Plasma neurological biomarkers as a measure of neurotoxicity in pediatric dental general anesthesia: a prospective observational feasibility study.

PURPOSE: Neurotoxicity concerns have been raised over general anesthesia and sedation medication use in children. Such concerns are largely based on animal studies, historical anesthetic agents, and assessment tools, thus warranting further investigations. Blood biomarkers in detecting neuronal inflammation and apoptosis are novel methods for detecting neuronal damage. Therefore, the aim of this feasibility study was to assess the usefulness of the levels of four plasma biomarkers in dental general anesthesia (DGA) as surrogate markers of neurotoxicity in children. The secondary aim was to compare changes in motor manipulative skills pre- and post-anesthetic exposure. METHODS: This single-center prospective observational study included 22 healthy children aged between 3 and 6 years old who underwent DGA. Subclinical neurotoxicity was measured with a panel of four plasma biomarkers: Caspase-3, neuron-specific enolase (NSE), neurofilament light chain, and S100B at three time points (1; at start, 2; end and 3; on recovery from DGA). The Skillings-Mack test was used to identify the difference in the biomarker levels at three time points. Motor manipulative score assessment, prior and two weeks after DGA was also performed. RESULTS: A total of 22 study participants (mean age = 5 ± 1 years) were included with a median DGA duration of 106 ± 28 min. A reduction in Caspase-3 levels was recorded, with pairwise comparison over three time points, reporting a statistical significance between time point 2 vs. 1 and time point 3 vs. 1. Although fluctuations in NSE levels were recorded, no significant changes were found following pairwise comparison analysis. Among other biomarkers, no significant changes over the three periods were recorded. Furthermore, no significant changes in manipulative motor scores were reported. CONCLUSION: Caspase-3 reduced significantly in the short time frames during day-care DGA; this might be due to the relatively short anesthesia duration associated with dental treatment as compared with more extensive medical-related treatments. Therefore, further studies on Caspase-3 as a potential biomarker in pediatric DGA neurotoxicity are required to further ascertain results of this study.

Prevalence of anxiety, sleep bruxism and temporomandibular disorders during COVID-19 in Qatari children and adolescents: a cross-sectional study.

PURPOSE: Understanding the impact of coronavirus disease-2019 (COVID-19) pandemic social restrictions on the lives of children and adolescents is of utmost importance to enable timely diagnosis and treatment. Therefore, the aim of this study was to explore the prevalence of anxiety, sleep bruxism, temporomandibular disorders (TMD) and change in dietary and brushing habits and their association with COVID-19 social restrictions. METHODS: Parents of fit and healthy Qatari children and adolescents were recruited and interviewed by the research team, whereby validated questioners were used to assess the prevalence of children's/adolescents' anxiety, sleep bruxism and TMD. Furthermore, changes in dietary and brushing habits were also evaluated. RESULTS: A total of 199 parents of children and adolescents (mean age = 9.3 ± 3.2 years old) were included. Overall anxiety symptoms, sleep bruxism and TMD were evident in 29.6%, 5.7% and 23.1%, respectively. An increased consumption of food, sweets and worsening of brushing habits were evident in 51.8%, 62.8% and 31.2%, respectively. CONCLUSION: Within the limitations of this study, pandemic-related social restrictions could result in elevated levels of anxiety, specifically, social phobia, amongst children and adolescents, which could inevitably lead to unwanted dental consequences.

Deep Learning Segmentation of the Nucleus Basalis of Meynert on 3T MRI.

BACKGROUND AND PURPOSE: The nucleus basalis of Meynert is a key subcortical structure that is important in arousal and cognition and has been explored as a deep brain stimulation target but is difficult to study due to its small size, variability among patients, and lack of contrast on 3T MR imaging. Thus, our goal was to establish and evaluate a deep learning network for automatic, accurate, and patient-specific segmentations with 3T MR imaging. MATERIALS AND METHODS: Patient-specific segmentations can be produced manually; however, the nucleus basalis of Meynert is difficult to accurately segment on 3T MR imaging, with 7T being preferred. Thus, paired 3T and 7T MR imaging data sets of 21 healthy subjects were obtained. A test data set of 6 subjects was completely withheld. The nucleus was expertly segmented on 7T, providing accurate labels for the paired 3T MR imaging. An external data set of 14 patients with temporal lobe epilepsy was used to test the model on brains with neurologic disorders. A 3D-Unet convolutional neural network was constructed, and a 5-fold cross-validation was performed. RESULTS: The novel segmentation model demonstrated significantly improved Dice coefficients over the standard probabilistic atlas for both healthy subjects (mean, 0.68 [SD, 0.10] versus 0.45 [SD, 0.11], P = .002, t test) and patients (0.64 [SD, 0.10] versus 0.37 [SD, 0.22], P < .001). Additionally, the model demonstrated significantly decreased centroid distance in patients (1.18 [SD, 0.43] mm, 3.09 [SD, 2.56] mm, P = .007). CONCLUSIONS: We developed the first model, to our knowledge, for automatic and accurate patient-specific segmentation of the nucleus basalis of Meynert. This model may enable further study into the nucleus, impacting new treatments such as deep brain stimulation.

