The SARS-CoV-2 Lambda variant and its neutralisation efficiency following vaccination with Comirnaty,Israel, April to June 2021

The SARS-CoV-2 Lambda (Pango lineage designation C.37) variant of interest, initially identified in Peru, has spread to additional countries. First detected in Israel in April 2021 following importations from Argentina and several European countries, the Lambda variant infected 18 individuals belonging to two main transmission chains without further spread. Micro-neutralisation assays following Comirnaty (BNT162b2 mRNA, BioNTech-Pfizer) vaccination demonstrated a significant 1.6-fold reduction in neutralising titres compared with the wild type virus, suggesting increased susceptibility of vaccinated individuals to infection.     

Adult primitive neuroectodermal tumor: proton MR spectroscopic findings with possible application for differential diagnosis

PURPOSE: To assess the utility of proton magnetic resonance (MR) spectroscopy in the clinical categorization of primitive neuroectodermal tumors (PNETs) in adults. MATERIALS AND METHODS: In vivo proton MR spectroscopy was performed with an echo time of 136 msec in nine adults with PNET, and findings were retrospectively compared with spectroscopic findings of 22 meningiomas, 12 low-grade astrocytomas, eight anaplastic astrocytomas, 23 glioblastomas, and 21 metastases. Nine resonances were semiquantitatively evaluated. Statistical analysis was performed by using Kruskal-Wallis and Mann-Whitney U tests. The Hochberg correction was applied for multiple comparisons. Results were prospectively validated in 24 tumors of the six types included in the study. RESULTS: The resonances of choice for identifying PNET were alanine (P <.001) and glutamate and glutamine (P =.004), both decreased with respect to meningioma; choline increased with respect to low-grade (P <.001) and anaplastic astrocytoma (P =.055); and lipids at 1.30 ppm decreased and choline and other trimethyl-amine-containing compounds increased with respect to glioblastoma (P <.001 and P =.004, respectively) and metastasis (P <.001 and P =.021, respectively). We developed an algorithm for bilateral differential diagnosis between PNET and other tumor types. The leave-one-out method was used to test the five possible differential situations in the retrospective data set, with the following results: PNET versus meningioma, 31/23/5/3 (number of total/correct/unclassifiable/incorrect procedures); PNET versus low-grade astrocytoma, 21/19/2/0; PNET versus anaplastic astrocytoma, 17/6/9/2; PNET versus glioblastoma, 32/28/2/2; and PNET versus metastasis, 30/27/1/2. In total, 131 consecutive procedures produced 103 (79%) correct classifications and nine (7%) misclassifications. Twenty-five (78%) of 32 possible procedures in the prospective independent test set produced correct classifications and four (13%) produced incorrect classifications. CONCLUSION: In vivo proton MR spectroscopy provides useful information in clinical differentiation between PNETs and common brain tumors in adults.     

Medical comorbidity in recurrent versus first-episode depressive patients

Gili M, Garcia‐Toro M, Vives M, Armengol S, Garcia‐Campayo J, Soriano JB, Roca M. Medical comorbidity in recurrent versus first‐episode depressive patients. Objective: This study compares the comorbidity of affective disorders and medical diseases in primary care patients with either a first or recurrent depressive episode. Method: A cross‐sectional epidemiological study in primary care centres in Spain was designed. A total of 10 257 primary care patients suffering a DSM‐IV major depressive episode (MDD) were analysed. Depression was assessed using the Montgomery–Asberg Depression Rating Scale (MADRS), and World Health Organization (WHO) medical diagnoses were provided by the patient’s general practitioner according to medical records revised on the basis of radiology or laboratory test data. Results: A total of 88.6% of recurrent patients and 71.1% of first‐episode depressive patients reported a medical condition (aOR = 2.61, CI = 2.31–2.93). All medical conditions were more prevalent in the recurrent group than in first‐episode group, and with the exception of myocardial infarction, psoriasis and migraine, all other crude ORs showed statistically significant differences between first‐ and recurrent episodes patients after adjusting for gender, age, education, socioeconomic status and body mass index (BMI). Conclusion: Recurrent depression is associated with a decrement in health that is significantly greater than in first‐episode depression. Special attention needs to be paid to the physical health in the middle‐ and long‐term management of patients with affective disorders.     

Outcomes for treated anxious children: a critical review of Long‐Term‐Follow‐Up studies

Background: Anxiety disorders are the most common psychiatric disorders of childhood, generating significant distress in the individual and an economic burden to society. They are precursors to diverse psychiatric illnesses and have an impact on development. Childhood anxiety's reach into the future accentuates the importance of studying the long‐term effect of treatment. The purpose of this paper is to examine existing Long‐Term‐Follow‐Up (LTFU) studies' capacity to inform us on the impact of anxiety treatment on development. Method: Medline, PsycInfo, SciSearch, SocScisearch, Cinhal, Embase, and the Cochrane library were searched. Bibliographies of relevant book chapters and review articles and information from colleagues with expertise in anxiety were also a source of information. The search produced more than a thousand citations. Only eight studies met inclusion criteria: follow‐up of a cohort of treated anxious youth for more than 2 years. Results: follow‐up ranged from 2 to 7.4 years. The studies were methodologically rigorous and, in general, showed maintenance of or improvement in acute treatment gains. The studies reviewed could not outline course of recovery or control for pivotal confounding variables such as maturation. Seven of the eight studies employed a Cognitive Behavioral intervention and one employed a manualized, time‐limited, psychodynamic intervention. No LTFU trial for medication was found. Conclusion: ample evidence exists for the short‐term benefit of pediatric anxiety treatment, but evidence is still lacking for the understanding of treatment's role in the facilitation of healthy development into adulthood. Recommendations for future research are proposed. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Methicillin-resistant Staphylococcus aureus in neonatal intensive care unit

A neonatal intensive care unit outbreak was caused by a strain of methicillin-resistant Staphylococcus aureus previously found in the community (ST45-MRSA-IV). Fifteen infected neonates were identified, 2 of whom died. This outbreak illustrates how a rare community pathogen can rapidly spread through nosocomial transmission.     

