Can the rate of mortality and neurological recovery be predicted from the time of onset of symptoms and MRI grade in patients with cerebral fat embolism?

Aims The aim of this study was to assess whether it is possible to predict the mortality, and the extent and time of neurological recovery from the time of the onset of symptoms and MRI grade, in patients with the cerebral fat embolism syndrome (CFES). This has not previously been investigated. Methods The study included 34 patients who were diagnosed with CFES following trauma between 2012 and 2018. The clinical diagnosis was confirmed and the severity graded by MRI. We investigated the rate of mortality, the time and extent of neurological recovery, the time between the injury and the onset of symptoms, the clinical severity of the condition, and the MRI grade. All patients were male with a mean age of 29.7 years (18 to 70). The mean follow-up was 4.15 years (2 to 8), with neurological recovery being assessed by the Glasgow Outcome Scale and the Mini-Mental State Examination. Results In all, seven who had early-onset CFES (< 24 hours), and a severe Takahashi grade on MRI, died. There was a significant association between the time of onset of neurological signs and mortality (p = 0.035). Mortality was also significantly associated with a severe Takahashi grade (p < 0.001). Among the 27 surviving patients, 26 (96.3%) recovered completely. One (3.7%) had a cognitive deficit. The mean time to recovery was 4.7 weeks (2 to 13), with late recovery aftereight eight weeks being recorded in three patients. Conclusion There was a significantly increased rate of mortality in patients with CFES who had an early onset of symptoms and a severe grade on MRI. Complete neurological recovery can be expected in most patients with CFES who survive. Cite this article: Bone Joint J 2022;104-B(1):142–149.

The Antioxidant Phytochemical Schisandrin A Promotes Neural Cell Proliferation and Differentiation after Ischemic Brain Injury

Schisandrin A (SCH) is a natural bioactive phytonutrient that belongs to the lignan derivatives found in Schisandra chinensis fruit. This study aims to investigate the impact of SCH on promoting neural progenitor cell (NPC) regeneration for avoiding stroke ischemic injury. The promoting effect of SCH on NPCs was evaluated by photothrombotic model, immunofluorescence, cell line culture of NPCs, and Western blot assay. The results showed that neuron-specific class III beta-tubulin (Tuj1) was positive with Map2 positive nerve fibers in the ischemic area after using SCH. In addition, Nestin and SOX2 positive NPCs were significantly (p < 0.05) increased in the penumbra and core. Further analysis identified that SCH can regulate the expression level of cell division control protein 42 (Cdc42). In conclusion, our findings suggest that SCH enhanced NPCs proliferation and differentiation possible by Cdc42 to regulated cytoskeletal rearrangement and polarization of cells, which provides new hope for the late recovery of stroke.

Plasma markers of neurologic injury and systemic inflammation in individuals with self-reported neurologic post-acute sequelae of SARS-CoV-2 infection (PASC)

Background: The biologic mechanisms underlying neurologic post-acute-sequelae of SARS-CoV-2 infection (PASC) are incompletely understood. Methods: We measured markers of neuronal injury (glial fibrillary acidic protein [GFAP], neurofilament light chain [NfL]) and soluble markers of inflammation among a cohort of people with prior confirmed SARS-CoV-2 infection at early and late recovery following the initial illness (defined as less than and greater than 90 days, respectively). The primary clinical outcome was the presence of self-reported central nervous system (CNS) PASC symptoms during the late recovery timepoint. We compared fold-changes in marker values between those with and without CNS PASC symptoms using linear mixed effects models and examined relationships between neurologic and immunologic markers using rank linear correlations. Results: Of 121 individuals, 52 reported CNS PASC symptoms. During early recovery, those who went on to report CNS PASC symptoms had elevations in GFAP (1.3-fold higher mean ratio, 95% CI 1.04-1.63, p=0.02), but not NfL (1.06-fold higher mean ratio, 95% CI 0.89-1.26, p=0.54). During late recovery, neither GFAP nor NfL levels were elevated among those with CNS PASC symptoms. Although absolute levels of NfL did not differ, those who reported CNS PASC symptoms demonstrated a stronger downward trend over time in comparison to those who did not report CNS PASC symptoms (p=0.041). Those who went on to report CNS PASC also exhibited elevations in IL-6 (48% higher during early recovery and 38% higher during late recovery), MCP-1 (19% higher during early recovery), and TNF-alpha (19% higher during early recovery and 13% higher during late recovery). GFAP and NfL correlated with levels of several immune activation markers during early recovery; these correlations were attenuated during late recovery. Conclusions: Self-reported neurologic symptoms present >90 days following SARS-CoV-2 infection are associated with elevations in markers of neurologic injury and inflammation at early recovery timepoints, suggesting that early injury can result in long-term disease. The correlation of GFAP and NfL with markers of systemic immune activation suggests one possible mechanism that might contribute to these symptoms. Additional work is needed to better characterize these processes and to identify interventions to prevent or treat this condition.