A Report on Cases with Communication Disorders at a Tertiary care Hospital in Mysore District of Karnataka, India: A Retrospective Study Across Five Years.

Communication disorders affect an individual's social, emotional and behavioural well-being. Estimating the number of clients with various causes of communication disorders can assist in the prevention, early identification, intervention, rehabilitation and counselling process. India is the second-largest populated country with diversity in terms of culture and geography. Therefore, estimating the data on number of clients presenting with communication disorders is warranted across different parts of the country. In a retrospective study, the clinical records of cases reporting to the JSS Institute of Speech and Hearing, Mysore, for the last five years were reviewed. A total of 9511 cases diagnosed with communication disorders were included in the study. The percentage of male cases was higher than the females amongst all the types of communication disorders. The percentage of paediatric cases with speech and language disorders was the highest, followed by adult cases. Across the hearing disorders, the highest number of cases were from the adult age group, and the lowest number of hearing-disordered cases were noted in the paediatric age group throughout all five years. Among all the risk factors, perinatal history was the highest seen risk factor, and consanguinity was the lowest seen risk factor associated with communication disorders. The results of the present study revealed that among cases with communication disorders at the tertiary care hospital in Mysore, hearing impairment was one of the most commonly seen conditions, followed by child language disorders. The history of perinatal factors as a risk for communication disorders was noted in a maximum number of cases.

Multiparametric Analysis of Dysphonic Voice - An Evidence from the Discriminant Analysis.

Even though earlier studies have investigated the relationship between various subjective and instrumental measures of voice, determining a standardized set of voice parameters in evaluating dysphonic voices can help in better diagnostic distinctions and judgment of the treatment outcomes in voice disorders. Thus, the primary objective was to examine the differences in the objective and subjective measures of voice between the participants with dysphonia and participants with a clinically normal voice. The subsequent objective was to identify the group of parameters sensitive to vocal changes in dysphonia using discriminant analysis. Two groups of participants were included in the study. Group 1 comprised of 15 participants with dysphonia. Group 2 included 15 participants with a clinically normal voice. Sustained phonations of vowels were recorded from the participants of both groups and were analyzed perceptually using the GRBAS rating scale. Acoustic, cepstral, spectral, and electroglottographic measures were analyzed from dysphonic voices and normal controls. There were significant differences in both instrumental and perceptual measures between the participants with and without dysphonia. The set of five parameters that were significant predictors that discriminated the dysphonic voice from the clinically normal voice with 100% accuracy was also determined using discriminant analysis. Future investigations on the relation between the specific instrumental and perceptual measures of voice identified in the present study among individuals with various voice disorders can deliver more promising and comprehendible insights into better diagnostic distinctions of voice disorders.

Cross-cultural Adaptation and Validation of the Vocal Performance Questionnaire into Kannada.

BACKGROUND/OBJECTIVES: Vocal Performance Questionnaire (VPQ) is a short and convenient tool with one-dimensional consistency to evaluate the vocal performance. Developing the Kannada version of VPQ can be a useful self-assessment clinical tool for evaluating dysphonia symptoms in Kannada-speaking patients. Hence, the objective of the study was to translate the VPQ into Kannada and to evaluate the psychometric properties and the cutoff scores for the Kannada version of the VPQ (VPQ-K). STUDY DESIGN: This investigation deployed a non-randomised, prospective standard group comparison. METHODS: VPQ was translated to Kannada and administered to 71 participants (37 males and 34 females) diagnosed with voice disorder with a mean age of 43.94 ± 15.31 years and 71 age and gender-matched participants with a clinically normal voice. RESULTS: The test-retest reliability of the VPQ-K was measured through Intra class correlation, and the results indicated excellent test-retest reliability. The Internal consistency of VPQ-K was determined using the Split half reliability by calculating the Spearmen-Brown coefficient, and the results revealed that VPQ-K had very strong internal consistency. Results also indicated that the participants in the control group had significantly lower VPQ-K scores compared to the participants in the study groups, indicating that VPQ-K had good construct validity. Receiver Operating Characteristic (ROC) curve analysis showed a cutoff point of 18.50 for VPQ-K. CONCLUSIONS: As VPQ-K is a quick, easy to fill and low-burden self-assessment tool, VPQ-K can be proposed as a sensitive clinical tool to assess the vocal performance in Kannada-speaking patients with voice disorders and to evaluate the treatment outcome.

