Asymptomatic Hypoxemia as a Characteristic Symptom of Coronavirus Disease: A Narrative Review of Its Pathophysiology

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a pandemic and caused a huge burden to healthcare systems worldwide. One of the characteristic symptoms of COVID-19 is asymptomatic hypoxemia, also called happy hypoxia, silent hypoxemia, or asymptomatic hypoxemia. Patients with asymptomatic hypoxemia often have no subjective symptoms, such as dyspnea, even though hypoxemia is judged by objective tests, such as blood gas analysis and pulse oximetry. Asymptomatic hypoxemia can lead to acute respiratory distress syndrome, and the delay in making a diagnosis and providing initial treatment can have fatal outcomes, especially during the COVID-19 pandemic. Thus far, not many studies have covered asymptomatic hypoxemia. We present a review on the human response to hypoxemia, focusing on the respiratory response to hypoxemia rather than the pathophysiology of lung injury arising from SARS-CoV-2 infection. We have also discussed whether asymptomatic hypoxemia is specific to SARS-CoV-2 infection or a common phenomenon in lung-targeted viral infections.

CLINICAL-NEURO-PHYSIOLOGICAL CHARACTERISTICS OF MYOFASCIAL PAIN SYNDROME IN A PATIENT WITH LEFT HEMYPLEGIA AFTER INTRACEREBRAL HEMORRHAGIC STROKE

Myofascial pain syndrome (MFPS) is one of the most common comorbid pathological processes that develops in skeletal muscle in patients with stroke, which is manifested by local seals and pain in various parts of the muscle. Despite the fact that the interest in MFPS arose in the last century, the intimate mechanisms of its development and course remain to be fully explored. It was found that the main manifestations of MFPS were the presence of miofascial trigger point in the area of palpation of the corresponding muscle with local pain and hypersensitivity within the palpated cord-segmentes, the characteristic pattern of reflected pain and reflected autonomic phenomenon, local convulsive response during transverse palpation. It is accompanied by muscle fatigue and significant muscle weakness without severe atrophy. Attention is drawn to the clear recurrence-reproducibility of pain, ie the so-called "recognizable" pain. All of the above symptoms constitute a general pattern of the disease, which has diagnostic value and is proposed for use as prognostic parameters with the obligatory use of the results of electromyographic examination. Diagnosis of active and latent MTP was performed on the basis of generally accepted l signs. The greatest discomfort for the patient is the presence of active MTP with characteristic spontaneously reproducing pain. Latent MTP is detected in up to 90% of cases among healthy people, and adverse factors only contribute to their transition to an active state with a characteristic symptom complex. The presence of an active myofascial trigger point with a characteristic spontaneously reproducing pain is the most painful manifestation. Latent MTP is also detected in most cases among healthy people, and unfavorable factors only contribute to their transition to an active state with a characteristic symptom complex. The study of the number of turns of the adhesive part of the potential in the zone of active ICC showed that there is a concentration of fibers in the zone of one motor units (MU). The average value of this indicator increases in the early stages of the process by 2 times. Even a small degree of desynchronization of the potentials of individual MU causes an increase in the number of rounds, which reflects the number of fibers involved in the generation of MC PMU. Absence of spontaneous muscle fibers (MF) activity, registration of end plate (EP) activity, PMU parameters such as amplitude decrease, shift of neurohistogram of potential distribution by duration towards smaller values or high percentage of polyphasicity, due to increase in number of turns, and also change their adhesive part, increase of MF density in zone MTP - they all determine changes in structural and functional parameters by muscle type. The work is devoted to the clinical, neuro-physiological characteristics of a patient with MFPS on the background of intracerebral hemorrhage and left hemyplegia based on the analysis of the neuro-functional organization of the motor units of the back muscles. Substantiated genesis and possible mechanism of development and formation of myofascial trigger point in such patients.

