- Prolonged Zika virus viremia in a patient with Guillain-Barré syndrome in Trinidad and Tobago. [Journal Article]
- RPRev Panam Salud Publica 2018 Feb 19; 41:e136
- An emerging mosquito-borne flavivirus, Zika virus (ZIKV) is a significant public health concern because of the syndromes associated with the infection. In addition, ZIKV is considered a major problem...
An emerging mosquito-borne flavivirus, Zika virus (ZIKV) is a significant public health concern because of the syndromes associated with the infection. In addition, ZIKV is considered a major problem due to large-scale spread of the disease and the possible clinical complications for the central nervous system, especially Guillain-Barré syndrome (GBS) and microcephaly. Since the introduction of ZIKV in the Caribbean, molecular detection of the viral RNA has been utilized as a more specific and sensitive approach to demonstrating acute infection. However, it is generally accepted that the virus has a short viremic period, generally less than 5 days. Serologic testing has the inconvenience of strong cross-reactivity among flaviviruses, such as dengue and yellow fever. As part of the laboratory surveillance activities for Zika and other arboviruses at the Caribbean Public Health Agency, in 2016 a sample from a male who was clinically diagnosed with GBS tested positive for Zika virus by real-time polymerase chain reaction (rRT-PCR). The serum sample had been taken on day 21 after the onset of symptoms. The case had initially been characterized as a typical ZIKV infection (mild fever with a generalized maculopapular rash). Later, weakness of limbs and other peripheral neurological symptoms appeared. Enzyme-linked immunoassay (ELISA) showed that the sample was negative for IgM antibodies against Zika, Chikungunya, and dengue viruses. The plaque reduction neutralization test was positive for ZIKV. This indicated parallel development of viremia and immune response against ZIKV. Recent reports have demonstrated a longer duration of the viremia in ZIKV infections. However, our report is the first one that links the infection with extended viremia and the development in parallel of a GBS case.
- Transplantation of Recombinant Vascular Endothelial Growth Factor (VEGF)189-Neural Stem Cells Downregulates Transient Receptor Potential Vanilloid 1 (TRPV1) and Improves Motor Outcome in Spinal Cord Injury. [Journal Article]
- MSMed Sci Monit 2018 Feb 21; 24:1089-1096
- CONCLUSIONS: Recombinant VEGF-NSCs transplantation following SCI is more efficacious compared to normal NSC transplantation. This might also be related to a reduced pain in the process of recovery due to reduced TRPV1 expression.
- Patient With 2 Hematologic Malignancies Presenting as Neurolymphomatosis. [Journal Article]
- JCJ Clin Neuromuscul Dis 2018; 19(3):124-130
- Peripheral nervous system damage from hematologic malignancies is related to neoplastic cells infiltration of peripheral nerves or to monoclonal antibody production cross-reacting with peripheral ner...
Peripheral nervous system damage from hematologic malignancies is related to neoplastic cells infiltration of peripheral nerves or to monoclonal antibody production cross-reacting with peripheral nerves' antigens. Neurolymphomatosis (NL), a rare manifestation of hematologic malignancies, occurs when malignant cells invade the peripheral nerves leading to various manifestations. Here, we report a case of NL with 2 hematologic malignancies in a 79-year-old woman presenting with lower extremity pain/weakness. Investigation revealed anemia, IgM kappa monoclonal gammopathy, and elevated anti-MAG titer. Electrodiagnostic studies were consistent with mononeuropathy multiplex while imaging suggested malignancy in her ovaries and right S1 nerve root. Bone marrow and ovarian biopsies revealed chronic myelomonocytic leukemia, Waldenstrom macroglobulinemia, and diffuse large B-cell lymphoma. She received standard chemotherapy resulting in radiographic resolution of disease and symptomatic relief. NL can precede the diagnosis of hematologic malignancy but its symptoms are not easily identifiable, whereas management depends on the treatment of the underlying tumor.
- COL6A and LAMA2 Mutation Congenital Muscular Dystrophy: A Clinical and Electrophysiological Study. [Journal Article]
- JCJ Clin Neuromuscul Dis 2018; 19(3):108-116
- CONCLUSIONS: COL6A has unique skin changes, central cloud appearance on muscle ultrasound. LAMA2 has demyelinating polyneuropathy and white matter changes on brain imaging. The presence of neurogenic changes on EMG and muscle histology in COL6A suggests motor axonal neuropathy. Genetic testing remains the gold standard in confirming COL6A congenital muscular dystrophy.
