Respiratory Syncytial Virus-Associated Neurologic Complications in Children: A Systematic Review and Aggregated Case Series.

OBJECTIVES: To describe the features and frequency of respiratory syncytial virus (RSV)-associated severe acute neurologic disease in children. STUDY DESIGN: We performed a systematic review of the literature to identify reports of severe acute neurologic complications associated with acute RSV infection in children aged <15 years (PROSPERO Registration CRD42019125722). Main outcomes included neurologic, clinical, and demographic features of cases and the frequency of disease. We aggregated available case data from the published literature and from the Australian Acute Childhood Encephalitis (ACE) study. RESULTS: We identified 87 unique studies from 26 countries describing a spectrum of RSV-associated severe acute neurologic syndromes including proven encephalitis, acute encephalopathy, complex seizures, hyponatremic seizures, and immune-mediated disorders. The frequency of RSV infection in acute childhood encephalitis/encephalopathy was 1.2%-6.5%. We aggregated data from 155 individual cases with RSV-associated severe acute neurologic complications; median age was 11.0 months (IQR 2.0-21.5), most were previously healthy (71/104, 68%). Seizure was the most frequently reported neurologic feature (127/150, 85%). RSV was detected in the central nervous system of 12 cases. Most children recovered (81/122, 66%); however, some reports described partial recovery (33/122, 27%) and death (8/122, 7%). CONCLUSIONS: RSV-associated neurologic complications have been widely reported, but there is substantial heterogeneity in the design and quality of existing studies. The findings from our study have implications for the investigation, management, and prevention of RSV-associated neurologic complications. Further, this systematic review can inform the design of future studies aiming to quantify the burden of childhood RSV-associated neurologic disease.

Respiratory syncytial virus subtype circulation and associated disease severity at an Australian paediatric referral hospital, 2014-2018.

AIM: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections in children and the development of vaccines to protect at-risk groups is a global priority. The aim of this study was to describe RSV subtype circulation patterns and associated disease severity to inform on potential impact of an RSV-specific prevention strategy. METHODS: Single-centre retrospective observational study of children aged <16 years with laboratory-confirmed RSV infection from 2014 to 2018 inclusive. We described the features and frequency of all RSV subtype detections. We selected a random sample of RSV-A and RSV-B cases from each year (n = 200), described demographic and clinical features of these cases, and compared indicators of disease severity between subtypes. RESULTS: We identified 3591 RSV detections over a 5-year period and found consistent co-circulation of subtypes with alternating predominance. Demographic and clinical characteristics were similar between children presenting with RSV-A and RSV-B infections. There was no difference in indicators of severity between the subtypes except for paediatric intensive care unit length of stay which was longer in the RSV-B group (3 vs. 5 days, P = 0.006). Respiratory co-infections were more frequent in the RSV-B group (41.8% vs. 27.4%, P = 0.035). When these were excluded there was no longer a detectable difference in paediatric intensive care unit length of stay. CONCLUSIONS: We found co-circulation of RSV subtypes and no convincing evidence of a difference in disease severity between subtypes. RSV-specific interventions will need to be equally effective against both RSV-A and RSV-B to have the greatest impact on reducing severe RSV disease in this population.

Macroprolactinemia revisited: a study on 106 patients.

The predominance of high molecular weight PRL, or macroprolactinemia, has long been known in hyperprolactinemic patients with maintained fertility. Among 1,106 consecutive patients investigated for hyperprolactinemia in our center over a 10-yr period, serum PRL chromatography was performed in 368 cases because of discordant clinical, biological, or neuroradiological findings. We prospectively studied the 106 patients with macroprolactinemia (96 women, 6 men, 4 children) and compared them with the 262 hyperprolactinemic patients with a normal PRL elution pattern. We concluded the following: 1) the incidence of macroprolactinemia in our hyperprolactinemic population was at least 10%; 2) despite preserved fertility with uneventful pregnancies, some of the usual symptoms of hyperprolactinemia were present; 3) mean PRL values were 61 +/- 66 microg/liter (range, 20-663) and exceeded 100 microg/liter in 8.5% of patients; 4) PRL levels usually remained stable over time; 5) on dopaminergic therapy, PRL returned to normal in 21 of 45 treated patients; 6) during follow-up of 7 pregnancies, PRL increased to supraphysiological levels in 5; and 7) pituitary magnetic resonance imaging was normal in 78% of patients or revealed diverse pituitary lesions, including adenomas (n = 5). A diagnostic method for macroprolactinemia should be available to all centers to avoid unnecessary hormonal or radiological investigations and treatments.

Avaliação de propriedades físico-químicas, tempo de endurecimento e drenagem de um cimento endodôntico adicionado ao MTA em diferentes proporções / Evaluation of physico-chemical properties, time of hardening and draining of an endodontic sealer added to mta in different proportions

Objetivo: o objetivo desta pesquisa foi avaliar o tempo e o fluxo de endurecimento do cimento AH-PLUS e MTA nas proporções de 10%, 20% e 30%, a fim de adicionar a capacidade de estimular a deposição de tecido duro. Material e Métodos: Para o teste de fluxo, 0,5 ml de cimento foram depositados em uma placa de vidro e outra placa foi adicionada com uma carga adicional, após 10 minutos a carga foi removida e o diâmetro do círculo formado pelo cimento foi medido com um Bússola digital. Para o tempo de endurecimento, foram utilizados moldes cilíndricos preenchidos com o cimento testado, mantidos dentro de um forno e os testes de agulha de Gillmore foram realizados no material em intervalos de 60 segundos até que as marcas não fossem visíveis na superfície do cimento testado. Resultados: Na vazão, os valores obtidos foram: 41,1 mm (10% MTA), 32,86 mm (20% MTA), 21,91 mm (30% MTA), 24,41 mm AHPlus® e 26,47 mm MTA Fillapex®. O tempo de endurecimento encontrado nesta pesquisa foi de 1631 'em proporção (10% MTA), 628,4 em proporção (20% MTA), 567' em proporção (30% MTA), 767 em AH Plus e Fillapex MTA não. presou dentro de 6 semanas. Conclusão: concluiu-se que a adição de 10%, 20% e 30% de MTA ao AH Plus não alterou as propriedades do fluxo e o tempo estabelecido

Objective: evaluate the hardening time and flow of AH-PLUS and MTA cement in the proportions of 10%, 20% and 30% in order to add the ability to stimulate the deposition of hard tissue. Material and Methods: For the flow test, 0.5 ml of cement was deposited on a glass plate and another plate was added with an additional charge, after 10 minutes the charge was removed and the diameter of the circle formed by the cement was measured with a digital compass. For the hardening time, cylindrical molds filled with the tested cement were used, kept inside a kiln and Gillmore needle tests were performed on the material at 60 second intervals until the marks were not visible on the surface of the tested cement. Results: In the flow rate, the values obtained were: 41.1mm (10% MTA), 32.86mm (20% MTA), 21.91mm (30% MTA), 24.41mm AHPlus® and 26.47mm MTA Fillapex®. The hardening time found in this survey was 1631 'in proportion (10% MTA), 628.4 in proportion (20% MTA), 567' in proportion (30% MTA), 767 in AH Plus and Fillapex MTA did not. took prey within 6 weeks. Conclusion: it was concluded that the addition of 10%, 20% and 30% of MTA to AH Plus did not change the flow properties and the established time