Iontophoresis with Aqueous solution of Nirgundi (Vitex negundo, Linn.) in the Management of Pada Kantaka (Plantar Fasciitis) - A Case Report

Vata kantaka is recognized as a Vatvyadhi. Walking bare-foot on uneven terrains causes vitiation of Vata which inturn causes pain which is specifically located at the heel of the foot. Vitiated Vata gets localized in Pada and it produces its characteristic symptom which is pricking pain like a thorn especially in the morning for first few steps, so as to be called as Vata kantak. Acharya Yogratnakar stated Vata kantaka as Pada kantaka. A 35 years old female patient visited Shalya tantra OPD with complaints of Right heel pain and diagnosed as Plantar fasciitis. 6 sittings of Iontophoresis with Nirgundi Aqueous extract were given on alternate day for 15-20 min. Pain on VAS was 7 before treatment. After treatment the score reduced to 0. Nirgundi is well known for its analgesic, anti inflammatory, anti rheumatic property. Iontophoresis is a technique which improves the penetration of drug transdermally due to application of a low voltage current. So the iontophoresis with Nirgundi aqueos solution was found significantly effective in relieving symptoms of Pada kantaka i.e. Plantar fasciitis.

Can fibromyalgia be considered a characteristic symptom of climacterium?

Fibromyalgia syndrome (FMS) is a chronic pain syndrome, characterised by diffuse pain in musculoskeletal system and accompanied by stiffness, fatigue, tender points, sleep disturbances and cognitive and gastrointestinal symptoms. It affects middle-aged women (between 40 and 65) predominantly. Climacteric syndrome, which is characterised by vasomotor, somatic (headache, sleep disorders, myalgia and arthralgia) and psychical (mood changes) symptoms, results from the change in brain neurotransmitter concentrations due to gradual decline of ovarian hormone levels. Currently, studies focus on the similarities of FMS and climacteric syndrome in terms of age of occurrence, epidemiology, etiopathogenesis, symptomatology and treatment. Hormonal fluctuation during menopausal transition is likely the triggering factor for both syndromes. Therefore, hormone replacement therapy is a favourable approach in the treatment of FMS due to the antiallodynic, anti-inflammatory and neuroprotective effect of oestrogen. In this review, we emphasise the similarity of FMS and climacteric syndrome and suggested that FMS could be considered as a characteristic symptom of climacterium.

The UGT2A1/UGT2A2 locus is associated with COVID-19-related anosmia

Loss of sense of smell is a characteristic symptom of infection with SARS-CoV-2. However, specific mechanisms linking infection with loss of smell are poorly understood. Using self-reported symptom data from the 23andMe COVID-19 study, we describe the demographic patterns associated with COVID-19 related anosmia, and find the symptom is more often reported in women and younger respondents, and less often by those of East Asian and African American ancestry compared to those of European ancestry. We ran a trans-ethnic genome-wide association study (GWAS) comparing loss of smell or taste (n=47,298) with no loss of smell or taste (n=22,543) among those with a positive SARS-CoV-2 test result. We identified an association (rs7688383) in the vicinity of the UGT2A1 and UGT2A2 genes (OR=1.115, p-value=4x10-15), which have been linked to olfactory function. These results may shed light on the biological mechanisms underlying COVID-19 related anosmia.

Association of citrus virus A to citrus impietratura disease symptoms.

Citrus impietratura disease (CID) is a graft transmissible, virus-like disease observed in old-line citrus trees; its characteristic symptom is the appearance of gum in the albedo of the affected fruits. To identify the causal agent of the disease, high throughput sequencing (HTS) was performed on symptomatic orange fruits. The analysis of the obtained data revealed in all samples, mixed infections of viroids commonly found in citrus trees together with the recently described citrus virus A (CiVA). Examination of additional symptomatic fruits with conventional RT-PCRs led to the identification of a single CiVA infection in one tree, which was verified by HTS. Indexing of the single CiVA-infected tree on indicator plants resulted in the appearance of characteristic symptoms in the leaves that were correlated with virus accumulation. Moreover, a comparative analysis among symptomatic and asymptomatic fruits derived from the same trees was performed and included the single CiVA-infected orange tree. The analysis revealed a positive correlation between the appearance of symptoms and the accumulation of CiVA RNAs. To facilitate CiVA detection during certification programs of propagation material a quantitative RT-qPCR targeting the movement protein of the virus, was developed and evaluated for reliable and sensitive detection of the virus. To the best of our knowledge this is the first study that associates CiVA with the appearance of impietratura disease symptoms.

