COVID‐19 can occasionally be associated with cranial nerve involvement, but facial palsy, particularly if bilateral, is exceptional. We here report a patient who presented with severe bilateral ...facial palsy and evidence of SARS‐CoV‐2 infection preceded by upper respiratory symptoms. He also had serological evidence of coinfection with Epstein‐Barr virus, which could have also played a role in his neurological manifestations. PCR in the cerebrospinal fluid was negative for both EBV and SARS‐CoV‐2, which suggests an indirect, immune‐mediated mechanism rather than direct, viral‐induced damage. The patient was treated with prednisone 60 mg/24h with a tapering schedule and had a favorable outcome, with an almost complete recovery in 3 weeks. SARS‐CoV‐2 adds to the list of infectious agents causative of bilateral facial palsy. Coinfection with SARS‐CoV‐2 is not rare and should be considered in the differential diagnosis.
Bilateral facial palsy is a rare entity, accounting for 0.3 to 2% of all peripheral facial palsies. It can be caused by infections, inflammatory disorders (sarcoidosis), brainstem neoplasias, or can be idiopathic (bilateral Bell's palsy). SARS‐CoV‐2 adds to the list of infectious agents causative of bilateral facial palsy. Coinfection with SARS‐CoV‐2 is not rare (in this patient there was evidence of Epstein‐Barr virus coinfection) and should be considered in the differential diagnosis.
Purpose
Percutaneous dilational tracheostomy (PDT) is routinely performed in the intensive care unit with bronchoscopy guidance. Recently, ultrasound has emerged as a potentially useful tool to ...assist PDT and reduce procedure-related complications.
Methods
An open-label, parallel, non-inferiority randomized controlled trial was conducted comparing an ultrasound-guided PDT with a bronchoscopy-guided PDT in mechanically ventilated critically ill patients. The primary outcome was procedure failure, defined as a composite end-point of conversion to a surgical tracheostomy, unplanned associated use of bronchoscopy or ultrasound during PDT, or the occurrence of a major complication.
Results
A total of 4965 patients were assessed for eligibility. Of these, 171 patients were eligible and 118 underwent the procedure, with 60 patients randomly assigned to the ultrasound group and 58 patients to the bronchoscopy group. Procedure failure occurred in one (1.7 %) patient in the ultrasound group and one (1.7 %) patient in the bronchoscopy group, with no absolute risk difference between the groups (90 % confidence interval, −5.57 to 5.85), in the “as treated” analysis, not including the prespecified margin of 6 % for noninferiority. No other patient had any major complication in either group. Procedure-related minor complications occurred in 20 (33.3 %) patients in the ultrasound group and in 12 (20.7 %) patients in the bronchoscopy group (
P
= 0.122). The median procedure length was 11 7–19 vs. 13 8–20 min (
P
= 0.468), respectively, and the clinical outcomes were also not different between the groups.
Conclusions
Ultrasound-guided PDT is noninferior to bronchoscopy-guided PDT in mechanically ventilated critically ill patients.
Abstract
Angiotensin II receptor 1(AT1) antagonists are beneficial in focal ischemia/reperfusion (I/R). However, in cases of global I/R, such as cardiac arrest (CA), AT1 blocker's potential benefits ...are still unknown. Wistar male rats were allocated into four groups: Control group (CG)—animals submitted to CA by ventricular fibrillation induced by direct electrical stimulation for 3 min, and anoxia for 5 min; Group AT1 (GAT1)—animals subjected to CA and treated with 0.2 mg/kg of candesartan diluted in dimethylsulfoxide (DMSO) (0.1%); Vehicle Group (VG): animals subjected to CA and treated with 0.2 ml/kg of DMSO and Sham group (SG)—animals submitted to surgical interventions, without CA. Cardiopulmonary resuscitation consisted of group medications, chest compressions, ventilation, epinephrine (20 mcg/kg) and defibrillation. The animals were observed up to 4 h after spontaneous circulation (ROSC) return, and survival rates, hemodynamic variables, histopathology, and markers of tissue injury were analyzed. GAT1 group had a higher rate of ROSC (62.5% vs. 42.1%,
p
< 0.0001), survival (100% vs. 62.5%,
p
= 0.027), lower incidence of arrhythmia after 10 min of ROSC (10% vs. 62.5%,
p
= 0.000), and lower neuronal and cardiac injury scores on histology evaluation (
p
= 0.025 and
p
= 0.0052, respectively) than GC group. The groups did not differ regarding CA duration, number of adrenaline doses, or number of defibrillations. AT1 receptor blockade with candesartan yielded higher rates of ROSC and survival, in addition to neuronal and myocardial protection.
