One‐step and sequential SARSCOV‐2 polymerase chain reaction tests would not work every time

IntroductionRT‐PCR is widely used as a diagnostic test for the detection of SARS‐CoV‐2. In this study, we aim to describe the clinical utility of serial PCR testing in the final detection of COVID‐19.MethodWe collected multiple nasopharyngeal swab samples from patients who had negative RT‐PCR test on the first day after hospitalization. RT‐PCR tests were performed on the second day for all patients with initial negative result. For the patients with secondary negative results on day 2, tertiary RT‐PCR tests were performed on day 3 after hospitalization.ResultAmong 68 patients with initial negative test results, at the end of follow‐up, the mortality number was 20 (29.4%). About 33.8% of patients had subsequent positive PCR test results for the second time and 17.4% of the patients who performed third PCR test had positive result.ConclusionBased on this study, serial RT‐PCR testing is unlikely to yield additional information.     

Management challenges for chronic dysimmune neuropathies during the COVID-19 pandemic

Since March 2020, the COVID-19 pandemic has led to the need to re-think the delivery of services to patients with chronic dysimmune neuropathies. Telephone/video consultations have become widespread but have compounded concerns about objective evaluation. Therapeutic decisions need, more than ever before, to be considered in the best interests of both patients, and society, while not denying function-preserving/restoring treatment. Immunoglobulin therapy and plasma exchange, for those treated outside of the home, expose patients to the hazards of hospital or outpatient infusion centers. Steroid therapy initiation and continuation pose increased infectious risk. Immunosuppressant therapy similarly becomes highly problematic, with the risks of treatment continuation enhanced by uncertainties regarding duration of the pandemic. The required processes necessitate considerable time and effort especially as resources and staff are re-deployed to face the pandemic, but are essential for protecting this group of patients and as an integral part of wider public health actions.     

Hereditary neuropathy with liability to pressure palsies

Journal of Neurology - Hereditary neuropathy with liability to pressure palsies (HNPP) is characterized by recurrent sensory and motor neuropathy in individual nerves starting in adolescence or...     

Should we change our approach to resuscitating victims of femoral fracture?A clinical experience in a busy trauma hospital in Shiraz,Iran

Purpose Traumatic hemorrhagic shock is a life-threatening event worldwide.Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α,IL-1.The primary treatment in these cases is hydration with crystalloids,which has both benefits and complications.The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics,coagulation profiles,and blood gases in such patients.Methods In this cross-sectional study,patients were divided into two groups:femoral fracture group and non-femoral group.The hemodynamic status,coagulation profile,and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later.Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test.Results A total of 681 trauma patients(605 men and 76 women)participated in this study,including 69(86.3%)men and 11(13.8%)women in femoral fracture group and 536 men(89.2%)and 65 women(10.8%)in non-femoral group.The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later.Blood gases decreased in the fracture group despite fluid therapy(p<0.003),and the coagulation profile worsened although the change was not statistically significant.Conclusion The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine.If there is evidence of clinical shock,excessive crystalloid infusion(limited to 1 L)should be avoided,and blood and blood products should be started as soon as possible.     

Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims

ProposeIn this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.MethodsAll trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.ResultsIn the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.ConclusionWe concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.     

Prevalence of coagulase-positive staphylococci in the skin of dogs; antibacterial resistance and plasmid profile of the isolates

This study was designed to understand the prevalence of coagulase-positive staphylococci in the skin of dogs and the role of dogs as reservoirs of pathogenic and antimicrobial-resistant staphylococci. Swab samples were taken from the surface of the skin at muzzle sites of 100 clinically normal dogs. Antibiotic susceptibility of coagulase-positive staphylococci isolates was assessed by antibiotic disc diffusion method using filter paper discs and plasmid DNAs were extracted from the isolates. Staphylococci were isolated from 79 of the 100 dogs sampled and of these 51 were coagulase positive. All coagulase-positive staphylococci isolates were resistant to penicillin G, amoxicillin, cefazolin, streptomycin, erythromycin, ampicillin, tetracycline, gentamicin, trimethoprim-sulfamethoxazole, and enrofloxacine at 100%, 100%, 72%, 48%, 44%, 44%, 12%, 4%, 8%, and 4% respectively. Characterization of plasmid DNAs by agarose gel electrophoresis showed that 22 out of the 51 coagulase-positive staphylococci isolates harbored a single plasmid. The results of the present study indicate that pathogenic and resistant staphylococci are located in the skin of the dogs and may transfer to human and other hosts. It is important to establish reliable antibiotic sensitivity data regarding these bacteria to select suitable antibacterial treatment.     

