Delayed onset Bickerstaff brainstem encephalitis overlapping Miller-Fisher Syndrome during SARS-CoV-2 infection.

Bickerstaff brainstem encephalitis (BBE) is a neuroimmunologic disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance, mostly subsequent to an infection. BBE is considered to be a variant of Miller-Fisher syndrome (MFS), which also exhibits external ophthalmoplegia and ataxia but not presenting consciousness alterations. Therefore, these two medical conditions are included in the clinical spectrum of the "Fisher-Bickerstaff syndrome" ( Shahrizaila and Yuki in J Neurol Neurosurg Psychiatry 84(5):576-583) [1]. With regard to the etiopathogenesis, increasing evidence worldwide suggests that SARS-CoV-2 infection-enhanced immune response is involved in a wide range of neurological complications such as Guillain-Barré syndrome (GBS), MFS, acute necrotizing encephalitis (ANE), myelitis, acute disseminated encephalomyelitis (ADEM), and, although very rarely, BBE either (Hosseini et al. in Rev Neurosci 32:671-691) [2]. We report a case of a patient affected by delayed onset BBE overlapping MFS during a mild SARS-CoV-2 infection. To the best of our knowledge, similar cases have never been reported.

Evaluating the effects of polices on nursing care as promoted by the Veneto region: the research protocol and its implications for public health.

Study design: Multi-centre mixed-method study design organised into several phases. Background: The Veneto region has recently defined a set of policies on nursing care by determining the needed amount of daily care in minutes and by initiating a systematic measurement of nursing outcomes; also, with a more recent policy, missed nursing care (MNC) has been established as a process measure of interest. To measure the effect of these policies, a research protocol - aimed at evaluating several end points - has been designed, involving a large target population and hospital units. The aim of this manuscript is to briefly present the research protocol and to discuss the public health implications of its expected end-points. Methods: The endpoints of the protocol are: (a) to describe the frequency of MNC as perceived by nurses; (b) to identify contributing factors; (c) to identify practices adopted in low-occurrence MNC units and to assess the effectiveness of implementing them in units with higher levels of MNC; (d) to explore the relationship between the amount of nursing care provided, MNC, and patient outcomes; and (e) to validate a tool that measures MNC as perceived by patients/caregivers. A total of 3,460 nurses, 5,000 patient/day and 160 nursing coordinators of the medical and surgical units of public hospitals in the Veneto Region will be included. Conclusions: Measuring the association between the amount of nursing care and patient outcomes, as well as evaluating the role of MNC as perceived by nurses and patients in hindering or increasing the risk of some patient outcomes can provide a body of evidence capable of further informing policies in the field, both at the national and at the international level. Moreover, emerging good practices capable of preventing or minimising MNC, sharing and implementing them in other units where high levels of missed care are reported and evaluating their effectiveness, can also inform public health policies.

Antimycobacterial and PknB Inhibitory Activities of Venezuelan Medicinal Plants.

Global control and elimination of tuberculosis are hindered by the high prevalence of drug-resistant strains, making the development of new drugs to fight tuberculosis a public health priority. In this study, we evaluated 118 extracts from 58 Venezuelan plant species for their ability to inhibit the growth of Mycobacterium tuberculosis mc26020, using the agar dilution method. Additionally, we determined the ability of these extracts to inhibit the activity of PknB protein, an essential M. tuberculosis serine/threonine kinase, using a high-throughput luminescent assay. Of the 118 extracts tested, 14 inhibited bacterial growth with a minimum inhibitory concentration ≤500 µg/ml, and 36 inhibited the kinase activity with a half-maximal inhibitory concentration <200 µg/ml. Five extracts inhibited M. tuberculosis growth and inhibited the activity of the kinase protein, suggesting that this could be the basis of their growth inhibition.

Management of pedodontic patients in moderate sedation in clinical dentistry: evaluation of behaviour before and after treatment.

The aim of this study is to evaluate the success of functional rehabilitation of one dental session in patients with severe disabilities such as severe autism, baby bottle syndrome and severe odontophobia, and to assess how patient compliance pre- and post-intervention changes in moderate sedation. Between the beginning of 2016 and the end of 2018, 20 pedodontic patients with severe odontophobia, severe autism and baby bottle syndrome who needed dental treatment came to our attention. Patients were aged between 3 and 12 years, including 9 males and 11 females, including 10 odontophobics, 6 with severe autism and 4 with baby bottle syndrome. During the first visit, these patients were evaluated with a rating scale to evaluate the need to carry out dental intervention in a moderate sedation regime. We were able to treat 18 of the 20 patients, and carried out a total of 45 extractions, 4 oral hygiene sessions, 60 dental caries, 29 root canal treatments and 13 sealing pits and fissures. Before and after treatment, each patient's mood was assessed by using a test. Control visits were performed after 30 days, 3 months and the last one after 6 months. After the last follow-up visit, the patient was asked to complete the assessment test of his mood so that it could be compared with the one completed before the intervention. Complete functional and aesthetic rehabilitation of the patient's oral cavity was carried out in a single session. Emotional state and patient compliance improved one year after surgery in about 67% of patients, especially in children with odontophobia. Children with severe autism showed less collaboration in post-intervention assessment. The approach with moderate sedation was effective for the elimination of pain and for the treatment of preventive care, also improving the compliance and the mood of young patients.

