ABSTRACT
INTRODUCTION: VEXAS (Vacuoles, E1 Enzyme, X-linked, autoinflammatory, Somatic) syndrome is a recently described severe adult-onset autoinflammatory disorder mediated by X-linked gene UBA1 somatic mutations, responsible of recurrent fever, skin involvement, chondritis, macrocytic anemia and inflammatory syndrome. Neurological manifestations are rarely described, and predominantly involve peripheral nervous system (PNS) impairment. RESULTS: We report the first central nervous system (CNS) vasculitis in VEXAS syndrome, characterized by headache, cognitive dysfunction and focal signs (cerebellar ataxia). Magnetic resonance imaging (MRI) revealed multifocal white-matter lesions corresponding to recent ischemic strokes, combined with cortical hemorrhagic lesions and gadolinium enhancement of the distal wall vessels. Treatment with methylprednisone, ruxolitinib and tocilizumab led to clinical improvement and a decrease of the inflammatory syndrome. The patient died few months after due to infectious complications. CONCLUSION: CNS vasculitis, occurring as a manifestation of the systemic auto-inflammatory state of VEXAS syndrome, might be a rare but severe complication. We suggest that it be added to the list of inflammatory vasculopathies. More prospective studies are needed to optimize the treatment.
Subject(s)
Confusion , Confusion/diagnosis , Confusion/etiology , Diagnosis, Differential , Female , HumansABSTRACT
The aim of this study is to investigate the effects of rapid testing and social distancing in controlling the spread of COVID-19, particularly in the city of Jakarta, Indonesia. We formulate a modified susceptible exposed infectious recovered compartmental model considering asymptomatic individuals. Rapid testing is intended to trace the existence of asymptomatic infected individuals among the population. This asymptomatic class is categorized into two subclasses: detected and undetected asymptomatic individuals. Furthermore, the model considers the limitations of medical resources to treat an infected individual in a hospital. The model shows two types of equilibrium point: COVID-19 free and COVID-19 endemic. The COVID-19-free equilibrium point is locally and asymptotically stable if the basic reproduction number ( R 0 ) is less than unity. In contrast, COVID-19-endemic equilibrium always exists when R 0 > 1 . The model can also show a backward bifurcation at R 0 = 1 whenever the treatment saturation parameter, which describes the hospital capacity, is larger than a specific threshold. To justify the model parameters, we use the incidence data from the city of Jakarta, Indonesia. The data pertain to infected individuals who self-isolate in their homes and visit the hospital for further treatment. Our numerical experiments indicate that strict social distancing has the potential to succeed in reducing and delaying the time of an outbreak. However, if the strict social distancing policy is relaxed, a massive rapid-test intervention should be conducted to avoid a large-scale outbreak in the future.
Subject(s)
Nitrous Oxide/poisoning , Paresthesia/chemically induced , Spinal Cord Diseases/chemically induced , Chronic Disease , Humans , Inhalation Exposure/adverse effects , Magnetic Resonance Imaging , Male , Nitrous Oxide/administration & dosage , Paresthesia/diagnosis , Paresthesia/etiology , Recreational Drug Use , Spinal Cord Diseases/diagnosis , Vitamin B 12 Deficiency/chemically induced , Vitamin B 12 Deficiency/diagnosis , Young AdultSubject(s)
Chorioretinitis/etiology , Neisseria gonorrhoeae/isolation & purification , Neurosyphilis/diagnosis , Acute Disease , Adult , Fluorescein Angiography , Gonorrhea/complications , Gonorrhea/diagnosis , Humans , Male , Neisseria gonorrhoeae/genetics , Neurosyphilis/complications , Syphilis Serodiagnosis , Visual AcuityABSTRACT
A study was carried out to determine whether hands-on classroom experience with low-fat foods would increase children's acceptance of those foods in the school's lunch program. The 9-month project took place at an elementary school in upstate New York. Half of the classrooms served as the intervention group and received classroom experience with new foods; the other half served as the control group and received no classroom experience. Consumption measurements of 16 new foods, introduced at approximately 2-week intervals, were taken for all students who ate school lunches. Compared with children in the control group, those in the intervention group ate significantly more of the new foods when they were offered in the lunch program. The study demonstrated that experiential learning about food in the classroom is an effective way to gain acceptance of diverse, low-fat foods in the school lunch program.
