A systematic review of neurological manifestations of SARS-CoV-2 infection: the devil is hidden in the details.

BACKGROUND AND PURPOSE: We systematically reviewed available evidence for reports of neurological signs and symptoms in patients with COVID-19 to identify cases with severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infection or immune-mediated reaction in the nervous system. METHODS: We followed PRISMA guidelines and used the MEDLINE, EMBASE, Google Scholar, MedRxiv and ChinaXiv databases to search for articles on COVID-19 and nervous system involvement that were published from 1 January to 24 April 2020. Data on design, sample size, neurological assessment and related work-up were extracted. Biases were assessed with the Newcastle-Ottawa scale. RESULTS: We analysed 27 publications on potential neuroinvasive or parainfectious neurological complications of COVID-19. The reports focused on smell and taste (n = 5) and evaluation of neurological symptoms and signs in cohorts (n = 5). There were cases of Guillain-Barré syndrome/Miller-Fisher syndrome/cranial neuropathy (seven cases), meningitis/encephalitis (nine cases) and various other conditions (five cases). The number of patients with examination of cerebrospinal fluid and, in particular, SARS-CoV-2 polymerase chain reaction was negligible. Two had a positive SARS-CoV-2 polymerase chain reaction examination of cerebrospinal fluid specimen. Study of potential parenchymal involvement with magnetic resonance imaging was rare. Only four reports received a rating of the highest quality standards. CONCLUSIONS: This systematic review failed to establish comprehensive insights into nervous system manifestations of COVID-19 beyond immune-mediated complications in the aftermath of respiratory symptoms. The authors therefore provide guidance for more careful clinical, diagnostic and epidemiological studies to characterize the manifestations and burden of neurological disease caused by SARS-CoV-2 on behalf of the Infectious Disease Panel of the European Academy of Neurology.

No proinflammatory signature in CD34+ hematopoietic progenitor cells in multiple sclerosis patients.

Autologous hematopoietic stem cell transplantation (aHSCT) has been used as a therapeutic approach in multiple sclerosis (MS). However, it is still unclear if the immune system that emerges from autologous CD34+ hematopoietic progenitor cells (HPC) of MS patients is pre-conditioned to re-develop the proinflammatory phenotype. The objective of this article is to compare the whole genome gene and microRNA expression signature in CD34+ HPC of MS patients and healthy donors (HD). CD34+ HPC were isolated from peripheral blood of eight MS patients and five HD and analyzed by whole genome gene expression and microRNA expression microarray. Among the differentially expressed genes (DEGs) only TNNT1 reached statistical significance (logFC=3.1, p<0.01). The microRNA expression was not significantly different between MS patients and HD. We did not find significant alterations of gene expression or microRNA profiles in CD34+ HPCs of MS patients. Our results support the use of aHSCT for treatment of MS.

[Improper body posture of bus drivers]. / Nepovoljni polozaj tijela vozaca autobusa.

The role of bus transport in the city and intercity traffic, the development of bus transport and the consequences of the driver's unsuitable body position upon health are dealt with. Buses make 0.4-0.5% of the total number of registered motor-driven vehicles. Of the total number of traffic accidents caused by motor vehicle drivers in Croatia those due to bus drivers come to 1.9-2.2%. The bus driver's tasks, working conditions, work environment and other characteristic job related activities are discussed. Special emphasis is given to the driver's unsuitable body posture and to the ergonomic requirements of the driver's seat. Investigations show the unsuitable posture to be cause of health disorders. The most common are diseases of circulation (especially arterial hypertension), locomotor system diseases (back pain syndrome) and psychic disorders.

[Respiratory symptoms and pulmonary ventilating capacity in professional drivers and mechanics]. / Respiratorni simptomi i ventilacijski kapacitet pluca profesionalnih vozaca i mehanicara.

