Ultra-low-dose radiation treatment for early-stage ocular adnexal MALT lymphoma

Purpose: To investigate the long-term outcomes of ultra-low-dose (4 Gy) radiation treatment (RT) in patients with early-stage ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: This retrospective case series includes eight patients with ocular adnexal MALT lymphoma who received ultra-low-dose RT at a single tertiary referral center between March 2016 and February 2018. Response to treatment and the time taken to respond were analyzed. Results: Of the eight patients (three men, five women), seven patients had conjunctival lymphoma (T1N0M0), and one patient had orbital lymphoma (T2N0M0). Six patients with T1 disease showed complete response (CR), and the median time to CR was 4.5 months (range 2–5). Partial response was achieved in the remaining two patients (one each with T1 and T2). During the median follow-up period of 44 months (range 30–54), none of the patients had a relapse or needed additional treatment. RT was well-tolerated in all patients with no ocular complications, including cataracts and dry eye. Conclusion: This case series suggests that ultra-low-dose RT is effective and well-tolerated in patients with early-stage ocular adnexal MALT lymphoma. Further studies with a larger sample size and long-term follow-up are needed to evaluate the local control rate and disease-free survival precisely.

Mixed Amphetamine Salts Without a Mood Stabilizer for Treating Comorbid Attention-Deficit Hyperactivity Disorder and Bipolar Disorder: Two Case Reports

ABSTRACT Attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) are often comorbid in patients and can have significant overlap in symptoms. Because of this common comorbidity and often overlapping symptoms, accurate diagnoses can be difficult. The standard treatment for these comorbid disorders is a mood stabilizer with the possibility of adding a psychostimulant. However, research suggesting treatment for comorbid disorders with a psychostimulant without a mood stabilizer is lacking. Here, we present two cases where mixed amphetamine salts, which are traditionally avoided in those with BD, were effectively used without a mood stabilizer to treat comorbid BD and ADHD in both patients. The outcome of this case series serves to motivate future investigations which are needed to validate treatment with a psychostimulant without a mood stabilizer for the treatment of comorbid BD and ADHD.

Enhance embodiment of a virtual prosthesis through a training protocol using an EMG-based human-machine interface: a case series

Background: The embodiment of a prosthesis can bring a series of benefits during the rehabilitation of people with amputation, such as improvement of motor control and sense of agency, in addition to optimizing the training process with the prosthetic limb. New therapeutic strategies capable of enhancing prosthesis embodiment are, therefore, a key point for better adaptation to and acceptance of prosthesis use. In this study, we developed a system and a new rehabilitation protocol using an EMG-based human-machine interface (HMI) to induce and enhance the embodiment of a virtual prosthesis.Methods: This is a case series with seven people of both sexes with unilateral transfemoral traumatic amputation without previous use of prostheses. Participants performed a training protocol with the EMG-based HMI during the preprosthetic rehabilitation phase, composed of six sessions held twice a week, each lasting thirty minutes. This system was composed of myoelectric control of the movements of a virtual prosthesis immersed in a 3D virtual environment. Additionally, vibrotactile stimuli were provided on the participant’s back corresponding to the movements performed. The objectives were to evaluate the virtual prosthesis embodiment, to investigate motor learning during training with EMG-based HMI, and to determine whether vibrotactile stimuli could facilitate the perception of virtual limb movements. The embodiment was investigated from a set of physiological and behavioral measurements and reports before and after the training. Motor learning was assessed through performance analysis. To investigate the use of vibrotactile stimulation to guide virtual prosthesis movements, the performance was assessed during the virtual prosthesis control test without adding vision.Results and conclusions: The different features evaluated throughout the protocol training consistently showed the induction and enhancement of virtual prosthesis embodiment and increased motor control. Therefore, this protocol using EMG-based HMI was shown to be a viable option to achieve the embodiment of a virtual prosthetic limb and to train motor control. Furthermore, the participants were able to guide the prosthesis based on vibrotactile stimuli, showing that this method can be used as an alternative sensorial path to be implemented in new therapeutic strategies and neuroprostheses to facilitate the movement perception of a prosthetic limb.

Neural Changes Induced by a Speech Motor Treatment in Childhood Apraxia of Speech: A Case Series

We report a case series of children with childhood apraxia of speech, by describing behavioral and white matter microstructural changes following 2 different treatment approaches. Five children with childhood apraxia of speech were assigned to a motor speech treatment (PROMPT) and 5 to a language, nonspeech oral motor treatment. Speech assessment and brain MRI were performed pre- and post-treatment. The ventral (tongue/larynx) and dorsal (lips) corticobulbar tracts were reconstructed in each subject. Mean fractional anisotropy and mean diffusivity were extracted. The hand corticospinal tract was assessed as a control pathway. In both groups speech improvements paralleled changes in the left ventral corticobulbar tract fractional anisotropy. The PROMPT treated group also showed fractional anisotropy increase and mean diffusivity decrease in the left dorsal corticobulbar tract. No changes were detected in the hand tract. Our results may provide preliminary support to the possible neurobiologic effect of a multimodal speech motor treatment in childhood apraxia of speech.

Influence of Novel Coronavirus COVID-19 and HIV: A Scoping Review of Hospital Course and Symptomatology

Background: An outbreak of novel coronavirus (SARS-CoV-2) was observed on December 2019 in Wuhan, China which led to a global pandemic declared in March 2020. As a consequence, it imposed delirious consequences in patients with underlying co-morbid conditions that make them immunocompromised. The purpose of this paper is to provide an in-depth review of influence of COVID-19 in patients with underlying HIV in terms of mortality and hospitalization. Authors also aim to provide a thorough risk analysis of hospitalization, ICU admission and mortality of PLWH and COVID-19. The secondary objective was to analyze the CD4+ count variations and outcome of COVID-19 and to correlate if ART provided a protective role. Authors also aim to provide an evaluation of typical clinical presentation of COVID-19 in PLWH. ART is found to show activity against SARS-CoV-2 in vitro, and there is some similarity in the structure of HIV-1 gp41 and S2 proteins of SARS-CoV since they both belong to +ssRNA type. Methods: We conducted a literature review using search engines namely, Cochrane, PubMed and Google Scholar. The following keywords were targeted: "COVID-19," "SARS-CoV-2," and "HIV." We included case reports, case series, and cohort (retrospective and prospective) studies. We excluded clinical trials and review articles. We came across 23 articles that met the inclusion criteria. PRISMA guidelines were followed for study acquisition (Fig. 9). Results: From the 23 studies, we found a total of 651 PLWH with confirmed COVID-19 (549, 91, and 11 in cohorts, case series, and case reports, respectively). The overall risk of hospital admission from pooled data of the 23 reviewed articles was 69.13% (450/651), ICU admission was 12.90% (84/651) in total infected patients, and 18.67% (84/450) among hospitalized patients. The overall case fatality rate from the 23 reviewed articles was 11.21 (73/651).A weak positive correlation was found between CD4+ counts and hospital admissions in case series and case reports, while the weak negative correlation was found in cohorts. For mortality, there was a negative weak association in the cohorts and in case series, while a weak positive was seen in case reports (Fig.7). We assessed the presenting symptoms of PLWH with COVID-19, and our review demonstrated this group does not greatly differ from the rest of the population, as their common presenting symptoms were cough, fever, and SOB. Conclusion: Our results indicated that there was a high rate of hospitalization, ICU admission, and mortality among patients living with HIV and COVID-19. PLWH needs to be noted as a high-risk group for COVID-19 complications and severity. We recommend that PLWH be closely monitored by their physicians and strictly adhere to antiretroviral therapy and standard universal COVID-19 precautions.