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Despite extensive efforts to monitor the diffusion of COVID-19, the actual wave of infection is worldwide characterized by the presence of emerging SARS-CoV-2 variants. The present ...study aims to describe the presence of yet undiscovered SARS-CoV-2 variants in Italy.
Next Generation Sequencing was performed on 16 respiratory samples from occasionally employed within the Bangladeshi community present in Ostia and Fiumicino towns. Computational strategy was used to identify all potential epitopes for reference and mutated Spike proteins. A simulation of proteasome activity and the identification of possible cleavage sites along the protein guided to a combined score involving binding affinity, peptide stability and T-cell propensity.
Retrospective sequencing analysis revealed a double Spike D614G/S939F mutation in COVID-19 positive subjects present in Ostia while D614G mutation was evidenced in those based in Fiumicino. Unlike D614G, S939F mutation affects immune response by the slight but significant modulation of T-cell propensity and the selective enrichment of potential binding epitopes for some HLA alleles.
Collectively, our findings mirror further the importance of deep sequencing of SARS-CoV-2 genome as a unique approach to monitor the appearance of specific mutations as for those herein reported for Spike protein. This might have implications on both the type of immune response triggered by the viral infection and the severity of the related illness.
This study aimed to assess the diagnostic criteria, ancillary investigations and treatment response using real-life data in multifocal motor neuropathy (MMN) patients.
Clinical and laboratory data ...were collected from 110 patients enrolled in the Italian MMN database through a structured questionnaire. Twenty-six patients were excluded due to the unavailability of nerve conduction studies or the presence of clinical signs and symptoms and electrodiagnostic abnormalities inconsistent with the MMN diagnosis. Analyses were conducted on 73 patients with a confirmed MMN diagnosis and 11 patients who did not meet the diagnostic criteria.
The European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria were variably applied.
When applying the American Association of Electrodiagnostic Medicine criteria, an additional 17% of patients fulfilled the criteria for probable/definite diagnosis whilst a further 9.5% missed the diagnosis. In 17% of the patients only compound muscle action potential amplitude, but not area, was measured and subsequently recorded in the database by the treating physician. Additional investigations, including anti-GM1 immunoglobulin M antibodies, cerebrospinal fluid analysis, nerve ultrasound and magnetic resonance imaging, supported the diagnosis in 46%-83% of the patients. Anti-GM1 immunoglobulin M antibodies and nerve ultrasound demonstrated the highest sensitivity. Additional tests were frequently performed outside the EFNS/PNS guideline recommendations.
This study provides insights into the real-world diagnostic and management strategies for MMN, highlighting the challenges in applying diagnostic criteria.
Background and purpose
The aim was to evaluate the risk of relapse after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination, and its safety and tolerability, in patients with ...chronic inflammatory neuropathies.
Methods
In this multicenter, cohort and case‐crossover study, the risk of relapse associated with SARS‐CoV‐2 vaccination was assessed by comparing the frequency of relapse in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) patients who underwent or did not undergo vaccination. Frequency of relapse in the 3 months prior to and after vaccination, and safety and tolerability of SARS‐CoV‐2 vaccination, were also assessed.
Results
In all, 336 patients were included (278 CIDP, 58 MMN). Three hundred and seven (91%) patients underwent SARS‐CoV‐2 vaccination. Twenty‐nine patients (9%) did not undergo vaccination. Mild and transient relapses were observed in 16 (5%) patients (13 CIDP, 3 MMN) after SARS‐CoV‐2 vaccination and in none of the patients who did not undergo vaccination (relative risk RR 3.21, 95% confidence interval CI 0.19–52.25). There was no increase in the specific risk of relapse associated with type of vaccine or diagnosis. Comparison with the 3‐month control period preceding vaccination revealed an increased risk of relapse after vaccination (RR 4.00, 95% CI 1.35–11.82), which was restricted to CIDP patients (RR 3.25, 95% CI 1.07–9.84). The safety profile of SARS‐CoV‐2 vaccination was characterized by short‐term, mild‐to‐moderate local and systemic adverse events.
Conclusions
Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination in CIDP and MMN patients does not seem to be associated with an increased risk of relapse at the primary end‐point, although a slightly increased risk in CIDP patients was found compared to the 3 months before vaccination.
Cardiac arrhythmias are a common but often overlooked symptom that occur during or after epileptic seizures. The characterization of seizure-related heart rhythm disorders could shed light on the ...functional organization of the so-called "central autonomic network" and possibly on the pathophysiology of sudden death of epilepsy patients (SUDEP). Indeed, epileptic discharges may affect the heart through the involvement of cortical regions selectively driving autonomic functions. Ictal atrial fibrillation is an exceedingly rare phenomenon, usually associated with generalized tonic-clonic seizures. Here, we report a case of paroxysmal atrial fibrillation as a core presenting feature of a focal non-motor seizure in a 68-year-old man, at first misdiagnosed and treated for a typical cardiogenic arrhythmia. A brief literature review is included.
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