Autonomic dysfunction in non-critically ill COVID-19 patients during the acute phase of disease: an observational,cross-sectional study

Neurological Sciences - Evidence is emerging about an extra-pulmonary involvement of SARS-CoV-2, including the nervous system. Autonomic dysfunction in patients recovering from acute coronavirus...     

Grand rounds: could occupational exposure to n-hexane and other solvents precipitate visual failure in leber hereditary optic neuropathy?

CONTEXT: Leber hereditary optic neuropathy (LHON) is a maternally inherited loss of central vision related to pathogenic mutations in the mitochondrial genome, which are a necessary but not sufficient condition to develop the disease. Investigation of precipitating environmental/occupational (and additional genetic) factors could be relevant for prevention. CASE PRESENTATION: After a 6-month period of occupational exposure to n-hexane and other organic solvents, a 27-year-old man (a moderate smoker) developed an optic neuropathy. The patient had a full ophthalmologic and neurologic investigation, including standardized cycloergometer test for serum lactic acid levels and a skeletal muscle biopsy. His exposure history was also detailed, and he underwent genetic testing for LHON mitochondrial DNA mutations. The patient suffered a sequential optic neuropathy with the hallmarks of LHON and tested positive for the homoplasmic 11778G--> A/ND4 mutation. Routine laboratory monitoring revealed increased concentrations of urinary 2.5 hexandione (n-hexane metabolite) and hippuric acid (toluene metabolite) in the period immediately preceding the visual loss. DISCUSSION: In a subject carrying an LHON mutation, the strict temporal sequence of prolonged appreciable occupational exposure followed by sudden onset of visual loss must raise a suspicion of causality (with a possible further interaction with tobacco smoke). RELEVANCE: In this article, we add to the candidate occupational/environmental triggers of LHON and highlight the need for appropriate case-control (and laboratory) studies to validate the causal effect of mixed toxic exposures.     

Anatomically‐based transoral surgical approach to early‐stage oral tongue squamous cell carcinoma

The mainstream of treatment of early‐stage oral tongue squamous cell carcinoma (OTSCC) is represented by transoral resection with “adequate” free margins. Despite that, a precise and shared definition of “adequate margin” is lacking, and so is a standardized transoral surgical technique.The tongue is a symmetrically paired organ, consisting of intertwining intrinsic and extrinsic muscles, which can be distinguished during dissection. Routes of tumoral spread in oral tongue cancer are well‐known and should be taken into account during resection. We propose herein a standardized and replicable surgical technique to resect early‐stage OTSCC, based on rational anatomical considerations.     

ASO Visual Abstract: Is Nodal Clipping Beneficial for Node-Positive Breast Cancer Patients Receiving Neoadjuvant Chemotherapy?

Annals of Surgical Oncology -     

The Presence of Uveitis Is Associated with a Sustained Response to the Interleukin (IL)-1 Inhibitors Anakinra and Canakinumab in Behçet’s Disease

ABSTRACT

Purpose: To identify factors associated with sustained response to interleukin (IL)-1 inhibition among demographic, clinical and therapeutic data in patients with Behçet disease (BD).

Methods: BD patients treated with anakinra or canakinumab were enrolled. Patients were divided into two groups according to the clinical response: group 1 included subjects showing a treatment duration of at least 52 weeks and no secondary inefficacy during the first follow-up year; the remaining patients were included in the group 2. Demographic, clinical and therapeutic data were analyzed to identify significant differences between groups.

Results: Eighteen patients were included in group 1 and 18 patients in group 2. A better response to IL-1 inhibitors was significantly more common among patients with BD-related uveitis (p = 0.006) and patients with a longer disease duration (p = 0.03).

Conclusion: IL-1 blockade is effective in BD, especially in the subset of patients presenting eye involvement and in those with long-lasting disease.     

Nerve Compression Injuries After Prolonged Prone Position Ventilation in Patients With SARS-CoV-2: A Case Series

BackgroundProne positioning improves oxygenation in adult respiratory distress syndrome. This procedure has been widely used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, this procedure can also be responsible for nerve damage and plexopathy.MethodsWe retrospectively reviewed a series of 7 infectious patients with coronavirus disease 2019 who underwent prone positioning ventilation at the San Raffaele Hospital of Milan, Italy, during the SARS-CoV-2 pandemic.ResultsClinical and neurophysiological data of 7 patients with nerve compression injuries have been reported.ConclusionsHealth care workers should take into consideration the risk factors for prone positioning–related plexopathy and nerve damage, especially in patients with coronavirus disease 2019, to prevent this type of complication.