Long-lasting brain fog is related with severity clusters of symptoms in COVID-19 patients

BACKGROUND: COVID-19 patients may experience Long-lasting symptoms from weeks to even months. AIM: To evaluate long-term cognitive impairment based on the severity of symptoms of COVID-19 infection in a primary health system setting. Material and Methods: From a database of 363 patients, 83 cases aged 47 ± 15 years, (58% females) were selected from June to August 2020. In patients who survived the virus, 24 infection-related symptoms were collected to create three severity clusters (mild, moderate, and severe). The follow-up time was at least seven months. Comparing the first two clusters with the severe cluster, the existence of brain fog and risk factors (obesity, hypertension, diabetes, chronic lung disease, and hypothyroidism) were analyzed. RESULTS: Thirty-one patients (37%) had persistent symptoms lasting up to 240 days. Fifty-one patients (61%) experienced brain fog. Concentration was affected by symptom severity (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.26-10.46, p = 0.02). Short- or long-term memory loss was not affected. Moreover, symptom severity was related to brain fog (OR 3.16, 95% CI 1.05-9.51, p = 0.04). Patients with persistent symptoms had a concentration impairment associated with severity patterns (OR 24.3, 95% CI 1.73-340.11, p = 0.03). Conclusions: Brain fog is associated with symptom severity in COVID-19 survivors and lasts for more than eight months.

ANTECEDENTES: Los pacientes que han tenido COVID-19 pueden experimentar síntomas persistentes que duran semanas a meses. OBJETIVO: Evaluar el deterioro cognitivo a largo plazo en función de la severidad de los síntomas de la infección por COVID-19, en un escenario de sistema primario de salud. Material y Métodos: De una base de datos de 363 pacientes se seleccionaron 83 casos de 47 ± 15 años (58% mujeres), de junio-agosto de 2020. Se recopilaron 24 síntomas relacionados con la infección, creando tres grupos (leve, moderado y severo), en pacientes que padecieron y sobreviven al virus. El tiempo de seguimiento fue de al menos siete meses. La existencia de niebla cerebral y de factores de riesgo (obesidad, hipertensión, diabetes, enfermedad pulmonar crónica e hipotiroidismo) se comparó los dos grupos de severidad más bajos con el nivel superior. RESULTADOS: Treinta y un pacientes (37%) tuvieron síntomas prolongados con una duración de hasta 240 días. Cincuenta y un pacientes (61%) mostraron niebla cerebral. El deterioro de la concentración fue afectado por la severidad (Razón de riesgo (RR) = 3,63, Intervalos de confianza (IC) 95%: 1,26-10,46, p = 0,02). La pérdida de memoria a corto o largo plazo no fue afectada. El grupo con mayor severidad se asoció a niebla cerebral (RR = 3,16, IC95%: 1,05-9,51, p = 0,04). Los portadores de síntomas prolongados tuvieron una alteración de la concentración asociado a severidad (RR: 3,16, IC95%: 1,05-9,51, p= 0,04). Conclusiones: La niebla cerebral está relacionada con la severidad de los síntomas en supervivientes de COVID-19 permaneciendo por más de ocho meses.

Long-lasting brain fog is related with severity clusters of symptoms in COVID-19 patients.

BACKGROUND: COVID-19 patients may experience Long-lasting symptoms from weeks to even months. AIM: To evaluate long-term cognitive impairment based on the severity of symptoms of COVID-19 infection in a primary health system setting. MATERIAL AND METHODS: From a database of 363 patients, 83 cases aged 47 ± 15 years, (58% females) were selected from June to August 2020. In patients who survived the virus, 24 infection-related symptoms were collected to create three severity clusters (mild, moderate, and severe). The follow-up time was at least seven months. Comparing the first two clusters with the severe cluster, the existence of brain fog and risk factors (obesity, hypertension, diabetes, chronic lung disease, and hypothyroidism) were analyzed. RESULTS: Thirty-one patients (37%) had persistent symptoms lasting up to 240 days. Fifty-one patients (61%) experienced brain fog. Concentration was affected by symptom severity (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.26-10.46, p = 0.02). Short- or long-term memory loss was not affected. Moreover, symptom severity was related to brain fog (OR 3.16, 95% CI 1.05-9.51, p = 0.04). Patients with persistent symptoms had a concentration impairment associated with severity patterns (OR 24.3, 95% CI 1.73-340.11, p = 0.03). CONCLUSIONS: Brain fog is associated with symptom severity in COVID-19 survivors and lasts for more than eight months.