Impact of 2016 intense drought to small tropical reservoir: An early onset and late recovery experience in Timah Tasoh, Malaysia

This study investigates the hydrological drought impact during the extreme 2016 El-Nino to small tropical reservoir of Timah Tasoh, in Perlis, Malaysia. Small tropical reservoirs are important freshwater supplier due to its economic & strategic factors including (i) closer distance to inhabitants and agriculture footprints, (ii) easy access to the resource, and (iii) cheaper cost of water pipelines system. In theory, small tropical lakes or reservoirs are facing higher risk to drought compared to the bigger ones. However, detail information and evidence are required for site specific drought adaptation in the future especially the onset and offset of the drought at specific hydrometeorological and dam scale. Prior to that, a case study was conducted in one of the small-sized and shallow reservoirs of Timah Tasoh, Perlis to analyze the impact. The larger Pedu reservoir was selected as control site. Both reservoirs were having identical hydro-climatic characteristics (seasonality of rainfall). The observation on the rainfall and reservoir level data indicated that the small sized reservoir (Timah Tasoh) tends to dry about 2 months faster (reached dam critical level) and recover 1 month late compared to the normal dry season. In comparison with the Pedu reservoir, the drought onset and offset in Timah Tasoh was earlier and late respectively although the rainfall pattern is typical. The total impacted drying days for Timah Tasoh is 197 days compared to 78 days of Pedu (about 3 months longer). The findings indicate that the 2016 extreme drought impacted the Timah Tasoh small reservoir where they would suffer longer dry season and experienced slower recovery compared to the bigger Pedu reservoir. The outcome of this investigation signifies that the early drought onset monitoring should be implemented for the small sized reservoirs to take appropriate mitigation and preventive measures in adapting to the intense drought.

Late Recovery of Parathyroid Function after Total Thyroidectomy: A Case-Control Study

The clinical characteristics of patients with postoperative hypoparathyroidism who recover parathyroid function more than 12 months after surgery have not been studied. We aimed to evaluate whether the intensity of replacement therapy with calcium and calcitriol is related to the late recovery of parathyroid function. We compared the demographic, surgical, pathological, and analytical features of two groups of patients: cases, i. e., late recovery patients (those who recover parathyroid function>1 year after thyroidectomy, n=40), and controls, i. e., patients with permanent hypoparathyroidism (n=260). Replacement therapy with calcium and calcitriol was evaluated at discharge of surgery, 3–6 months, 12 months, and last visit. No significant differences were found in clinical, surgical, pathological, or analytical characteristics between cases and controls. The proportion of cases who required treatment with calcium plus calcitriol at 12 months was significantly lower than that found in controls (p<0.001). Furthermore, daily calcium and calcitriol doses in controls were significantly higher than those in cases at 3–6 months (p=0.014 and p=0.004, respectively) and at 12 months (p<0.001 and p=0.043, respectively). In several models of logistic regression analysis therapy with calcium and calcitriol at 12 months was negatively related to late recovery of parathyroid function. Although delayed recuperation of parathyroid function after total thyroidectomy is uncommon (13%), follow-up beyond 12 months is necessary in patients with postoperative hypoparathyroidism, especially in those whose needs of treatment with Ca and calcitriol are reducing over time.