Adaptation and Validation of the Voice-Related Quality of Life Measure into Kannada.

BACKGROUND: Earlier researchers have developed various objective tools to document the impact of dysphonia on the patient's daily living and quality of life. Of all these available tools, Voice Related Quality of Life (V-RQOL) is one of the essential self-reported tools to document the quality of life related to voice. Thus, developing the Kannada version of V-RQOL can be a useful tool in the clinical assessment of Kannada-speaking dysphonic patients. OBJECTIVES: To translate the V-RQOL into Kannada and to evaluate the psychometric properties and the cut off scores for the Kannada version of the V-RQOL. STUDY DESIGN: This investigation deployed a non-randomized, prospective standard group comparison. METHODS: V-RQOL was translated to Kannada and was administered to 70 patients with voice disorders (42 males and 28 females) with a mean age of 43.2 ± 15.8 years, and 70 age and gender-matched participants with a clinically normal voice. RESULTS: Spearman's correlation coefficient was more than 0.94 indicating a good test-retest reliability. Therefore, the Kannada version of VRQOL had a good level of reproducibility. The test also showed a Cronbach alpha coefficient of 0.92, indicating a strong internal consistency of the Kannada version of VRQOL. Receiver Operating Characteristic (ROC) curve analysis revealed that the cut off score for the Kannada version of VRQOL was 93.75 indicating that Kannada version of VRQOL had an excellent construct validity. CONCLUSION: The present study findings revealed that the Kannada version of VRQOL is a reliable, valid and sensitive self-assessment tool to document the impact of voice problems on the patient's quality of life.

Multiparameter Voice Assessment in Dysphonics: Correlation Between Objective and Perceptual Parameters.

BACKGROUND: Perceptual assessment and objective measures of voice provide a quantifiable tool for determining the degree of glottal closure, thus helping to distinguish dysphonic voices from normal voices. The correlation between the perceptual and objective parameters of voice in dysphonic can enable the voice pathologist to be more effective in differentiating the normal voices from dysphonic voices. However, only a few studies have investigated the correlation between these measures. OBJECTIVE: To document the differences in the perceptual and objective parameters of voice in participants with dysphonia and normal controls and to investigate the correlation between the perceptual and objective parameters of voice among participants with dysphonia. STUDY DESIGN: This investigation deployed standard group comparison and a retrospective study. METHODS: Two groups of participants were included in the study. Participants in group 1 were diagnosed as having a voice disorder secondary to organic pathologies and group 2 participants had a clinically normal voice. Phonation samples of all the participants were collected and perceptual analysis was carried out using the GRBAS rating scale. As part of the objective measures, acoustic and cepstral measures were extracted from the phonation samples. RESULTS: The analysis of the results revealed significant differences in perceptual ratings between the normal (control) and dysphonic groups. The mean values of all the objective measures of voice presented significant differences between participants of both groups. The perceptual ratings of grade, breathiness, and roughness showed better correlations with the cepstral measures than with the time-based acoustic measures. CONCLUSIONS: Further foraging research on the correlation between perceptual and objective measures of voice in various degrees of dysphonia will improve reliability while discriminating and quantifying hoarse, harsh and breathy voices from modal voices.

Multiparametric analysis of voice following prolonged voice use and voice rest in teachers: evidence from discriminant analysis.