We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key ...clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010-2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1-10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice.
Depression is a major health problem worldwide. Most prescribed anti-depressants, the selective serotonin reuptake inhibitors (SSRI) show limited efficacy and delayed onset of action, partly due to ...the activation of somatodendritic 5-HT(1A)-autoreceptors by the excess extracellular serotonin (5-HT) produced by SSRI in the raphe nuclei. Likewise, 5-HT(1A) receptor (5-HT(1A)R) gene polymorphisms leading to high 5-HT(1A)-autoreceptor expression increase depression susceptibility and decrease treatment response. In this study, we report on a new treatment strategy based on the administration of small-interfering RNA (siRNA) to acutely suppress 5-HT(1A)-autoreceptor-mediated negative feedback mechanisms. We developed a conjugated siRNA (C-1A-siRNA) by covalently binding siRNA targeting 5-HT(1A) receptor mRNA with the SSRI sertraline in order to concentrate it in serotonin axons, rich in serotonin transporter (SERT) sites. The intracerebroventricular (i.c.v.) infusion of C-1A-siRNA to mice resulted in its selective accumulation in serotonin neurons. This evoked marked anti-depressant-like effects in the forced swim and tail suspension tests, but did not affect anxiety-like behaviors in the elevated plus-maze. In parallel, C-1A-siRNA administration markedly decreased 5-HT(1A)-autoreceptor expression and suppressed 8-OH-DPAT-induced hypothermia (a pre-synaptic 5-HT(1A)R effect in mice) without affecting post-synaptic 5-HT(1A)R expression in hippocampus and prefrontal cortex. Moreover, i.c.v. C-1A-siRNA infusion augmented the increase in extracellular serotonin evoked by fluoxetine in prefrontal cortex to the level seen in 5-HT(1A)R knockout mice. Interestingly, intranasal C-1A-siRNA administration produced the same effects, thus opening the way to the therapeutic use of C-1A-siRNA. Hence, C-1A-siRNA represents a new approach to treat mood disorders as monotherapy or in combination with SSRI.
•The immune response of chagas vectors is relatively well understood.•There is variation in the immune response of insects against different chagas disease strains.•A missing point in the triatomines ...immune response is the potential occurrence of immune priming (memory).•The immune priming should be studied in triatomines taking into account the parasite strain variation.
The present work aimed to review the immune response from different triatomines against Trypanosoma cruzi and Trypanosoma rangeli and propose the study of immune memory in such insects. Trypanosoma use triatomines as vectors to reach and infect mammals. A key question to be answered about vector-parasite interaction is why the immune defense and resistance of the insect against the parasites vary. Up to date data shows that the defense of triatomines against parasites includes cellular (phagocytosis, nodulation and encapsulation) and humoral (antimicrobial peptides, phenoloxidase and reactive oxygen and nitrogen species) responses. The immune response varies depending on the triatomine species, the trypanosome strain and species, and the insect intestinal microbiota. Despite significant advances to understand parasite-insect interaction, it is still unknown if triatomines have immune memory against parasites and if this memory may derive from tolerance to parasites attack. Therefore, a closer study of such interaction could contribute and establish new proposals to control the parasite at the vector level to reduce parasite transmission to mammals, including men. For instance, if immune memory exists in the triatomines, it would be interesting to induce weak infections in insects to find out if subsequent infections are less intense and if the insects succeed in eliminating the parasites.
