Chronic cough in post-COVID syndrome: Laryngeal electromyography findings in vagus nerve neuropathy.

BACKGROUND: Despite being a new entity, there is a large amount of information on the characteristics of SARS-CoV-2 infection and the symptoms of the acute phase; however, there are still many unknowns about the clinical features and pathophysiology of post-COVID syndrome. Refractory chronic cough is one of the most prevalent symptoms and carries both a medical problem and a social stigma. Many recent studies have highlighted the role of SARS-CoV-2 neurotropism, but no studies have demonstrated vagus nerve neuropathy as a cause of persistent chronic cough or other COVID-19 long-term effects. OBJECTIVE: The main objective was to assess the involvement of the vagus nerve neuropathy as a cause of chronic cough and other post-COVID syndrome symptoms. MATERIAL AND METHODS: This was a single-center observational study with prospective clinical data collected from 38 patients with chronic cough and post-COVID-19 syndrome. Clinical characteristics and laryngeal electromyographic findings were analyzed. RESULTS: Clinical data from 38 patients with chronic cough after 12 weeks of the acute phase of COVID-19 infection were analyzed. Of these patients, 81.6% suffered from other post-COVID conditions and, 73.6% reported fluctuating evolution of symptoms. Laryngeal electromyography (LEMG) of the thyroarytenoid (TA) muscles and cricothyroid (CT) muscles was pathological in 76.3% of the patients. Of the patients with abnormal LEMG, chronic denervation was the most frequent finding (82.8%), 10.3% presented acute denervation signs, and 6.9% presented myopathic pattern in LEMG. CONCLUSIONS: LEMG studies suggest the existence of postviral vagus nerve neuropathy after SARS-CoV-2 infection that could explain chronic cough in post-COVID syndrome.

Admission Severity of Atrial-Fibrillation-Related Acute Ischemic Stroke in Patients under Anticoagulation Treatment: A Systematic Review and Meta-Analysis.

Background: In non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission anticoagulants impact the prognosis of AF related AIS (AF-AIS). We sought to analyze the literature to assess the association between pre-admission anticoagulation (VKA or DOAC) and admission severity of AF-AIS. Methods: A Systematic literature search (PubMed and ScienceDirect) between January 2011 to April 2021 was undertaken to identify studies describing the outcome of AF-AIS. Results: A total of 128 articles were identified. Of 9493 patients, 1767 were on DOAC, 919 were on therapeutical VKA, 792 were on non-therapeutical VKA and 6015 were not anticoagulated. In comparison to patients without anticoagulation, patients with therapeutical VKA and under DOAC presented with less severe stroke (MD −1.69; 95% CI [−2.71, −0.66], p = 0.001 and MD −2.96; 95% Cl [−3.75, −2.18], p < 0.00001, respectively). Patients with non-therapeutical VKA presented with more severe stroke (MD 1.28; 95% Cl [0.45, 2.12], p = 0.003). Conclusions: In AF-AIS, patients under therapeutical VKA or DOAC have reduced stroke severity on admission in comparison to patients without any anticoagulation, with higher magnitude of protection for DOAC.

Utility and limitations of metabolic parameters in head and neck cancer: finding a practical segmentation method.

PURPOSE: Although metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have shown good prognostic value in head and neck cancer (HNC), there are still many issues to resolve before their potential application in standard clinical practice. The purpose of this study was to compare the discrimination ability of two relevant segmentation methods in HNC and to evaluate the potential benefit of adding lymph nodes' metabolism (LNM) to the measurements. METHODS: We retrospectively analyzed a recently published database of 62 patients with HNC treated with chemoradiotherapy. MTV and TLG were measured using an absolute threshold of SUV2.5. Comparison analysis with previously published background-level threshold (BLT) results was done through Concordance index (C-index) in eight prognostic models. RESULTS: BLT obtained better C-index values in five out of the eight models. The addition of LNM improved C-index values in six of the prognostic models. CONCLUSION: We found a potential benefit in adding LNM to the main tumor measurements, as well as in using a BLT for MTV segmentation compared to the most commonly used SUV2.5 threshold. Despite its limitations, this study suggests a practical and simple manner to use these parameters in standard clinical practice, aiming to help elaborate a general consensus.

Genome-wide clonal variability in European pear "Rocha" using high-throughput sequencing.

