Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study.

Post-COVID-19 condition, also known as long COVID-19 syndrome and post-acute sequelae of SARS-CoV-2, encompasses an array of symptoms that persist well beyond the initial phase of the viral infection. These symptoms can range in intensity, from mild and manageable to severe and incapacitating. Due to the evolving nature of the SARS-CoV-2 pandemic, treatment protocols for the illness are in a constant state of evolution. The early stage of long COVID-19 syndrome contributes to a dearth of treatment protocols based on empirical evidence, while the absence of a conclusive pathophysiological understanding further complicates the development of such protocols. Current treatment regimens include homeopathic medicine, specialist system-focused treatments, infusion therapies, hyperbaric oxygenation, antivirals, and polypharmacy. The physiological, psychological, and societal impact of long COVID-19 cannot be approached casually and must govern the intensity with which the healthcare community approaches the treatment of long COVID-19 syndrome. In this 41-patient cohort study from a chronic pain management practice, the use of either unilateral or bilateral stellate ganglion block (SGB) was explored to manage symptoms associated with long COVID-19 syndrome. Results indicated that a substantial proportion of patients (86%) experienced a reduction of their symptoms following SGB treatment.

Diagnostic accuracy of general dermatologists and supportive oncodermatologists for biopsied cutaneous immune-related adverse events.

PURPOSE: Supportive oncodermatology has been shown to improve several aspects of care for patients with cancer, but research showing improved diagnostic accuracy as a benefit of supportive oncodermatology is largely lacking. We thus aimed to evaluate different dermatologist groups' diagnostic accuracy for heterogenous cutaneous toxicities, using cutaneous immune-related adverse events (cirAEs) from immune checkpoint inhibitors (ICIs) as a test model. METHODS: Billing/requisition codes were used to identify patients who initiated programmed death-1/ligand-1 (PD-1/PD-L1) ICIs between 2010 and 2019 at Dana-Farber Cancer Institute/Brigham and Women's Hospital/Massachusetts General Hospital and underwent a subsequent skin biopsy. For each biopsied cirAE, pre-biopsy clinical diagnoses and post-biopsy clinico-pathologic diagnoses were retrospectively obtained from the medical record. Each biopsy-ordering dermatology provider was categorized as a general dermatologist or supportive oncodermatologist on the basis of providing clinical care within a cancer-center or attending on a hospital/clinic service dedicated to anti-cancer drug-related skin toxicities. RESULTS: Of 4,183 patients who initiated anti-PD-1/PD-L1 therapy between 2010 and 2019, 101 (2.4%) patients collectively had 104 biopsied cirAEs. In more than one-third of all reviewed biopsied cirAEs (n = 39, 37.5%), histopathology results frequently led to revision of the pre-biopsy clinical diagnosis. The rate of initial cirAE misclassification amongst supportive oncodermatologists was significantly lower than that amongst general dermatologists (18/66, 27.3% vs. 21/38, 55.3%; Fischer's-exact-test p = 0.006). CONCLUSION: Experienced supportive oncodermatologists may benefit patient care through increased diagnostic accuracy for skin toxicities from ICIs. Collectively, these results underscore that both skin biopsy from any dermatology provider and oncodermatology referral (where available) are valuable resources that should be integrated into supportive cancer care.

Traits and tradeoffs among non-native ectomycorrhizal fungal symbionts affect pine seedling establishment in a Hawaiian coinvasion landscape.

Pine invasions lead to losses of native biodiversity and ecosystem function, but pine invasion success is often linked to coinvading non-native ectomycorrhizal (EM) fungi. How the community composition, traits, and distributions of these fungi vary over the landscape and how this affects pine success is understudied. A greenhouse bioassay experiment was performed to test the effects of changes in EM fungal community structure from a pine plantation, to an invasion front to currently pine-free areas on percent root colonization and seedling biomass. Soils were also analysed by qPCR to determine changes in inoculum and spore density over distance for a common coinvading EM fungus, Suillus pungens. Percent colonization increased with distance from the plantation, which corresponded with an increase in seedling biomass and stark changes in EM fungal community membership where Suillus spp. dominated currently pine-free areas. However, there was a negative relationship between S. pungens inoculum potential versus root colonization over distance. We conclude that the success of pine invasions is facilitated by specific traits of Suillus spp., but that the success of Suillus is contingent on a lack of competition with other ectomycorrhizal fungi.