PURPOSE: Even though recent investigations have used multiparametric protocol, the set of robust parameters in determining the effects of vocal fatigue and voice rest in teachers is not clear. The first objective of the study was to document the impact of prolonged voice use and voice rest on the subjective and objective voice parameters among Indian secondary school teachers. The second objective was to determine the set voice parameters sensitive to vocal changes resulting from continuous voice use and voice rest. METHOD: The study included 15 male and 15 female secondary school teachers with a clinically normal voice and no history of voice disorders. Phonation samples were recorded in three different conditions, i.e., condition 1 (before voice use), condition 2 (following voice use), and condition 3 (following voice rest). The vocal Fatigue Index (version 2) was administered before the voice recordings in all three conditions. The objective parameters, namely fundamental frequency, range of fundamental frequency, jitter (%), shimmer (%), harmonic to noise ratio, and smoothened cepstral peak prominence, were extracted. RESULTS: Results revealed that fundamental frequency, jitter, shimmer, Harmonic to noise ratio, and smoothened cepstral peak prominence were significantly different across the three conditions. The discriminant analysis revealed that only three parameters classified 98.3% of samples accurately between the three conditions. CONCLUSION: Further research on the correlation between the other subjective and the objective parameters of voice after vocal fatigue would provide more penetrating and ample in-depth insights into the assessment and quantification of vocal fatigue.

Maternal diabetes and fetal cardiac output.

BACKGROUND: The intrauterine environment is a key determinant for long-term health outcomes. Adverse fetal environments, such as maternal diabetes, obesity and placental insufficiency are strongly associated with long-term health risks in children. Little is known about differences in fetal cardiac output hemodynamics of diabetic mothers (DM) vs. non-diabetic mothers (NDM). Our study aims to investigate the left-sided, right-sided, and combined cardiac output (CCO) in fetuses of DM vs. NDM. METHODS: Retrospective data were collected in fetuses of DM (N = 532) and NDM (103) at mean gestational age 24 weeks. Examination included 2D echo and pulse wave Doppler. Wilcoxon rank sum tests and Chi-square tests were used to test for distribution difference of maternal and fetal continuous and categorical measures respectively between DM and NDM. Intraclass correlation coefficients were calculated to assess intra-observer reliability of fetal cardiac measurements. RESULTS: DM mothers had higher mean weight (89.7±22.2 kg) than NDM (76.8±19.8 kg), p < 0.0001 and higher mean BMI (33.4±7.5) than NDM (28.3±5.8), p < 0.0001. C-section delivery occurred in 66% of DM vs. 35% of NDM fetuses. Fetuses of DM mothers had significantly larger semilunar valve diameter, higher left ventricular (LV) output, higher combined cardiac output and lower right ventricle /left ventricle ratio compared to NDM. CONCLUSION: The greater CCO (adjusted for fetal weight), left sided cardiac output in the fetuses of DM, compared to NDM, represent differences in cardiac adaptation to the diabetic environment.

A functional hiPSC-cortical neuron differentiation and maturation model and its application to neurological disorders.

The maturation and functional characteristics of human induced pluripotent stem cell (hiPSC)-cortical neurons has not been fully documented. This study developed a phenotypic model of hiPSC-derived cortical neurons, characterized their maturation process, and investigated its application for disease modeling with the integration of multi-electrode array (MEA) technology. Immunocytochemistry analysis indicated early-stage neurons (day 21) were simultaneously positive for both excitatory (vesicular glutamate transporter 1 [VGlut1]) and inhibitory (GABA) markers, while late-stage cultures (day 40) expressed solely VGlut1, indicating a purely excitatory phenotype without containing glial cells. This maturation process was further validated utilizing patch clamp and MEA analysis. Particularly, induced long-term potentiation (LTP) successfully persisted for 1 h in day 40 cultures, but only achieved LTP in the presence of the GABAA receptor antagonist picrotoxin in day 21 cultures. This system was also applied to epilepsy modeling utilizing bicuculline and its correction utilizing the anti-epileptic drug valproic acid.

Nosocomial COVID-19: experience from a large acute NHS Trust in South-West London.

Transmission of coronavirus disease 2019 (COVID-19) in healthcare settings has significant implications for patients and healthcare workers, may amplify local outbreaks, and may place additional burden on already stretched resources. Risk of missed or late diagnosis of COVID-19 was high during the UK's initial 'containment phase', because of strict criteria for testing. The risk remains due to asymptomatic/pre-symptomatic transmission, complicated by challenges faced with laboratory testing. We present a case study of potential nosocomial transmission associated with the first case of COVID-19 at a large acute NHS Trust in South-West London, and we describe the prevailing burden of nosocomial infections.

Crystal structures of (E)-4-[1-(2-carbamo-thio-yl-hydrazinyl-idene)eth-yl]phenyl acetate and (E)-4-[1-(2-carbamo-thio-ylhydrazinyl-idene)eth-yl]phenyl benzoate.