The prevalence of respiratory symptoms and ventilatory capacity were studied in 116 drives and 119 mechanics. The drivers and mechanics demonstrated a significantly higher prevalence of most chronic respiratory symptoms than control workers. Among drivers smokers there was a significantly higher prevalence of most chronic respiratory symptoms than among non-smoking drivers. Drivers and mechanics with more than 10 years of service also showed a higher prevalence of respiratory symptoms than those employed for less than 10 years. A certain number of subjects complained of acute symptoms during work shift. All ventilatory capacity tests, particularly FEF25, demonstrated lower values in comparison to predicted normal values. Our data for drivers and mechanics indicate that long-term employment, particularly in combination with smoking, may cause the development of respiratory symptoms and changes in lung function.

[Specificity of diagnostic procedures in occupational diseases]. / Specificnosti dijagnostickih postupaka kod profesionalnih bolesti.

Characteristics and specificities of diagnostic procedures as a basis of diagnosis of occupational diseases are explained. The aforementioned include working history, clinical, laboratory and functional tests and evaluation of working environment. Examples of practical application of such procedures are listed.

[Occupational medicine worldwide and in Croatia]. / Medicina rada u svijetu i u Hrvatskoj.

The development of occupational medicine, its complexity and international position as well as the actual and anticipated tasks connected with modernisation of industry, workers' health protection and humanization of work is presented. Education in the field of occupational medicine is also evaluated. Eighteen countries: ten in Europe, United States of America, Canada, Brasil and Chile from the area of South America, Israel, Japan, China and Singapore in Asia are included in the review. At the end, the development of occupational health services in Croatia, its present organisation, legislation, education and training, future needs and goals are shortly discussed.

[Approach to treatment of lumbar pain syndromes and criteria of evaluating driving capability in professional drivers of large motor vehicles]. / Pristup lijecenju lumbalnog bolnog sindroma i kriteriji ocjene vozacke sposobnosti profesionalnih vozaca teskih motornih vozila.

In truck drivers the negative effects of long-lasting body posture stress, vibration, muscular effort, changing of weather and climate conditions, monotony of driving, irregular rest, sleep and diet summarize. Our investigations performed on 80 professional truck drivers admitted to the commission demonstrated that in 35.5% back pain was the leading or one of leading diagnoses. The temporary working disability was injustifiable too long--32.5% more than 2 years, and the number of attacks in 70% over 4. The performed treatment was neither complex, nor continuous. 91.3% have lost the driving ability for professional truck driving. 89% of them were classified as able for an adequate job with full time, and 8.2% for part time. Only in 2.8% total permanent working disability was found. We developed following approach to the treatment of back pain in professional truck drivers: In the first attack the treatment should be carefully performed with high professional physiotherapy. In the second attack there should be performed possible improvements of working conditions and regime. In the third attack the disability is imminent, and the driver should be transferred to another adequate job. Such approach in the treatment ensures to truck driver maximal possible working span and profitable business.

[Eye injuries in traffic accident traumatology]. / Ozljede oka u prometnoj traumatologiji.

The authors discuss traffic eye injuries on the basis of their own clinical patients. A total of 334 patients were treated surgically or conservatively. Reviewing the results of the cure, they point out new possibilities and perspectives of treatment.

Study of some immunological parameters in workers occupationally exposed to benzene.

OBJECTIVE: The aim of the study was to investigate the immunotoxicity of benzene exposure, to establish the correlation between the exposure biomarkers and some immunological parameters, and to assess the possible influence of confounding factors on the results of immunological assay applicable in routine medical surveillance of benzene-exposed workers. METHODS: Forty-nine female workers in the shoemaking industry who were exposed to solvent mixtures and 27 nonexposed controls were examined. Workers were exposed to benzene concentrations of up to 15 ppm, and to toluene of up to 50 ppm. RESULTS: Significant differences in the levels of benzene and toluene in blood and phenols in post-shift urine between the exposed and the control group confirmed solvent exposure. The number of B-lymphocytes (P = 0.01) was lower in the shoe workers than in the controls. Significant correlation was found between the level of immunoglobulin G and benzene in the work atmosphere, while confounding factors had no impact on immunological values. CONCLUSION: According to these results, exposure to benzene concentration lower than 15 ppm can induce depression of the circulating B-lymphocyte level and therefore this fact could be used to develop a promising method for health surveillance of benzene-exposed workers. However, considerably more effort in the research on benzene immunotoxicity, especially in the search for suitable health surveillance methods, is still required.