The relationship between common cognitive screening tests (Standardised Mini-Mental State Examination and Rowland Universal Dementia Assessment Scale) and the Cognitive Functional Independence Measure.

OBJECTIVES: To assess whether the Cognitive Functional Independence Measure (Cog-FIM) is correlated with the Standardised Mini-Mental State Examination (SMMSE) and Rowland Universal Dementia Assessment Scale (RUDAS) and whether there is agreement between the Cog-FIM and these two tests. METHODS: Functional Independence Measure assessments were undertaken on 98 subacute patients. Forty-eight (48) patients were administered the SMMSE, and 50 were administered the RUDAS. Agreement was examined using the Bland-Altman plot. RESULTS: Correlation was observed between the Cog-FIM and both the SMMSE and the RUDAS. The Bland-Altman analysis demonstrated agreement between the Cog-FIM and RUDAS, but not the Cog-FIM and SMMSE. The limits of agreement between the Cog-FIM and RUDAS were -13 to 13. CONCLUSIONS: The Cog-FIM is correlated with the RUDAS, but the agreement is unclear. Despite agreement of the means, the limits of agreement are large, which may suggest a clinically meaningful difference. The study should be repeated with a larger sample size.

Reinfection with new variants of SARS-CoV-2 after natural infection: a prospective observational cohort in 13 care homes in England.

BACKGROUND: Understanding the duration of protection and risk of reinfection after natural infection is crucial to planning COVID-19 vaccination for at-risk groups, including care home residents, particularly with the emergence of more transmissible variants. We report on the duration, neutralising activity, and protection against the alpha variant of previous SARS-CoV-2 infection in care home residents and staff infected more than 6 months previously. METHODS: We did this prospective observational cohort surveillance in 13 care homes in Greater London, England. All staff and residents were included. Staff and residents had regular nose and throat screening for SARS-CoV-2 by RT-PCR according to national guidelines, with ad hoc testing of symptomatic individuals. From January, 2021, antigen lateral flow devices were also used, but positive tests still required RT-PCR confirmation. Staff members took the swab samples for themselves and the residents. The primary outcome was SARS-CoV-2 RT-PCR positive primary infection or reinfection in previously infected individuals, as determined by previous serological testing and screening or diagnostic RT-PCR results. Poisson regression and Cox proportional hazards models were used to estimate protective effectiveness of previous exposure. SARS-CoV-2 spike, nucleoprotein, and neutralising antibodies were assessed at multiple timepoints as part of the longitudinal follow-up. FINDINGS: Between April 10 and Aug 3, 2020, we recruited and tested 1625 individuals (933 staff and 692 residents). 248 participants were lost to follow-up (123 staff and 125 residents) and 1377 participants were included in the follow-up period to Jan 31, 2021 (810 staff and 567 residents). There were 23 reinfections (ten confirmed, eight probable, five possible) in 656 previously infected individuals (366 staff and 290 residents), compared with 165 primary infections in 721 susceptible individuals (444 staff and 277 residents). Those with confirmed reinfections had no or low neutralising antibody concentration before reinfection, with boosting of titres after reinfection. Kinetics of binding and neutralising antibodies were similar in older residents and younger staff. INTERPRETATION: SARS-CoV-2 reinfections were rare in older residents and younger staff. Protection from SARS-CoV-2 was sustained for longer than 9 months, including against the alpha variant. Reinfection was associated with no or low neutralising antibody before reinfection, but significant boosting occurred on reinfection. FUNDING: Public Health England.