Coastal altimetry products are available and are being extensively validated. Their accuracy has been assessed in many coastal zones around the world and they are ready for exploitation near the ...shore. This opens a variety of applications of the sea level data obtained from the specific reprocessing of radar altimeter signals in the coastal strip. In this work, we retracked altimeter waveforms of the European Space Agency satellites: ERS-2 RA and Envisat RA-2 from descending track (#0360) over the eastern side of the Strait of Gibraltar using the Adaptive Leading Edge Sub-waveform (ALES) retracker. We estimated along-track Sea Level Anomaly (AT_SLA) profiles (RA-2) at high posting rate (18 Hz) using improved range and geophysical corrections. Tides were removed with a global model (DTU10) that displays a good performance in the study area: the mean root square sum (RSS) of the main constituents obtained with DTU10 and 11 tide gauge stations was 4.3 cm in agreement with the RSS using a high-resolution local hydrodynamic model (UCA2.5D) (4.2 cm). We also estimated a local mean sea surface by reprocessing ERS-2/Envisat waveforms (track #0360) with ALES. The use of this local model gave more realistic AT_SLA than the values obtained with the global model DTU15MSS. Finally, the along-track Absolute Dynamic Topography (AT_ADT) was estimated using a local Mean Dynamic Topography obtained with the local hydrodynamic model UCA2.5D. We analysed the cross-strait variability of the sea level difference between the African/Spanish coasts along the selected track segment. This was compared to the sea level cross-strait difference from the records of two tide gauges located in the African (Ceuta) and Spanish (Tarifa) coasts. The sea level differences from altimetry and tide gauges were linked to the zonal component of the wind. We found a positive and significant (>95% c.l.) correlation between easterlies/westerlies and positive/negative cross-strait sea level differences between the southern and northern coasts of the Strait in both datasets (altimetry: r = 0.54 and in-situ: r = 0.82).
•A Global Tidal Model (DTU10) reproduces well tides in the Strait of Gibraltar.•A Global Mean Sea Surface model (DTU15) masks the oceanographic signals.•An improved MSS based on ALES is consistent with the expected circulation patterns.•A local tidal hydrodynamic Mean Dynamic Topography model outperforms DTU15 MDT.•Improved altimetry captures the wind-induced sea level differences along the Strait.
ABSTRACT We describe a large-scale far-infrared line and continuum survey of protoplanetary disk through to young debris disk systems carried out using the ACS instrument on the Herschel Space ...Observatory. This Open Time Key program, known as GASPS (Gas Survey of Protoplanetary Systems), targeted ∼250 young stars in narrow wavelength regions covering the OI fine structure line at 63 μm the brightest far-infrared line in such objects. A subset of the brightest targets were also surveyed in OI145 μm, CII at 157 μm, as well as several transitions of H2O and high-excitation CO lines at selected wavelengths between 78 and 180 μm. Additionally, GASPS included continuum photometry at 70, 100 and 160 μm, around the peak of the dust emission. The targets were SED Class II-III T Tauri stars and debris disks from seven nearby young associations, along with a comparable sample of isolated Herbig AeBe stars. The aim was to study the global gas and dust content in a wide sample of circumstellar disks, combining the results with models in a systematic way. In this overview paper we review the scientific aims, target selection and observing strategy of the program. We summarise some of the initial results, showing line identifications, listing the detections, and giving a first statistical study of line detectability. The OI line at 63 μm was the brightest line seen in almost all objects, by a factor of ∼10. Overall OI63 μm detection rates were 49%, with 100% of HAeBe stars and 43% of T Tauri stars detected. A comparison with published disk dust masses (derived mainly from sub-mm continuum, assuming standard values of the mm mass opacity) shows a dust mass threshold for OI63 μm detection of ∼10-5 M⊙. Normalising to a distance of 140 pc, 84% of objects with dust masses ≥10-5 M⊙ can be detected in this line in the present survey; 32% of those of mass 10-6-10-5 M⊙, and only a very small number of unusual objects with lower masses can be detected. This is consistent with models with a moderate UV excess and disk flaring. For a given disk mass, OI detectability is lower for M stars compared with earlier spectral types. Both the continuum and line emission was, in most systems, spatially and spectrally unresolved and centred on the star, suggesting that emission in most cases was from the disk. Approximately 10 objects showed resolved emission, most likely from outflows. In the GASPS sample, OI detection rates in T Tauri associations in the 0.3-4 Myr age range were ∼50%. For each association in the 5-20 Myr age range, ∼2 stars remain detectable in OI63 μm, and no systems were detected in associations with age >20 Myr. Comparing with the total number of young stars in each association, and assuming a ISM-like gas/dust ratio, this indicates that ∼18% of stars retain a gas-rich disk of total mass ∼1 MJupiter for 1-4 Myr, 1-7% keep such disks for 5-10 Myr, but none are detected beyond 10-20 Myr. The brightest OI objects from GASPS were also observed in OI145 μm, CII157 μm and CO J = 18 - 17, with detection rates of 20-40%. Detection of the CII line was not correlated with disk mass, suggesting it arises more commonly from a compact remnant envelope.
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