Segmental zoster paresis as a cause for persistent fever in an immunocompromised patient

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.

Identifying and prioritizing potential human-infecting viruses from their genome sequences

Determining which animal viruses may be capable of infecting humans is currently intractable at the time of their discovery, precluding prioritization of high-risk viruses for early investigation and outbreak preparedness. Given the increasing use of genomics in virus discovery and the otherwise sparse knowledge of the biology of newly discovered viruses, we developed machine learning models that identify candidate zoonoses solely using signatures of host range encoded in viral genomes. Within a dataset of 861 viral species with known zoonotic status, our approach outperformed models based on the phylogenetic relatedness of viruses to known human-infecting viruses (area under the receiver operating characteristic curve [AUC] = 0.773), distinguishing high-risk viruses within families that contain a minority of human-infecting species and identifying putatively undetected or so far unrealized zoonoses. Analyses of the underpinnings of model predictions suggested the existence of generalizable features of viral genomes that are independent of virus taxonomic relationships and that may preadapt viruses to infect humans. Our model reduced a second set of 645 animal-associated viruses that were excluded from training to 272 high and 41 very high-risk candidate zoonoses and showed significantly elevated predicted zoonotic risk in viruses from nonhuman primates, but not other mammalian or avian host groups. A second application showed that our models could have identified Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) as a relatively high-risk coronavirus strain and that this prediction required no prior knowledge of zoonotic Severe Acute Respiratory Syndrome (SARS)-related coronaviruses. Genome-based zoonotic risk assessment provides a rapid, low-cost approach to enable evidence-driven virus surveillance and increases the feasibility of downstream biological and ecological characterization of viruses.

1252 A Systematic Review of International Colorectal Multidisciplinary Team Meetings: The Development of Best Practice Through Inter-Regional Learning

Aim Colorectal multi-disciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of colorectal cancer. However, there are no gold standards set for this process. The aim of this study is to establish recommendations on the principles, organisation, structure and output of CR MDTs internationally. Method The available literature on the role of CR MDTs from January 1999 and March 2020 in the United Kingdom (UK), United States of America (USA) and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient selection criteria, quality assurance, output and outcomes were extracted from data from the UK, USA, and continental Europe. Results Fifty studies were identified that specifically met the inclusion criteria. CR MDTs should occur at least once a month with established key members. Generally, all colorectal cancer patients should be discussed and there should be a focus on education. There are noted differences in the lead member of the CR MDT, the use of information technology and storage of MDT information in databases and quality assurance internationally. Conclusions The most common issues facing MDTs internationally include a lack of staffing and resources as well as limited information on the patient’s fitness and preference for surgery. These factors are important and urgent improvements are required in these areas in CR MDTs. Quality assurance should be a mandatory component of every CR MDT.

Criteria to evaluate neurological lower urinary tract dysfunction in children with Congenital Zika Syndrome: Revised version after the fourth year of use v1

Congenital Zika Syndrome (CZS) has been associated with microcephaly and other central nervous system abnormalities including areas that have been implicated in the control of the lower urinary tract [1] Neurological lower urinary tract dysfunction (NLUTD) is a common condition among patients with CZS and microcephaly [2][1][3][4][5]. But the lack of knowledge that CZS causes NLUTD delays investigation and treatment. This revised version includes changes based on the observations of four-years of experience using our first published protocol [6], the new sequels found in children with CZS, which are cryptorchidism [7] and the neurogenic bowel [5], and related publications [8][9]. This new version includes the vision of the authors, who are from five different institutions in Brazil. They have been working with patients with NLUTD and participate in the development of the new Urological care network for patients with CZS. Our protocol aims to alert health professionals to the relationship between neurological lower urinary tract dysfunction and Congenital Zika Syndrome and to initiate an early investigation to minimize the risks associated with neurological lower urinary tract dysfunction and other genitourinary disorders that may be found in these children. A thorough investigation of these children can reduce the impact of this important sequelae, which is the neurological lower urinary tract dysfunction, reducing comorbidities and consequent impairment of renal function and mitigating the disease burden for patients and families and the Health Systems.

Multi view based imaging genetics analysis on Parkinson disease

Longitudinal studies integrating imaging and genetic data have recently become widespread among bioinformatics researchers. Combining such heterogeneous data allows a better understanding of complex diseases origins and causes. Through a multi-view based workflow proposal, we show the common steps and tools used in imaging genetics analysis, interpolating genotyping, neuroimaging and transcriptomic data. We describe the advantages of existing methods to analyze heterogeneous datasets, using Parkinson’s Disease (PD) as a case study. Parkinson’s disease is associated with both genetic and neuroimaging factors, however such imaging genetics associations are at an early investigation stage. Therefore it is desirable to have a free and open source workflow that integrates different analysis flows in order to recover potential genetic biomarkers in PD, as in other complex diseases.