Six hundred years of South American tree rings reveal an increase in severe hydroclimatic events since mid-20th century.

South American (SA) societies are highly vulnerable to droughts and pluvials, but lack of long-term climate observations severely limits our understanding of the global processes driving climatic variability in the region. The number and quality of SA climate-sensitive tree ring chronologies have significantly increased in recent decades, now providing a robust network of 286 records for characterizing hydroclimate variability since 1400 CE. We combine this network with a self-calibrated Palmer Drought Severity Index (scPDSI) dataset to derive the South American Drought Atlas (SADA) over the continent south of 12°S. The gridded annual reconstruction of austral summer scPDSI is the most spatially complete estimate of SA hydroclimate to date, and well matches past historical dry/wet events. Relating the SADA to the Australia-New Zealand Drought Atlas, sea surface temperatures and atmospheric pressure fields, we determine that the El Niño-Southern Oscillation (ENSO) and the Southern Annular Mode (SAM) are strongly associated with spatially extended droughts and pluvials over the SADA domain during the past several centuries. SADA also exhibits more extended severe droughts and extreme pluvials since the mid-20th century. Extensive droughts are consistent with the observed 20th-century trend toward positive SAM anomalies concomitant with the weakening of midlatitude Westerlies, while low-level moisture transport intensified by global warming has favored extreme rainfall across the subtropics. The SADA thus provides a long-term context for observed hydroclimatic changes and for 21st-century Intergovernmental Panel on Climate Change (IPCC) projections that suggest SA will experience more frequent/severe droughts and rainfall events as a consequence of increasing greenhouse gas emissions.

Resilience, sleep quality and morningness as mediators of vulnerability to depression in medical students with sleep pattern alterations.

The medical career is considered highly stressful, especially during internships when academic and clinical demands, combined with changes in sleep patterns, increase students' likelihood to develop depression. Resilience, which is considered as opposite vulnerability to stress and, along with another protective factor, namely morningness, may cause a student to be less reactive to stimuli and, therefore, less prone to depression. The objective of this study was to evaluate the role of resilience and morningness facing to sleep quality and main risk factors, on the development of depression symptoms in a group of students with sleep pattern alterations. To this end, an observational and longitudinal study was performed with 30 undergraduate interns, with an average age of 22.63 years (SE ± 0.13), 33% men and 67% women. A survey was conducted in three different times during the year of internship: at the beginning (T1), in the middle (T2) and the end (T3). The instruments were the Brief Resilience Scale, Composite Scale of Morningness, Pittsburgh Sleep Quality Index and Patient Health Questionnaire. The path analysis examined the roles of morningness, sleep quality and resilience as potential mediators between family history of depression and depression symptoms at different times. The results showed that resilience had a protective effect on depression symptoms at T2 (ß = -0.18, p < 0.05) and with greater power at T3 (ß = -0.41, p < 0.05), as did morningness, although less strongly, on the symptoms at T3 (ß = -0.13, p < 0.05). A relationship between these two mediating variables was also observed (ß = 0.30, p < 0.05). The initial sleep quality had an effect on the increase of depression symptoms at T1 (ß = 0.61, p < 0.05) and T3 (ß = 0.21, p < 0.05), while family history of depression had a direct effect on the measures of depression at T2 (ß = 0.49, p < 0.05) and T3 (ß = 0.19, p < 0.05). Aside from personal risk factors, it is possible to conclude that the levels of resilience, morningness and sleep quality manifested by students at the beginning of their internship may explain the decrease in depression symptoms at the end of the course.

Validation of a predictive index of neoplasia in unexplained weight loss / Validación de un índice predictivo de neoplasia en pérdida de peso inexplicada

Background: Involuntary weight loss (IWL) is associated with a bad prognosis. A causal diagnosis is difficult and the priority is to identify those patients at risk of a serious underlying disease, such as malignant neoplasia. Objective: External validation of a prognostic index of neoplasia in patients with IWL. Methods: Patients referred for IWL from 2005 to 2014 to the Department of Internal Medicine, of a specialty care hospital in Mexico City were studied. Al of them underwent an evaluation consisting of medical history, physical examination and basic laboratory studies, those patients without an apparent cause of IWL, were included. A probability of neoplasia according to Hernández prognostic index was calculated. Complementary diagnostic studies were performed until a causal diagnosis was reached, or the cases were classified as "unknown cause", if the etiology was not possible to find after one year of follow-up. A binarian logistic model was constructed with five variables age, leucocyte count, albumin, lactic dehydrogenase and alkaline phosphatase levels, and a prediction rule was developed. Results: 130 Patients were included and 45 of them (30%) had a neoplastic cause of IWL. The prediction rule according to Hernández criteria, correctly classified 65% of the patients (sensitivity 29%, Specificity 85%, positive predictive value 50% and negative predictive value 69%). When the original index was modified in two categories (high and low probability), it showed a sensitivity of 84.4% and a negative predictive value of 85.7%. Conclusion: The Hernández index has a limited value as a screening tool.