Destabilization of Alzheimer’s Aβ42 protofibrils with acyclovir, carmustine, curcumin, and tetracycline: Insights from molecular dynamics simulations

One of the most common dementia among neurodegenerative diseases is Alzheimer’s disease (AD). The characteristic symptom of AD is the deposition and aggregation of amyloid-β-peptide in the neural tissue. A...

The history of the formation of phthisiology as a science

Humanity has been familiar with tuberculosis for a long time: the confirmation of this was found during archaeological excavations and the discovery of traces of damage to the remains of people who lived more than 5 thousand years ago. Scientists associate this fact with the high prevalence of mycobacteria among animals, as well as the extreme duration of the disease and the high degree of chronicity of the process. The first descriptions of tuberculous lesions were found in the writings of Hippocrates. The most characteristic symptom of the disease, as in the present days, was considered hemoptysis, and the extreme degree of exhaustion and pulmonary bleeding was quite typical for this category of patients. This disease was initially called consumption, or phthisi. Subsequently, it gave the name to the science that studies various clinical manifestations in the tuberculosis process, their diagnosis and treatment. Today, phthisiology is a clinical discipline that studies the etiology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis of pulmonary and extrapulmonary forms of tuberculosis, as well as the main approaches to etiotropic and pathogenetic treatment.

Looking ahead

The rapid spread of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has become a public health emergency of international concern. The outbreak was characterized as a pandemic by the World Health Organization (WHO) in March 2020. The most characteristic symptom of patients with COVID-19 is respiratory distress. Some patients may also show neurologic signs and symptoms ranging from headache, nausea, vomiting, and confusion to anosmia, ageusia, encephalitis, and stroke. Coronaviruses are known pathogens with neuroinvasive potential. There is increasing evidence that coronavirus infections are not always confined to the respiratory tract. CNS involvement can occur in susceptible individuals and may contribute overall morbidity and mortality in the acute setting. In addition, postinfectious, immune-mediated complications in the convalescent period are possible. Awareness and recognition of neurologic manifestations is essential to guide therapeutic decision-making because the current outbreak continues to unfold.

Functioning of Patients with Myasthenia Gravis after Plasmapheresis

Introduction. Myasthenia gravis is an autoimmune disease of the postsynaptic part of the neuromuscular junction. A characteristic symptom of myasthenia gravis is the so-called fatigability or muscle fatigue, which also affects the respiratory muscles. Plasmapheresis is one of the treatments that improve breathing and reduce the symptoms that cause muscle weakness. Aim. The aim of the study was to assess the functioning of patients with myasthenia gravis before and after plasmapheresis. Material and Methods. The research was conducted in 2019 in the Anaesthesiology and Intensive Care department on a group of 30 patients with clinically confirmed myasthenia gravis. The author’s questionnaire was used to assess the functioning of patients. The research was approved by the Bioethics Committee. Results. The patient’s condition improved after the procedure in each of the analysed areas of functioning (physical activity, movement, breathing, swallowing, mood, social functioning). The plasmapheresis most preferably affected the area of physical activity of the subjects. The conducted statistical analysis proved a significant difference (p = 0.000) for all results, in every aspect (before and after the procedure). At the same time, the highest average increase was observed in relation to physical activity — an increase of 3.17 points. Conclusions. Plasmapheresis had a positive effect on patients’ health in both physical and mental aspects. (JNNN 2019;8(4):143–147) Key Words: myasthenia gravis, plasmapheresis, functional assessment