Utility of proton MR spectroscopy in the diagnosis of radiologically atypical intracranial meningiomas

Our aim was to evaluate the usefulness of proton MR spectroscopy ((1)H MRS) in the diagnosis of radiologically atypical brain meningiomas. We studied 37 patients with intracranial meningiomas with MRI and (1)H MRS (TE 136 ms). Their spectra were quantitatively assessed and compared with those of 93 other intracranial brain neoplasms: 15 low-grade and 14 anaplastic astrocytomas, 30 glioblastomas and 34 metastases. The most characteristic features of meningiomas were the presence of alanine, high relative concentrations of choline and glutamine/glutamate and low concentrations of creatine-containing compounds, N-acetyl-containing compounds and lipids. These resonances were assembled in algorithms for two-way differentiation between meningioma and the other tumours. The performance of the algorithms was tested in the 130 patients using the leave-one-out method, with 94% success in differentiating between meningioma and other tumour. Of the 37 meningiomas, five (14%) were thought atypical on MRI, and in only one of these, found to be malignant on histology, was a diagnosis other than meningioma suggested by the algorithm. The other four were correctly classified. We suggest that (1)H MRS provides information on intracranial meningiomas which may be useful in diagnosis of radiologically atypical cases.     

Anaesthesia-related diplopia after cataract surgery

Background. We studied the incidence and clinical characteristicsof persistent diplopia related to anaesthesia for cataract surgeryin a general hospital. Methods. This was a retrospective review of anaesthesia for3587 cataract surgeries. Of all the cases of diplopia referredto the ocular motility clinic after cataract surgery, thoseinvolving anaesthesia-related diplopia lasting longer than 1month were studied. Results. During the study period, 3450 cataract surgeries wereperformed by phacoemulsification and 137 by extracapsular extraction.Retrobulbar block was used in 2024 cases, peribulbar block in98, topical anaesthesia in 1420 and general anaesthesia in 43.Twenty-six cases of persistent diplopia were found (0.72% incidence),nine of which (0.25%) were considered to be related to anaestheticfactors; five of the latter involved the left eye. Five werecaused by paresis of the inferior rectus muscle and three byfibrosis. In one patient, the inferior oblique muscle was affected.Anaesthesia was by retrobulbar block in eight cases (0.39%)and by peribulbar block in one. No diplopia was found in patientswho had topical or general anaesthesia. Treatment was with surgeryin two patients and with prisms in six. One patient continuesto be studied. Conclusions. Persistent diplopia can occur after cataract surgeryusing retrobulbar block predominantly through direct damageto the inferior rectus muscle. The overall incidence of anaesthesia-relateddiplopia in this series was 0.25%. Br J Anaesth 2003; 90: 189–92     

Structural alteration of erythrocyte cell membrane in presence of artificial prostheses: a radiowave dielectric spectroscopy study.

The exposure of a biomaterial to blood gives rise to complex reactions playing an important role in many biological phenomena, such as the problem of biocompatibility and the mechanism of cardiovascular and thromboembolic diseases. In the present work, we use a frequency-domain dielectric spectroscopy approach to evaluate possible changes in the passive electrical parameters of the erythrocyte membrane, i.e., the membrane conductivity sigma(s) and the membrane permittivity epsilon(s), after the insertion of a prosthesis (mean implantation time 8 days) in the circulatory system of patients treated for aortic aneurysm and the consequent interactions of erythrocyte cells with the biomaterial surface. We observe an increase of both the membrane conductivity and membrane permittivity, indicating changes at molecular level in the structural organization of the membrane. These membrane alterations can be viewed as precursory events for the initiation of the complex sequence of enzymatic reactions that take place on the material surface. Our results, although preliminary imply that a direct interaction between erythrocyte cell membrane and vascular prostheses may occur, causing a marked alteration in the electrical properties of the cell membrane. These findings might have relevant clinical implications and might offer possibilities to predict biocompatibility of biomaterials and give some further suggestions to resolve the problem of biomaterial-associated thrombogenicity.     

Neutralising capacity against Delta (B.1.617.2) and other variants of concern following Comirnaty (BNT162b2, BioNTech/Pfizer) vaccination in health care workers,Israel

SARS-CoV-2 Delta (B.1.617.2) variant of concern (VOC) and other VOCs are spreading in Europe. Micro-neutralisation assays with sera obtained after Comirnaty (BNT162b2, BioNTech/Pfizer) vaccination in 36 healthcare workers (31 female) demonstrated significant fold change reduction in neutralising titres compared with the original virus: Gamma (P.1) 2.3, Beta (B.1.351) 10.4, Delta 2.1 and 2.6. The reduction of the Alpha (B.1.1.7) variant was not significant. Despite being lower, remaining neutralisation capacity conferred by Comirnaty against Delta and other VOCs is probably protective.