Introducción: la pérdida involuntaria de peso es un factor de mal pronóstico. Su diagnóstico causal es difícil y es prioritario identificar los casos que tienen una enfermedad grave subyacente. Objetivo: validar un índice pronóstico de neoplasia en pacientes con pérdida involuntaria de peso. Métodos: pacientes referidos por pérdida involuntaria de peso de 2005 a 2014, fueron evaluados mediante historia clínica y exámenes básicos de laboratorio; en el estudio fueron incluidos los pacientes sin causa aparente después de la evaluación. Se calculó la probabilidad de neoplasia, según el índice de Hernández. Se realizaron estudios complementarios hasta identificar una causa o fueron clasificados como "causa desconocida", si no se encontró la etiología después de un año de seguimiento. Se construyó un modelo de regresión logística binaria con las variables edad, cifras de leucocitos, albúmina, deshidrogenasa láctica y fosfatasa alcalina; con la ecuación resultante se predijo neoplasia como causa de pérdida involuntaria de peso. Resultados: se incluyeron 130 pacientes, 45 tuvieron causa neoplásica (30%). La ecuación de predicción clasificó correctamente a 65% de los sujetos analizados (especificidad 85%, sensibilidad 29%, valor predictivo positivo 50%, valor predictivo negativo 69%). Al modificarse el índice original en dos categorías (probabilidad alta y baja), mostró una sensibilidad del 84.4% y un valor predictivo negativo del 85.7%. Conclusión: el índice tuvo baja sensibilidad, lo que limita su uso como prueba de tamizaje.

Surgical treatment of transmigration of mandibular canine

Introduction: The occurrence of canine impaction is not a rare phenomenon, but transmigration of the tooth across the midline is a less common event. The finding is normally asymptomatic and the etiologic factors involved in the transmigration process are still unclear. Objective: To present a clinical case of surgical treatment of a transmigrated mandibular canine. Case report: A 17-year-old male patient presented to the dental clinic to remove an unerupted canine. Clinical and radiological examinations led to the diagnosis of a transmigrated canine in the mental region. Surgical removal was the treatment of choice and further radiographs were needed to complement the clinical exam and to determine the location of the tooth precisely for the surgical procedure. Postoperative period was uneventful. Canine transmigration is a rare finding and symptoms are usually absent. Conclusion: An early detection is important to plan the treatment and mainly to avoid future complications.

Efeito antimicrobiano do cianoacrilato em bactérias bucais / Antimicrobial effect of cyanoclylate in oral bacteria

Objetivo: O objetivo deste estudo foi avaliar as propriedades antimicrobianas do etil-cianoacrilato (Super Bonder®).Materiais e métodos: O método utilizado foi o de Difusão em meio sólido – orifício em agar contra S.aureus, S. mutans, S. oralis, S. epidermidis, E. faecalis, E.coli and B. subtilis. A ação bacteriostática foi observada através da medi-ção dos halos de inibição e a bactericida através do repique.Resultados: Todos os microrganismos foram inibidos na presence do Super Bonder®, apresentando halos que variaram de 2 a 12 mm. Porém, todos apresentaram crescimento após o repique, o que significa que o Super Bonder® é apenas bacteriostático.Conclusão: foi concluído que o Super Bonder® (Loctite) apresenta propriedades antimicrobianas na inibição do crescimento por contato

Objective: The aim of this study was to evaluate antimicrobial properties of ethyl-cyanoacrylate (Super Bonder®).Materials and methods: The method used was Diffusion in Solid Mean - Orifice in Agar against S.aureus, S. mutans, S. oralis, S. epidermidis, E. faecalis, E.coli and B. subtilis. The bacteriostatic action was observed through the measurement of inhibition halos and the bactericidal one for rebound piece of halo of each nutrient.Results: All microorganisms had been inhibited in the presence of Super Bonder®, presenting halos that had varied of 2 to 12 mm. However, all the microorganisms had presented growth after rebound, what it means that the Super Bonder® is only bacteriostatic.Conclusion: It was concluded that the Super Bonder® (Loctite) presents antimicrobial properties that inhibit the bacterial growth for contact