In the title compounds, C11H13N3O2S, (I), and C16H15N3O2S, (II), the thio-semicarbazone group adopts an extended conformation. The acetate ester (I) crystallizes with two independent mol-ecules in the asymmetric unit. In the benzoate ester (II), the planes of the two aryl rings are inclined to one another by 46.70 (7)°. In both compounds, there is a short intra-molecular N-H⋯N contact present, forming an S(5) ring motif. In the crystals of both compounds, mol-ecules are linked via pairs of N-H⋯S hydrogen bonds, forming dimers with R22(8) ring motifs. The dimers are linked by N-H⋯S and N-H⋯O hydrogen bonds, forming slabs parallel to (01-1). In (I), there are N-H⋯π and C-H⋯π inter-actions present within the slabs, while in (II), there are only N-H⋯π inter-actions present.

Sense and simplicity in HADDOCK scoring: Lessons from CASP-CAPRI round 1.

Our information-driven docking approach HADDOCK is a consistent top predictor and scorer since the start of its participation in the CAPRI community-wide experiment. This sustained performance is due, in part, to its ability to integrate experimental data and/or bioinformatics information into the modelling process, and also to the overall robustness of the scoring function used to assess and rank the predictions. In the CASP-CAPRI Round 1 scoring experiment we successfully selected acceptable/medium quality models for 18/14 of the 25 targets - a top-ranking performance among all scorers. Considering that for only 20 targets acceptable models were generated by the community, our effective success rate reaches as high as 90% (18/20). This was achieved using the standard HADDOCK scoring function, which, thirteen years after its original publication, still consists of a simple linear combination of intermolecular van der Waals and Coulomb electrostatics energies and an empirically derived desolvation energy term. Despite its simplicity, this scoring function makes sense from a physico-chemical perspective, encoding key aspects of biomolecular recognition. In addition to its success in the scoring experiment, the HADDOCK server takes the first place in the server prediction category, with 16 successful predictions. Much like our scoring protocol, because of the limited time per target, the predictions relied mainly on either an ab initio center-of-mass and symmetry restrained protocol, or on a template-based approach whenever applicable. These results underline the success of our simple but sensible prediction and scoring scheme. Proteins 2017; 85:417-423. © 2016 Wiley Periodicals, Inc.

Adoption of direct oral anticoagulants for stroke prevention in atrial fibrillation.

BACKGROUND: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter. AIMS: To analyse the adoption and application of these drugs in a regional hospital inpatient cohort and compare with national prescribing data. METHODS: Digital medical records identified prescribed anticoagulants for patients admitted with AF and atrial flutter during 2013-2014. Analysis of patient demographics and stroke risk identified trends in prescribing DOAC versus warfarin. For broader comparison, data from the Pharmaceuticals Benefits Scheme were sourced to determine the nation-wide adoption of DOAC. RESULT: Of the 615 patients identified, 505 (255 in 2013, 250 in 2014) had sufficient records to include in the study. From 2013 to 2014, DOAC prescriptions increased from 9 to 28% (P < 0.001), warfarin and aspirin remained comparatively stable (38-34%, 22-20%), and those prescribed no medication declined (17-8%, P < 0.001). DOAC were prescribed to patients with lower CHA2 DS2 VASc scores than warfarin (3.6 vs 4.4; P = 0.005), lower HAS-BLED scores (1.7 vs 2.3; P < 0.01), higher glomerular filtration rates; 70 vs 63 ml/min; P = 0.002) and younger age (74 vs 77 years; P = 0.006). Nationally, warfarin prescriptions are higher in total numbers but increasing at a slower rate than DOAC, which increased 10-fold (101 158 in 2013, 1 095 985 in 2014). CONCLUSION: DOAC prescribing grew rapidly from 2013 to 2014, regionally and nationally. Warfarin prescriptions have remained stable, indicating that more patients are being appropriately anticoagulated for AF who previously were not. DOAC were found to be prescribed to patients with lower CHA2 DS2 VASc and HAS-BLED scores, younger age and higher glomerular filtration rates. Aspirin therapy remains over utilised in AF.

Predicting Productivity Returns on Investment: Thirty Years of Peer Review, Grant Funding, and Publication of Highly Cited Papers at the National Heart, Lung, and Blood Institute.