Cavitary Covid Lesions - An Unusual Imaging Feature

On January 30, 2020, the coronavirus disease 2019 (Covid-19), formerly known as the 2019 novel coronavirus (2019-nCoV), was declared as a global health emergency by the World Health Organization. Coronavirus disease 2019 (Covid-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Imaging plays an essential role in the evaluation of Covid-19, with chest computed tomography (CT) being the major modality in diagnosing and managing Covid-19 pneumonia. Common signs of Covid-19 pneumonia on chest CT scan are ground-glass opacities, consolidation, nodules, and linear opacities, halo and reverse halo signs. It can be accompanied by a “crazy-paving” pattern, air bronchograms, pleural hypertrophy, and pleural effusion. Cavitations are known to occur but are rare presentations. There are cases reported in the literature of the development of pulmonary cavity after bacterial infection in the late recovery stage in SARS patients. We present a case report of this rare entity in Covid-19 infection in a previously stable patient

Relationships between measures of boat acceleration and performance in rowing, with and without controlling for stroke rate and power output

Purpose Boat acceleration profiles provide a valuable feedback tool by reflecting both rower technique and force application. Relationships between measures of boat acceleration and velocity to inform interpretation of boat acceleration profiles in rowing were investigated here. Methods Thirteen male singles, nine female singles, eight male pairs, and seven female pairs participated (national and international level, age 18–27 y). Data from each stroke for 74 2000-m races were collected using Peach PowerLine and OptimEye S5 GPS units. General linear mixed modelling established modifying effects on velocity of two within-crew SD of boat acceleration variables for each boat class, without and with adjustment for stroke rate and power, to identify potential performance-enhancement strategies for a given stroke rate and power. Measures of acceleration magnitude at six peaks or dips, and six measures of the rate of change (jerk) between these peaks and dips were analyzed. Results were interpreted using rejection of non-substantial and substantial hypotheses with a smallest substantial change in velocity of 0.3%. Results Several boat acceleration measures had decisively substantial effects (-2.4–2.5%) before adjustment for stroke rate and power. Most effect magnitudes reduced after adjustment for stroke rate and power, although maximum negative drive acceleration, peak drive acceleration, jerk during the mid-drive phase, and jerk in the late recovery remained decisively substantial (-1.8–1.9%) in some boat classes. Conclusion Greater absolute values of maximum negative drive acceleration and jerk in the late recovery are related to improved performance, likely reflecting delayed rower centre-of-mass negative acceleration in preparation for the catch. Greater absolute values of peak drive acceleration, first peak acceleration, and jerk in the early and mid-drive are also associated with improved performance, likely reflecting propulsive force during the drive. These proposed mechanisms provide potential strategies for performance enhancement additional to increases in stroke rate and power output.

Markers of immune activation and inflammation in individuals with post-acute sequelae of SARS-CoV-2 infection

BACKGROUND: The biological processes associated with post-acute sequelae of SARS-CoV-2 infection (PASC) are unknown. METHODS: We measured soluble markers of inflammation in a SARS-CoV-2 recovery cohort at early (<90 days) and late (>90 days) timepoints. We defined PASC as the presence of one or more COVID-19-attributed symptoms beyond 90 days. We compared fold-changes in marker values between those with and without PASC using mixed effects models with terms for PASC and early and late recovery time periods. RESULTS: During early recovery, those who went on to develop PASC generally had higher levels of cytokine biomarkers including TNF-alpha (1.14-fold higher mean ratio, 95%CI 1.01-1.28, p=0.028) and IP-10 (1.28-fold higher mean ratio, 95%CI 1.01-1.62, p=0.038). Among those with PASC, there was a trend toward higher IL-6 levels during early recovery (1.28-fold higher mean ratio, 95%CI 0.98-1.70, p=0.07) which became more pronounced in late recovery (1.44-fold higher mean ratio, 95%CI: 1.11-1.86, p<0.001). These differences were more pronounced among those with a greater number of PASC symptoms. CONCLUSIONS: Persistent immune activation may be associated with ongoing symptoms following COVID-19. Further characterization of these processes might identify therapeutic targets for those experiencing PASC.

Neuro-ophthalmologic manifestations of corona virus disease (COVID-19): A case series

Manifold neuro-ophthalmological signs & symptoms have been described in association with corona virus disease 19 (COVID-19). These presenting manifestations probably due to the result of a range of pathophysiological mechanisms throughout the course from acute illness to recovery phase & late recovery phase. Optic nerve dysfunction like optic neuropathy is associated with post COVID-19 infection. In this case series we want to highlight about the course, sequelae & association of optic neuropathy in COVID-19 patients. BSMMU J 2021; 14 (COVID -19 Supplement): 42-44