Avaliação dos testes empregados para detecção de perfurações em luvas cirúrgicas / Evaluation of the tests used for detection of perforations in surgical gloves

A integridade das luvas cirúrgicas durante procedimentos de Cirurgia Bucal pode sofrer avarias. Dentro desse contexto, a reutilização das mesmas, seja para procedimentos invasivos ou não invasivos, prática ainda usada em alguns setores de saúde, que alegam ganho financeiro devido a poucos recursos disponíveis, é um risco desnecessário para o profissional e para o paciente. Assim, esse estudo teve como objetivo avaliar a eficiênciados testes de inspeção visual, auditiva e tátil, bem como variações dessas técnicas, empregados na detecçãode perfurações em luvas cirúrgicas. Quarenta pares de luvas cirúrgicas receberam perfurações com diferentesmateriais pérfuro-cortantes e foram submetidos a diferentes testes para avaliar a eficiência dos mesmos na detecção das perfurações. Os resultados mostram que os testes comumente utilizados para verificação de perfurações em luvas cirúrgicas, não são capazes de detectar todas as perfurações. Os achados demonstramque está totalmente contra-indicada a reutilização de luvas, sendo um risco desnecessário para o profissional e o paciente.

The integrity of the surgical gloves during procedures of Oral Surgery can suffer damages. Inside of this context, reuse of same for invasive or not invasive procedures, practice used in some health sectors who makeuse of it justify such practice through financial benefits an unnecessary risk both to the professional and the patient.Thus, this study aimed to evaluate the effectiveness of the visual, auditory and tactile, as well as variations of these techniques, inspection tests used in thedetection of perforations in surgical gloves. Forty pairs of surgical gloves have holes with different perforationsmaterials and were subjected to various tests to assess the efficiency of them in detection of holes. The results show that the tests commonly used about to verification of perforations in surgical gloves, are not capable of detectingall the perforations. The finds demonstrate that is fully not indicated the reuse of gloves, being an unnecessary risk about to the professional and the patient.

Avaliação da prevalência de trismo em pacientes submetidos à exodontia de terceiros molares / Evaluation of the prevalence of trismus in patients submitted to third molar surgery

Objetivos: Avaliar o grau de abertura bucal pós-operatória e fatores que possam influenciá-la, em pacientes submetidos à remoção de terceiros molares inferiores e superiores no ambulatório de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Federal de Santa Maria, Rio Grande do Sul, Brasil. Método: Foram examinados pacientes submetidos à exodontia de terceiros molares inferiores e superiores no ambulatório de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Federal de Santa Maria. A abertura bucal dos pacientes foi medida em milímetros minutos antes, dois e sete dias após a exodontia, com o uso de uma régua. Resultados: O trismo é uma ocorrência freqüente nas cirurgias de terceiros molares inclusos, ocorrendo em 56,5% dos pacientes no período de dois dias após a cirurgia, havendo uma redução na reavaliação após sete dias. Conclusão: Conclui-se que o trismo é uma ocorrência freqüente nas cirurgias de terceiros molares inclusos e que não foram encontradas relação significante entre o trauma da cirurgia e a presença de trismo.

[Fulminant meningitis caused by Streptococcus pneumoniae. Report of three cases]. / Meningitis fulminante por Streptococcus pneumoniae. A propósito de tres casos.

The prevalence of Streptococcus pneumoniae (S. pneumoniae) resistant to penicillin is an increasing problem with variable prevalence across the world. In Mexico, some reports inform prevalence as high as 50% of the isolations. S. penumoniae is a germ that produces a wide variety of diseases, although the most serious infections are in respiratory tract and meningitis. Most patients with the infection caused by this microorganism have a good response to the treatment. The cases with bad prognosis and those which are eventually lethal are related to host factors and microbiologic characteristics such as resistance to beta-lactam antibiotics. The aim of this paper is to inform on three cases of fulminant meningitis due to S. pneumoniae resistant to penicillin, which presented neurological focalization, acute loss of consciousness, coma, and death within the first week, in spite of treatment with cephalosporin of third and fourth generation. In all these cases, S. pneumoniae was isolated from cerebrospinal fluid. The presence of similar cases should alert the clinician to consider an early diagnosis of penicillin resistant meningitis in order to establish an appropriate antibiotic therapy, and consequently, modify the prognosis of the patients.