Targeting versus tinkering: Explaining why the clinic is frustrated with molecular mapping of disease mechanisms

We argue that our common diseases should not necessarily be taken as a sign of physiological error. Regulatory networks developed by evolutionary forces to support reproductive fitness happen to include disease as a side-effect. For example, inflammatory and autoimmune diseases are secondary to a strong defence against infections. An evolutionary perspective can help us understand why many drugs targeted to single molecules or linear signaling pathways fail in clinical trials. We present the hypothesis that a tinkering research strategy, as compared with the prevailing reductionist approach, may be more likely to help us find the tools needed to interfere optimally with disease-generating networks. One application of the hypothesis can be to analyze how manipulation with diet and gut microbial flora influences multiple sclerosis patients, rather than to first map in detail the molecular disease mechanism and then develop targeting drugs.     

Aspirin, nonsteroidal anti-inflammatory drugs, and the risks of cancers of the esophagus.

BACKGROUND: Frequent consumption of aspirin and nonsteroidal anti-inflammatory drugs (NSAID) has been associated with reduced occurrence of cancers of the esophagus, although potential modifying effects of other causal factors remain relatively unexplored. METHODS: We compared nationwide samples of Australian patients with adenocarcinomas of the esophagus (EAC; n = 367) or esophagogastric junction (EGJAC; n = 426) or esophageal squamous cell carcinoma (ESCC; n = 309) with control participants sampled from a population register (n = 1,580). Intakes of aspirin, other NSAIDs, and acetaminophen (paracetamol) were assessed from self-reports. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) using multivariable logistic regression. RESULTS: Compared with never-users of aspirin, those who used aspirin at least weekly had significantly lower risks of EAC (OR, 0.48; 95% CI, 0.32-0.72), EGJAC (OR, 0.71; 95% CI, 0.49-1.01), and ESCC (OR, 0.63; 95% CI, 0.40-0.98). At least weekly use of other NSAIDs was also associated with reduced risks of EAC (OR, 0.74; 95% CI, 0.51-1.08), EGJAC (OR, 0.53; 95% CI, 0.37-0.77), and ESCC (OR, 0.46; 95% CI, 0.30-0.73). No association was observed between frequent use of acetaminophen and esophageal cancer. Risk reductions for EAC among users of aspirin and NSAIDs were greater among those who experienced at least weekly symptoms of reflux (OR, 0.26; 95% CI, 0.12-0.55 and OR, 0.41; 95% CI, 0.21-0.77, respectively) than those who did not experience reflux (OR, 0.96; 95% CI, 0.46-2.00 and OR, 0.78; 95% CI, 0.35-1.72, respectively). Recent use of NSAIDs in the past 5 years was associated with greater risk reductions. CONCLUSIONS: Frequent use of aspirin and NSAIDs is associated with reduced occurrence of esophageal cancers, particularly among those with frequent symptoms of gastroesophageal reflux.     

Spleen hemostasis using high-intensity ultrasound: survival and healing

BACKGROUND: Previous studies have shown that high-intensity focused ultrasound (HIFU) can effectively control bleeding of incised livers and spleens and punctured vessels. This current study investigated the long-term safety of HIFU in splenic hemostasis. METHODS: A total of 21 rabbits were randomly assigned to two groups: HIFU treatment (n = 14), and sham treatment (n = 7). All animals underwent sterile laparotomy and splenic exposure. The HIFU-treated animals received splenic incisions, 8 to 10 mm long and 4 to 5 mm deep, and immediate 9.6-MHz HIFU until hemostasis was achieved. After recovery, ultrasound images, blood samples, and histologic samples were collected on days 0, 1, 3, 7, 14, 28, and 60. RESULTS: All 14 splenic injuries were hemostatic after an average of 96 seconds of HIFU application. There was evidence of rebleeding in one animal between days 3 and 7 posttreatment. Subsequent blood analysis showed no significant difference in serial hematologic or coagulation measures between HIFU and sham groups. Histologic examination up to 60 days posttreatment revealed scarring and spleen tissue regeneration at the treatment site. CONCLUSION: HIFU provides an effective and safe method of achieving hemostasis after acute splenic injury.