- Novel Myelin Protein Zero Mutation in 3 Generations of Vermonters With Demyelinating Charcot-Marie-Tooth Disease. [Journal Article]
- JCJ Clin Neuromuscul Dis 2018; 19(3):101-107
- CONCLUSIONS: The novel MPZ base-pair substitution in this family is associated with inherited distal demyelinating neuropathy and should be reclassified as pathogenic for Charcot-Marie-Tooth.
- Simultaneous acute Marchiafava-Bignami disease and central pontine myelinolysis: A case report of a challenging diagnosis. [Journal Article]
- MMedicine (Baltimore) 2018; 97(8):e9878
- CONCLUSIONS: This case suggests that Marchiafava-Bignami disease and central pontine myelinolysis might have a common pathogenesis, and brain magnetic resonance imaging is of crucial importance in chronic alcoholic patients presenting with nonspecific neurological deterioration. The appropriate administration of thiamine may prevent poor outcomes.
- The metabolic and endocrine characteristics in spinal and bulbar muscular atrophy. [Journal Article]
- JNJ Neurol 2018 Feb 20
- CONCLUSIONS: Metabolic alterations in glucose homeostasis (diabetes) and fat metabolism (combined hyperlipidemia), and sex hormone abnormalities (androgen insensitivity) could be observed among SBMA patients without association with the neuromuscular phenotype. Dehydroepiandrosterone sulfate was the only biomarker that correlated strongly with both weakness duration and the CAG repeat length after adjusting for age and BMI, indicating its potential as a biomarker for both disease severity and duration and, therefore, its possible use as a reliable outcome measure in future therapeutic studies.
- Network modules uncover mechanisms of skeletal muscle dysfunction in COPD patients. [Journal Article]
- JTJ Transl Med 2018 Feb 20; 16(1):34
- CONCLUSIONS: In summary, altered muscle bioenergetics appears as the most striking finding, potentially driving other abnormal skeletal muscle responses. Trial registration The study was based on a retrospectively registered trial (May 2017), ClinicalTrials.gov identifier: NCT03169270.
- Pre-hospital interventions: introduction to life support systems. [Journal Article]
- BB-ENT 2016; Suppl 26(1):41-54
- Pre-hospital interventions: introduction to life support systems. Crucial decisions in pre-hospital emergency care are often made; therefore, a tactical emergency medical support team (TEMS) should m...
Pre-hospital interventions: introduction to life support systems. Crucial decisions in pre-hospital emergency care are often made; therefore, a tactical emergency medical support team (TEMS) should maintain the capacity to capture the situation instantaneously and in all circumstances. However, low exposure to severe trauma cases can be a weakness for emergency specialists, which makes pre-hospital assessment more difficult. Pre-hospital interventions (PHI) are usually classified in Western countries into BLS (basic life support) and ALS (ad- vanced life support) levels, according to the methods used. This review introduces tactical combat casualty care for medical personnel (TCCC) guidelines, designed for basic care management under fire or in a hostile environment. The phases of TCCC are: (1) care under fire (or in an unstable environment); (2) tactical field care; and (3) tactical evacuation care, and are mainly dependent on the different hazard zones (hot, warm or cold). In a mass casualty situation due to disaster or cataclysm, standardized protocol and triage are unquestionably required for identifying the environmental risks, for categorizing the casualties in accordance with medical care priorities, and for the initial management of casualty care. When considering conflict situations, or chemical, biological, radiological, or nuclear (CBRN) events, processes always start at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. Otorhinolaryngologists should be aware of PHI procedures for completing preliminary assessment and management together with emergency specialists or TEMS.
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- Acute steroid myopathy: a highly overlooked entity. [Journal Article]
- QJMQJM 2018 Feb 15
- CONCLUSIONS: A high index of suspicion for the possibility of ASM is necessary, to ensure drug discontinuation and recovery. This is particularly true since the entity is not widely recognized and its symptoms are often erroneously interpreted as due to the patient's underlying disease.