There are conflicting data about the ability of peer review percentile rankings to predict grant productivity, as measured through publications and citations. To understand the nature of these apparent conflicting findings, we analyzed bibliometric outcomes of 6873 de novo cardiovascular R01 grants funded by the National Heart, Lung, and Blood Institute (NHLBI) between 1980 and 2011. Our outcomes focus on top-10% articles, meaning articles that were cited more often than 90% of other articles on the same topic, of the same type (eg, article, editorial), and published in the same year. The 6873 grants yielded 62 468 articles, of which 13 507 (or 22%) were top-10% articles. There was a modest association between better grant percentile ranking and number of top-10% articles. However, discrimination was poor (area under receiver operating characteristic curve [ROC], 0.52; 95% confidence interval, 0.51-0.53). Furthermore, better percentile ranking was also associated with higher annual and total inflation-adjusted grant budgets. There was no association between grant percentile ranking and grant outcome as assessed by number of top-10% articles per $million spent. Hence, the seemingly conflicting findings on peer review percentile ranking of grants and subsequent productivity largely reflect differing questions and outcomes. Taken together, these findings raise questions about how best National Institutes of Health (NIH) should use peer review assessments to make complex funding decisions.

Citation impact of NHLBI R01 grants funded through the American Recovery and Reinvestment Act as compared to R01 grants funded through a standard payline.

RATIONALE: The American Recovery and Reinvestment Act (ARRA) allowed National Heart, Lung, and Blood Institute to fund R01 grants that fared less well on peer review than those funded by meeting a payline threshold. It is not clear whether the sudden availability of additional funding enabled research of similar or lesser citation impact than already funded work. OBJECTIVE: To compare the citation impact of ARRA-funded de novo National Heart, Lung, and Blood Institute R01 grants with concurrent de novo National Heart, Lung, and Blood Institute R01 grants funded by standard payline mechanisms. METHODS AND RESULTS: We identified de novo (type 1) R01 grants funded by National Heart, Lung, and Blood Institute in fiscal year 2009: these included 458 funded by meeting Institute's published payline and 165 funded only because of ARRA funding. Compared with payline grants, ARRA grants received fewer total funds (median values, $1.03 versus $1.87 million; P<0.001) for a shorter duration (median values including no-cost extensions, 3.0 versus 4.9 years; P<0.001). Through May 2014, the payline R01 grants generated 3895 publications, whereas the ARRA R01 grants generated 996. Using the InCites database from Thomson-Reuters, we calculated a normalized citation impact for each grant by weighting each article for the number of citations it received normalizing for subject, article type, and year of publication. The ARRA R01 grants had a similar normalized citation impact per $1 million spent as the payline grants (median values [interquartile range], 2.15 [0.73-4.68] versus 2.03 [0.75-4.10]; P=0.61). The similar impact of the ARRA grants persisted even after accounting for potential confounders. CONCLUSIONS: Despite shorter durations and lower budgets, ARRA R01 grants had comparable citation outcomes per $million spent to that of contemporaneously funded payline R01 grants.

Borrelia miyamotoi infection in nature and in humans.

Borrelia miyamotoi is a relapsing fever Borrelia group spirochete that is transmitted by the same hard-bodied (ixodid) tick species that transmit the agents of Lyme disease. It was discovered in 1994 in Ixodes persulcatus ticks in Japan. B. miyamotoi species phylogenetically cluster with the relapsing fever group spirochetes, which usually are transmitted by soft-bodied (argasid) ticks or lice. B. miyamotoi infects at least six Ixodes tick species in North America and Eurasia that transmit Lyme disease group spirochetes and may use small rodents and birds as reservoirs. Human cases of B. miyamotoi infection were first reported in 2011 in Russia and subsequently in the United States, Europe and Japan. These reports document the public health importance of B. miyamotoi, as human B. miyamotoi infection appears to be comparable in frequency to babesiosis or human granulocytic anaplasmosis in some areas and may cause severe disease, including meningoencephalitis. The most common clinical manifestations of B. miyamotoi infection are fever, fatigue, headache, chills, myalgia, arthralgia, and nausea. Symptoms of B. miyamotoi infection generally resolve within a week of the start of antibiotic therapy. B. miyamotoi infection should be considered in patients with acute febrile illness who have been exposed to Ixodes ticks in a region where Lyme disease occurs. Because clinical manifestations are nonspecific, etiologic diagnosis requires confirmation by blood smear examination, PCR, antibody assay, in vitro cultivation, and/or isolation by animal inoculation. Antibiotics that have been used effectively include doxycycline for uncomplicated B. miyamotoi infection in adults and ceftriaxone or penicillin G for meningoencephalitis.