Neurological disease in the time of COVID-19. A case series

Introduction: we present a series of patients with neurological problems and SARS-CoV-2 infection, and review the respective evidence. Patients and methods: a retrospective descriptive study of consecutive RT-PCR SARS-CoV-2-positive patients in a neurology department from August 1 to December 31, 2020. Results: we recorded 30 patients: 16 men (53%), with a mean age of 65±17.3. In 53%, the neu rological problem preceded the respiratory symptoms and SARS-CoV-2 infection diagnosis. At the syndromic level, the following were found: CVAs 43% (13), seizures 10% (3), posterior reversible encephalopathy 10% (3), encephalopathy 7% (2), brief psychotic disorder 7% (2), myelopathy 3% (1), Guillain-Barré syndrome 3% (1), headache 3% (1), vasculitis 3% (1), intracerebral hemorrhage 3% (1), myasthenic crisis 3% (1) and recurrent optic neuritis 3% (1). Conclusions: SARS-CoV-2 induced neurological problems produce a wide variety of symptoms and may be the first manifestation, even without the development of respiratory symptoms from this infection. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2233).

Introducción: se presenta una serie de pacientes con compromiso neurológico e infección por SARS-CoV-2 y se revisa la evidencia al respecto. Pacientes y métodos: estudio descriptivo, retrospectivo de pacientes consecutivos RT-PCR positivos para SARS-CoV-2 del servicio de neurología desde el 1° de agosto hasta 31 de diciembre de 2020. Resultados: registramos 30 pacientes, 16 hombres (53%), edad media: 65±17.3. En el 53% el compromiso neurológico antecedió los síntomas respiratorios y el diagnóstico de infección por SARS-CoV-2. A nivel sindromático se observó: ACV 43% (13), crisis convulsivas 10% (3), encefalopatía posterior reversible 10% (3), encefalopatía 7% (2), trastorno psicótico breve 7% (2), mielopatía 3% (1), síndrome de Guillain-Barré 3% (1), cefalea 3% (1), vasculitis 3% (1), hemorragia intracerebral 3% (1), crisis miasténica 3% (1) y neuritis óptica recurrente 3% (1). Conclusiones: el compromiso neurológico por el SARS-CoV-2 produce una gran variedad de síntomas y puede ser la primera manifestación incluso sin el desarrollo de síntomas respiratorios por esta infección. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2233).

Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study.

BACKGROUND: During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. RESEARCH QUESTION: Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? STUDY DESIGN AND METHODS: This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). RESULTS: Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. INTERPRETATION: Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability.

Design and Manufacturing of a Disposable, Cyclo-Olefin Copolymer, Microfluidic Device for a Biosensor †.

This contribution outlines the design and manufacturing of a microfluidic device implemented as a biosensor for retrieval and detection of bacteria RNA. The device is fully made of Cyclo-Olefin Copolymer (COC), which features low auto-fluorescence, biocompatibility and manufacturability by hot-embossing. The RNA retrieval was carried on after bacteria heat-lysis by an on-chip micro-heater, whose function was characterized at different working parameters. Carbon resistive temperature sensors were tested, characterized and printed on the biochip sealing film to monitor the heating process. Off-chip and on-chip processed RNA were hybridized with capture probes on the reaction chamber surface and identification was achieved by detection of fluorescence tags. The application of the mentioned techniques and materials proved to allow the development of low-cost, disposable albeit multi-functional microfluidic system, performing heating, temperature sensing and chemical reaction processes in the same device. By proving its effectiveness, this device contributes a reference to show the integration potential of fully thermoplastic devices in biosensor systems.

