Tremor as a symptom of degenerative cervical myelopathy: a systematic review.

BACKGROUND: AO Spine RECODE-DCM (Research objectives and common data elements for degenerative cervical myelopathy) has highlighted that the subjective disability reported by people living with DCM is much broader than routinely considered today by most professionals. This includes a description of tremor. The objective of this review was to study the incidence and possible aetiology of tremor in degenerative cervical myelopathy (DCM). METHODS: A systematic review registered in PROSPERO (CRD42020176905) was conducted in Embase and MEDLINE for papers studying tremor and DCM published on or before the 20th of July 2020. All manuscripts describing an association between tremor and DCM in humans were included. Articles relating to non-human animals, and those not available in English were excluded. An analysis was conducted in accordance with PRISMA and SWiM guidelines for systematic reviews. RESULTS: Out of a total of 4402 screened abstracts, we identified 7 case reports and series describing tremor in 9 DCM patients. Papers were divided into three groups for the discussion. The first group includes DCM correctly identified on presentation, with tremor as a described symptom. The second group includes cases where DCM was misdiagnosed, often as Parkinson's disease. The third group includes a single case with a previous history of DCM, presenting with an otherwise unexplained tremor. This grouping allows for the clustering of cases supporting various arguments for the association between tremor and DCM. CONCLUSION: DCM can be associated with tremor. The current evidence is restricted to case series. Further study is warranted to establish tremor prevalence, and its significance to assessment and management.

Hypothermia is Associated With Poor Prognosis in Hospitalized Patients With Severe COVID-19 Symptoms.

Rationale Hypothermia forms a part of the diagnostic criteria for Systemic Inflammatory Response Syndrome (SIRS), National Early Warning Score (NEWS) and has repeatedly been shown to be associated with worse outcomes when compared to normothermic and hyperthermic patients with sepsis. We evaluate whether this is the case in COVID-19 patients. Objective To determine whether there is an association between hypothermia and worse prognosis in COVID-19 patients in the intensive care unit. Methods Retrospective study of a cohort of patients (n = 57) admitted to the intensive care unit of a community hospital with a positive test for COVID-19. Measurements Data relating to mortality, comorbidities and length of stay was recorded from electronic medical records for each patient. Hypothermia was defined as ≥2 recorded body temperatures of less than 96.5℉ (35.83℃) at the time of admission. Main results Of the 57 patients enrolled in the study, 21 developed hypothermia during their stay and 36 did not. Our results show that patients who have hypothermia at the time of admission spend a longer time intubated (p < 0.01) and go through longer ICU stays (p < 0.01). These patients are also 2.18 times more likely to suffer a fatal outcome compared to patients that did not develop hypothermia while in the intensive care unit (Chi-squared = 8.6209, p < 0.01, RR = 2.18). Conclusions Hypothermia in patients with severe COVID-19 at the time of admission to the ICU is associated with poorer outcomes for patients. This manifests as a longer period of intubation, longer ICU stay, and increased risk of mortality.

Acute psychosis and serotonin syndrome in the setting of "Triple-C" overdose: a case report.

BACKGROUND: Over-the-counter medication overdose is a difficult diagnostic challenge for many physicians as common drug screening assays cannot detect these substances. We present a case of acute psychosis, serotonin syndrome, and anticholinergic overdose-like properties in the setting of Coricidin HBP Cough & Cold tablets, known by their street name Triple-C. This is the first case report we are aware of involving a patient presenting with these symptoms and requiring critical-care-level support. CASE PRESENTATION: A 31-year-old African American female with a past medical history of anxiety, childhood asthma, previous methamphetamine abuse, and coronavirus disease 2019 infection in August 2020 was brought to the emergency department by the local police department with altered mental status. Initial blood work, including extended drug screens, were unremarkable for a definitive diagnosis. This patient required critical-care-level support and high sedation because of her symptoms. Collateral history revealed the patient regularly consumed Triple-C daily for the 6 weeks prior to admission. A trial off sedation was attempted after 24 hours with no complications. The patient admitted to regular Triple-C consumption and auditory hallucinations since adolescence. She was discharged safely after 48 hours back into the community. She was lost to follow-up with psychiatry and internal medicine; however, she was evaluated in the emergency room 1 month later with a similar psychiatric presentation. CONCLUSION: Overdose of Triple-C should be kept in the differential diagnosis of patients presenting with a triad of psychosis, serotonin syndrome, and anticholinergic overdose, in the setting of unknown substance ingestion.

