drug reactions-because of changes in pharmacodynamics, concurrent use of multiple medications and the related drug interactions. However, adverse drug reactions are significantly underestimated in the elderly population that is also exposed to inappropriate drugs. Amiodarone is an antiarrhythmic drug used commonly for the treatment of atrial fibrillation and is increasingly prescribed in older people. While amiodarone is an efficient drug for rhythm control, it's a carrier of different adverse reactions, and
and
must be carefully evaluated before its use especially in older people.
A 42-year-old male presented with weight loss and progressively increasing pain and swelling in joints over the past 3 months. Contrast-enhanced computed tomography (CT) demonstrated pleuropulmonary ...opacities and supra/infradiaphragmatic lymph nodes enlargement. Positron emission tomography (PET/CT) with 18F-fluorodeoxyglucose showed intensely increased tracer uptake in joints, in pulmonary opacities, as well as in thoracic, iliac, and inguinal nodes. On suspicion of lymphoma with synovial involvement, he was submitted to lymph node and synovial biopsy, which revealed reactive follicular lymphadenopathy and synovium inflammatory changes, respectively. Rheumatoid factor resulted increased, and thus, diagnosis of rheumatoid arthritis with related lung and lymph node involvement was made.
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