O efeito do uso de mochila na cinemática da marcha de crianças / The effect of backpack use in childrens gait kinematics

Este estudo teve como objetivo verificar diferenças cinemáticas na marcha de crianças com e sem o uso da mochila. Foi analisada a marcha de 4 crianças, todas com 9 anos de idade, com e sem o uso de mochila, utilizando-se de equipamentos de análise biomecânica. Opercentual de carga da mochila utilizada pelos sujeitos do estudo foi controlado e foram analisados os parâmetros de tempo dos passos, a velocidade da marcha e a variação angular do joelho. Os resultados mostraram não haver diferenças estatisticamente significativas do uso de mochila no parâmetros de marcha avaliados da população desse estudo. Pode-se concluir que os resultados do presente estudo sugerem que a recomendação de que a massa das mochilas não ultrapasse o valor de 10% da massa corporal para crianças estudantes do ensino fundmental, parece confirmar-se como verdadeiro, pois não acarretou, de maneira geral, alterações significativas nos padrões cinemáticos testados neste estudo.

[Gastroesophageal reflux disease in pediatric patients with asthma]. / Enfermedad por reflujo gastroesofágico en pacientes pediátricos con asma.

BACKGROUND: Nowadays, the gastroesophageal reflux is a predisposing factor for the development of asthmatic attacks. OBJECTIVE: To determine the prevalence of gastroesophageal reflux in pediatric patients with asthma of the Service of Allergy and Immunology at the Hospital Regional Lic. Adolfo López Mateos. MATERIAL AND METHODS: It was made an observational study from July 2000 to July 2001. Gastroesophageal gammagraphic and endoscopy (with taking of esophageal biopsy) were carried out to each of the patients in order to find out if there was gastroesophageal reflux. RESULTS: 112 patients with moderate persistent asthma (54 women and 58 men) were included and divided in three different age groups (group I, from 1 to 5 years old; group II, from 6 to 10 and III, from 11 to 16 years old). The prevalence of gastroesophageal reflux was 138, 100 and 93, respectively, being specially high in males. Differences in the prevalence among different groups were statistically significant between group I and II (p < 0.001) and between I and III (p < 0.001). Significant changes were not observed between group II and III (p = NS). CONCLUSIONS: The prevalence of gastroesophageal reflux the structured was high, situation directly related with the diagnostic suspicion in our asthmatic population.

[New prospects for the treatment of systemic lupus erythematosus]. / Nuevas perspectivas de tratamiento del lupus eritematoso sistémico.

The systemic lupus erythematosus is a significant therapeutic challenge: Multiorgan involvement and a variable disease course, characterized by clinical exacerbations and remissions, make difficult to predict the outcome. Few products have been specifically developed for this affection, and most accepted therapies have not been tested in randomized controlled trials of systemic lupus erythematosus. A variety of biological agents under investigation as potential treatments for systemic lupus erythematosus are designed to interfere with specific immunologic responses, hopefully avoiding generalized immunosuppression. Agents, which interfere with T cell-B cell collaboration, such as CTLA-4-Ig and anti-CD154 ligand monoclonal antibodies, may result in long-term therapeutic benefit. Products designed to decrease production of anti-dsDNA antibodies or inhibit complement activation, may prevent immune complex deposition and ameliorate organ-specific manifestations, such as renal disease. More aggressive interventions include gene therapy and stem cell transplantation.

Sinquisis centelleante: presentación en cámara anterior / Synchysis scintillans: presentation in the anterior chamber

La sinquisis centellante es una entidad de aparición poco frecuente y escasamente informada en la literatura. En este estudio revisamos los casos de dos pacientes con antecedentes de traumatismo ocular, pérdida posterior de la visión y aparición súbita de cristales refringentes en cámara anterior años después del traumatismo. El diagnóstico de sinquisis fue confirmado por ecografía y examen citoquímico en ambos, además de examen histopatológico en uno de ellos posterior a la evisceración. Debe realizarse diagnóstico diferencial con hialosis asteroidea

La ciclocrioterapia en el manejo del glaucoma / The cyclocryotherapy in the treatment of glaucoma

Se realizó una revisión sobre el efecto de la ciclocrioterapia en 24 casos de glaucoma en fases avanzadas. Las tensiones intraoculares bajaron en forma estadísticamente significativa, las agudezas visuales, por el contrario, continuaron deteriorándose, llegando en muchos casos a la no percepción de la luz, en cuanto al dolor desaparació en un gran porcentaje de casos después de la operación.