Linfoma cerebral de células B como complicación postrasplante cardiaco: reporte de caso / B-Cell Lynphoma as Cardiac Post-Transplant Complication: A Case Report

RESUMEN El trasplante se constituye en una alternativa de vida para pacientes con falla terminal de un órgano. Este tipo de tratamiento viene en aumento y para el caso de la falla cardiaca refractaria mejoran no sólo la expectativa de vida, sino la calidad de vida. Sin embargo cerca del 20% de las complicaciones observadas en estos pacientes, constituyen a complicaciones que afectan al sistema nervioso central, algunas relacionadas con el tratamiento inmunosupresor, como es el caso de las neuroinfecciones y las neoplasias. Se presenta y analiza el caso de una paciente quien posterior a un trasplante cardiaco, presenta una neoplasia del sistema nervioso central, en quién por patología de hace un diagnóstico post-morten de Linfoma de células B.

SUMMARY Transplantation is a life alternative for patients with organ terminal failure. This type of treatment is on the rise and in the case of refractory heart failure improves not only the life expectancy, too the quality of life. However, about 20% of the complications observed in these patients constitute complications that affect the central nervous system, some related to immunosuppressive treatment, such as infections and tumors. We present and analyze the case of a patient who, after a heart transplant, has central nervous system tumors, in whom by post-mortem diagnosis of B-cell lymphoma.

Hidrocefalia y aracnoiditis en neurocisticercosis / Hydrocephalus and arachnoiditis in neurocysticercosis

La neurocisticercosis es una enfermedad con alta prevalencia en países tropicales y de bajos recursos, sin embargo su incidencia ha aumentado en países desarrollados. Este es el caso de una mujer de 49 años con neurocisticercosis subaracnoidea generalizada asociada a compromiso encefálico y medular, una presentación rara de este parásito neurotrópico,con convulsiones y limitación motora severa. Las imágenes muestran respuesta inflamatoria generalizada del cerebro y el espacio subaracnoideo, hidrocefalia y múltiples lesiones calcificadas, reafirmando la importancia de las neuroimágenes para la correlación clínica y el diagnóstico de las enfermedades infecciosas cerebrales como la neurocisticercosis, con variabilidad en la presentación y múltiples compromisos del sistema nervioso central.

Neurocysticercosis is a disease of high prevalence in tropical and low-income countries and its incidence has been increased in developed countries. This is the case of 49-year-old woman with generalized subarachnoid neurocysticercosis associated to encephalic and medullar compromise, a rare presentation of this neurotropic parasite, with seizures and severe motor limitation. Images showed generalized inflammatory response of the brain and spinal subarachnoid space, hydrocephalus and multiple calcified lesions, demonstrating and reaffirming the importance of neuroimaging tools for the clinical correlation and diagnosis of brain infectious diseases as neurocysticercosis with variability on the presentation and multiple central nervous system involvement.

Normal transcription of the C1 inhibitor gene is dependent upon a polypurine-polypyrimidine region within the promoter.

Analysis of the transcriptional activity of C1 inhibitor (CIINH) promoter reporter constructs with mutations in the R-Y region indicate that triplex formation by this region is not a predictor of transcriptional activity and that normal promoter function depends on the interaction of trans acting factors with specific elements within this region. Electrophoretic mobility shift assay (EMSA) of Hep3B nuclear extracts using the wild type promoter probe (nucleotides -98 to -9) yielded four major bands. Incubation of the same extracts with probes lacking the HNF-1 site resulted in the disappearance of one band. Supershift assays indicate that HNF-1alpha is the only previously identified protein that is present in the EMSA bands. Southwestern blot analysis detected four bands (M(r)s -130, 75, 65 and 20 kDa). These data suggest that the -98 to -9 region of the C1INH promoter interacts with at least four proteins, one of which is HNF-1alpha.

Selección y adaptación de audifonos / Selection and fitting of hearing aids

Presentamos la forma de trabajo de nuestro equipo en la selección y adaptación de audífonos. Comenzamos hace 6 años usando la computadora Rastronics CCI-10/3, habiendo efectuado hasta el momento cerca de 2500 exámenes en más de 1000 pacientes estudiados