Neoadjuvant chemotherapy and penile conservation in the management of Buschke - Lowenstein tumor, a case report.

Buschke-Lowenstein tumor is a rare form of low-grade penile cancer. Its low prevalence amongst the population bars the establishment of a standardized treatment algorithm. We present a case of BLT that was managed with neoadjuvant chemotherapy followed by phallic sparing surgery.

Co-Occurrence of Aflatoxin B1 and Ochratoxin A in Lebanese Stored Wheat.

ABSTRACT: The aim of the study was to determine the levels of aflatoxin B1 (AFB1) and ochratoxin A (OTA) in durum wheat samples collected over six periods of time from two official warehouses (A and B) in Lebanon. The concentrations of AFB1 in wheat samples taken from both warehouses ranged from 1.05 to 7.36 µg/kg. Results showed that 23.3 and 25.3% of samples taken from warehouse A and warehouse B, respectively, had AFB1 levels >2 µg/kg. For OTA, the contamination level of wheat samples taken from warehouse A and warehouse B was 52.0 and 44.6%, respectively, with concentrations ranging from 0.51 to 9.71 µg/kg. The percentage of samples with high detectable OTA levels (>3 µg/kg) was 28.6 and 25.3% for wheat samples taken from warehouse A and warehouse B, respectively. Thus, the consumption of wheat and derived products in Lebanon can be considered hazardous and may present a significant risk to the health of the Lebanese population regarding the overall daily exposure to these mycotoxins.

OTA Prevention and Detoxification by Actinobacterial Strains and Activated Carbon Fibers: Preliminary Results.

Ochratoxin A (OTA) is a mycotoxin produced by several species of Aspergillus and Penicillium that contaminate food and feed raw materials. To reduce OTA contamination, we first tested in vitro, actinobacterial strains as potential biocontrol agents and afterward, through a physical decontamination method using activated carbon fibers (ACFs). Actinobacterial strains were screened for their ability to reduce OTA in solid co-culture with A. carbonarius, which is the major OTA-producing species in European vineyards. Four strains showed a high affinity for removing OTA (67%-83%) with no significant effect on fungal growth (<20%). The mechanism of action was first studied by analyzing the expression of OTA cluster genes (acOTApks, acOTAnrps, acOTAhal) by RT-qPCR showing a drastic reduction in all genes (7-15 times). Second, the ability of these strains to degrade OTA was assessed in vitro on ISP2 solid medium supplemented with OTA (100 µg/L). Two strains reduced OTA to undetectable levels. As for the physical method, high adsorption rates were obtained for ACFs at 0.8 g/L with a 50% adsorption of OTA in red wine by AC15 and 52% in grape juice by AC20 within 24 h. These promising methods could be complementarily applied toward reducing OTA contamination in food chains, which promotes food safety and quality.

Antifungal and Antiochratoxigenic Activities of Essential Oils and Total Phenolic Extracts: A Comparative Study.

This study is intended to prevent ochratoxin A (OTA) production by Aspergillus carbonarius S402 using essential oils (EOs) and total phenolic compounds extracted from plants and herbs. The EOs used in this study are the following: bay leaves, cumin, fenugreek, melissa, mint, and sage. As for the phenolic compounds, they were extracted from bay leaves, cumin, fenugreek, melissa, mint, sage, anise, chamomile, fennel, rosemary, and thyme. The experiments were conducted on Synthetic Grape Medium (SGM) medium at 28 °C for 4 days. OTA was extracted from the medium with methanol and quantified using HPLC (High Performance Liquid Chromatography). Results showed that EOs had a greater impact than the total phenolic extracts on the OTA production. Reduction levels ranged between 25% (sage) and 80% (melissa) for the EOs at 5 µL mL-1, and 13% (thyme) and 69% (mint) for the phenolic extracts. Although they did not affect the growth of A. carbonarius, total phenolic extracts and EOs were capable of partially reducing OTA production. Reduction levels depended on the nature of the plants and the concentration of the EOs. Reducing OTA with natural extracts could be a solution to prevent OTA production without altering the fungal growth, thus preserving the natural microbial balance.