Pears (Pyrus) are one of the most economically important fruits worldwide. The Pyrus genus is characterized by a high degree of genetic variability between species and interspecific hybrids, and several studies have been performed to assess this variability for both cultivated and wild accessions. These studies have mostly been limited by the resolving power of traditional molecular markers, although in the recent past the availability of reference genome sequences or SNP arrays for pear have enhanced the capability of high-resolution genomics studies. These tools can also be applied to better understand the intra-varietal (or clonal) variability in pear. Here we report the first high resolution genomics analysis of a pear clonal population using whole genome sequencing (WGS). Results showed unique signatures for the accumulation of mutations and transposable element insertions in each clone, which are likely related to their history of propagation and cultivation. The nucleotide diversity remained low in the clonal collection with the exception of few genomic windows, suggesting that balancing selection may be occurring. These windows included mainly genes related to plant fertility. Regions with higher mutational load were partially associated with transcription factors, probably reflecting the distinctive phenotypes in the collection. The annotation of variants also revealed the theoretical disruption of relevant genes in pear. Taken together, the results from this study show that pear clones accumulate mutations differently, and that those mutations can play a role on pear phenotypes, meaning that the study of pear clonal populations can be relevant in genetic studies, mainly when comparing with traditional association studies.

Musculoskeletal injuries in Portuguese CrossFit practitioners.

BACKGROUND: CrossFit training is performed at high intensity and with limited or no recovery time between sets, being associated to increased injury risk. That is why this study determined injury epidemiology and risk factors for injury in Portuguese CrossFit practitioners. METHODS: The sample included 270 CrossFit practitioners, aged 15 to 53, being 152 (56.3%) males. The measurement instrument was a questionnaire concerning characterization of the population, and aspects related to the modality and injuries. RESULTS: Sixty-one (22.6%) individuals had an injury in the previous year, with a total of 80 injuries. There were 1.34 injuries per 1,000 hours of CrossFit training. The most common injuries were joint injuries (30.8%), and muscle injuries (23.1%), located in the shoulder (35.9%) and the lumbar spine (17.9%). The CrossFit practitioners who didn´t participate in competitions showed a 2.64 greater probability of having an injury (95% CI: 1.37-5.09; P=0.004) than those who did participate, and the CrossFit practitioners who trained twice or less a week showed a 3.24 greater probability of injury (95% CI: 1.78-5.89; P≤0.001) than those who trained three or more times. CONCLUSIONS: In conclusion, injuries proved to be common among CrossFit practitioners, especially those who train less and/or do not take part in competitions.

Safety of Thrombolysis in a Patient with an Intracranial Dural Arteriovenous Fistula.

Intracranial dural arteriovenous fistula is an abnormal connection between an artery and a vein that has an increased risk of bleeding. This case report presents a 53-year-old man diagnosed with a dural arteriovenous malformation fistula in occipital topography, lacking therapeutic indication because of an extension. He was admitted to an intensive care unit due to a high-risk pulmonary thromboembolism with indication for thrombolysis. Taking into account the hemorrhagic risk associated with arteriovenous malformation, the authors discuss the therapeutic options and the inherent risks. LEARNING POINTS: Intracranial dural arteriovenous fistulas are pathologic shunts between dural arteries and veins that have an inherent risk of intracranial hemorrhage.Systemic thrombolytic agents are a therapeutic option for high-risk pulmonary thromboembolism. Their potential benefits outweigh the risk of life-threatening bleeding; however, careful patient risk stratification should be performed and other options, such as surgical embolectomy or percutaneous catheter-directed treatment, should be considered if available.Multidisciplinarity is the key to better therapeutic decisions and the patient's opinion should always be taken into account.

A Reflection on the Use of Enoxaparin Based on Three Case Reports.

Enoxaparin is indicated for the treatment or prevention of many clinical disorders including deep vein thromboembolism, atrial fibrillation and mechanical valve thrombosis. It is one of the most commonly prescribed drugs in hospitals. However, haemorrhagic complications can occur, particularly in the elderly, patients with renal function impairment and patients with a very high or very low body weight. The authors describe the cases of three patients who had one or more risk factors for haemorrhagic complications, such as abdominal haematomas. The clinical presentation was similar in all three cases, with sudden-onset abdominal pain, an altered state of consciousness and hypotension. In all cases, investigation showed acute anaemia and large abdominal haematomas on imaging studies. A conservative approach was taken in the three patients, with suspension and reversal of anticoagulation, fluid resuscitation and red blood cell transfusion. Haemodynamic stability was achieved in two of the patients, but the third patient died. The authors consider it is important to present these case reports because of the widespread use of enoxaparin, and the need for rigorous dose adjustment for renal function variations and body weight. We hope this article raises awareness of haemorrhagic complications in high-risk groups and propose protocols are introduced for dose adjustment and monitoring the efficacy of enoxaparin. LEARNING POINTS: Clinicians should consider the possibility of enoxaparin-associated haemorrhagic complications in high-risk groups.Prompt identification and treatment of the haemorrhagic disorder can improve outcome.Correct dosing with anti-Xa in high-risk populations, such as the elderly, those with abnormal renal function and those with extremely high or low body weight, may be helpful in patients anticoagulated with enoxaparin.