Relationship of the sacral slope with early gait derangements in robust older women

Background Trunk pelvic dissociation is fundamental to the compensatory mechanism for muscle weakness during body bending. We carried out an early investigation of gait changes in a sample of community-dwelling women ≥60 years without gait complaints. The primary objective was to correlate spine and pelvic angles with performance tests and accelerometry parameters. The secondary objective was to correlate performance tests with accelerometry. Methods In this cross-sectional study, 54 community-dwelling women ≥60 years were subjected to Falls Efficacy Scale-International (FES-I), performance tests (Berg Balance Scale, Timed Up and Go, and Gait analysis), and radiographic analysis of sagittal alignment (Thoracic and Lumbar Cobb, Pelvic Incidence, Sacral Slope, and Pelvic Tilt angles). Gait speed was assessed in a 10-m comfortable walk, and accelerometry parameters were obtained in a 30-m walk distance. Results The sample, aged 72 ± 6 years, exhibited moderate correlation between Sacral Slope and Step Length (+ 0.615). Sacral Slope weakly correlated with FES-I (− 0.339), Berg Balance Scale (+ 0.367), and with further accelerometry data in the AP plane: RMS, (+ 0.439) and Stride Regularity (+ 0.475), p < 0.05, all. Lumbar Cobb weakly correlated with the following accelerometry data in the AP plane: Step Length (+ 0.405), RMS, (+ 0.392), and Stride Regularity (+ 0.345), p < 0.05, all. Additionally, Stride Regularity in AP moderately correlated with FES-I (0,561, p < 0.05), among other weak correlations between performance tests and accelerometry data in AP. Conclusions Early alterations in Sacral Slope and gait abnormalities in the AP plane may provide understanding of the early gait changes in robust older women.

Late urological manifestation of stress incontinence surgery

The Stamey procedure was a popular procedure for female stress incontinence practiced widely in the 1980s before it was abandoned owing to high complication rates. The procedure aimed to suspend the bladder neck by placing two transvaginal Dacron buttress grafts either side of the bladder neck and suspending them with sutures passed through the retropubic space and tied suprapubically. Erosion of the graft into the bladder was a recognised complication. We report a case of an 84-year-old lady who presented with urinary symptoms forty years after an unspecified stress incontinence procedure. Imaging and cystoscopy revealed an eroded graft in her bladder wall. Further investigation revealed the graft was a Dacron buttress from a Stamey procedure. This case highlights the importance of having a working knowledge of historical techniques that may present with complications many years later and recognising the symptoms that should prompt early investigation.

Long-Term and Emergency Monitoring of Zhongbao Landslide Using Space-Borne and Ground-Based InSAR

This work presents the ideal combination of space-borne and ground-based (GB) Interferometric Synthetic Aperture Radar (InSAR) applications. In the absence of early investigation reporting and specialized monitoring, the Zhongbao landslide unexpectedly occurred on 25 July 2020, forming a barrier lake that caused an emergency. As an emergency measure, the GB-InSAR system was installed 1.8 km opposite the landslide to assess real-time cumulative deformation with a monitoring frequency of 3 min. A zone of strong deformation was detected, with 178 mm deformation accumulated within 15 h, and then a successful emergency warning was issued to evacuate on-site personnel. Post-event InSAR analysis of 19 images acquired by the ESA Sentinel-1 from December 2019 to August 2020 revealed that the landslide started in March 2020. However, the deformation time series obtained from satellite InSAR did not show any signs that the landslide had occurred. The results suggest that satellite InSAR is effective for mapping unstable areas but is not qualified for rapid landslide monitoring and timely warning. The GB-InSAR system performs well in monitoring and providing early warning, even with dense vegetation on the landslide. The results show the shortcomings of satellite InSAR and GB-InSAR and a clearer understanding of the necessity of combining multiple monitoring methods.

Magnitude and associated factors of peripheral cytopenia among HIV-infected children attending at University of Gondar Specialized Referral Hospital, Northwest Ethiopia

Background Isolated or multi lineage cytopenia are the most common clinicopathological features and independently associated with increased risk of disease progression and death among human immunodeficiency virus infected children. In the study area, there is scarcity of data about the magnitude of various cytopenia. Objectives Aimed to determine the magnitude and associated factors of peripheral cytopenia among HIV infected children at the University of Gondar Specialized Referral Hospital ART clinic, Northwest Ethiopia. Methods Institutional based cross-sectional study was conducted on 255 HIV infected children from January- April 2020. None probable convenient sampling technique was used to select the study participant. Socio demographic data were collected by pre tested structured questionnaire via face-to-face interview and their medical data were obtained from their follow-up medical records. Moreover, blood specimens were collected and examined for complete blood count, viral load and blood film, whereas stool specimens were collected and examined for intestinal parasites. Bi-variable and multi-variable logistic regression models were fitted to identify associated factors of cytopenia. P-Value <0.05 was considered as statistically significant. Result The overall magnitude of peripheral cytopenia was 38.9%. Anemia, leukopenia, lymphopenia, thrombocytopenia and bi-cytopenia were 21.2%, 12.2%, 11%, 1.6% and 3.9% respectively. Being in the age group of 2–10 years (AOR = 5.38, 95%CI 2.33–12.46), AZT based regimen (AOR = 5.44, 95%CI: 2.24–13.21), no eating green vegetables (AOR = 2.49, 95% CI: 1.26–4.92) and having plasma viral load >1000 copies /ml (AOR = 5.38, 95%CI: 2.22–13.03) showed significant association with anemia. Conclusion Anemia was the predominant peripheral cytopenia among HIV infected children in this study. It was strongly associated with AZT based drug type, age below 10 years and high viral load. Critical stress should be given for early investigation and management of cytopenia in addition to the use of alternative drug which leads to higher viral suppression and lower risk of toxicity issue.