Perfect secrecy cryptography via mixing of chaotic waves in irreversible time-varying silicon chips.

Protecting confidential data is a major worldwide challenge. Classical cryptography is fast and scalable, but is broken by quantum algorithms. Quantum cryptography is unclonable, but requires quantum installations that are more expensive, slower, and less scalable than classical optical networks. Here we show a perfect secrecy cryptography in classical optical channels. The system exploits correlated chaotic wavepackets, which are mixed in inexpensive and CMOS compatible silicon chips. The chips can generate 0.1 Tbit of different keys for every mm of length of the input channel, and require the transmission of an amount of data that can be as small as 1/1000 of the message's length. We discuss the security of this protocol for an attacker with unlimited technological power, and who can access the system copying any of its part, including the chips. The second law of thermodynamics and the exponential sensitivity of chaos unconditionally protect this scheme against any possible attack.

Nonlinear optical memory effect.

Light propagating through random media produces characteristic speckle patterns, directly related to the large multitude of scattering events. These complex dynamics remarkably display robustness to perturbation of the incoming light parameters, maintaining correlation in the scattered wavefront. This behavior is known as the optical memory effect. Here we unveil the properties of the nonlinear optical memory effect, which occurs when an optothermal nonlinearity perturbs the random material. The effect is characterized through a series of pump and probe experiments in silica aerogel, in the visible range. This additional degree of freedom further generalizes the memory effect, opening the road to applications based on the nonlinear response of random media.

Chromatin immunoprecipitation and high throughput sequencing of SVCV-infected zebrafish reveals novel epigenetic histone methylation patterns involved in antiviral immune response.

Chromatin immunoprecipitation (ChIP) and high throughput sequencing (ChIP-seq) have been used to assess histone methylation (epigenetic modification) dynamics within the internal organs of zebrafish after spring viremia of carp virus (SVCV) infection. Our results show H3K4me3 up-methylation in gene promoters associated with innate immune response during the first 5 days after SVCV infection. Gene Ontology (GO) enrichment analysis confirmed up-methylation in 218 genes in the "immune system process" category. In particular, the promoters of interferon (ifn), interferon stimulated genes (isg), Toll-like receptors (tlr) and c-reactive protein (crp) multi gene sets were marked with the permissive H3K4 methylation. Higher histone 3 methylation was associated with higher transcription levels of the corresponding genes. Therefore, the evidence presented here suggests that transcriptional regulation at the promoter level of key immune genes of the interferon signaling pathway and c-reactive proteins genes can be modulated by epigenetic modification of histones. This study emphasizes the importance of epigenetic control in the response of zebrafish to SVCV infection.

Persistence and Lifelong Fidelity of Phase Singularities in Optical Random Waves.

Phase singularities are locations where light is twisted like a corkscrew, with positive or negative topological charge depending on the twisting direction. Among the multitude of singularities arising in random wave fields, some can be found at the same location, but only when they exhibit opposite topological charge, which results in their mutual annihilation. New pairs can be created as well. With near-field experiments supported by theory and numerical simulations, we study the persistence and pairing statistics of phase singularities in random optical fields as a function of the excitation wavelength. We demonstrate how such entities can encrypt fundamental properties of the random fields in which they arise.

The effect of sazetidine-A and other nicotinic ligands on nicotine controlled goal-tracking in female and male rats.

Nicotine is the primary addictive component of tobacco products and its complex stimulus effects are readily discriminated by human and non-human animals. Previous research with rodents directly investigating the nature of the nicotine stimulus has been limited to males. The current study began to address this significant gap in the literature by training female and male rats to discriminate 0.4 mg/kg nicotine from saline in the discriminated goal-tracking task. In this task, access to sucrose was intermittently available on nicotine session. On interspersed saline session, sucrose was not available. Both sexes acquired the discrimination as evidenced by increased head entries into sucrose receptacle (goal-tracking) evoked by nicotine; the nicotine generalization curves were also similar between females and males. The pharmacological profile of the nicotine stimulus was assessed using substitution and targeted combination tests with the following ligands: sazetidine-A, PHA-543613, PNU-120596, bupropion, nornicotine, and cytisine. For females and males, nornicotine fully substituted for the nicotine stimulus, whereas sazetidine-A, bupropion, and cytisine all evoked partial substitution. Female and male rats responded in a similar manner to interaction tests where a combination of 1 mg/kg of sazetidine-A plus nicotine or nornicotine shifted the nicotine dose-effect curve to the left. The combination of sazetidine-A plus bupropion or cytisine failed to do so. These findings begin to fill a significant gap the in scientific literature by studying the nature of the nicotine stimulus and response to therapeutically interesting combinations using a model that includes both sexes.

Selective recognition and imaging of bacterial model membranes over mammalian ones by using cationic conjugated polyelectrolytes.

The development of new tools for the detection and fluorescence imaging of bacteria is of great interest in clinical diagnosis and food and environmental safety. In this work, we have explored the ability of two cationic fluorene-based conjugated polyelectrolytes, HTMA-PFP and HTMA-PFNT, emitting in the blue and red spectral regions respectively, to selectively label bacterial over mammalian cells. With this end in view, vesicles with lipid compositions mimicking those of bacterial or mammalian membranes were used as model membranes to explore the interaction of the polyelectrolytes with both systems in samples containing either a single type of vesicle or a mixture of both. Changes in the intrinsic fluorescence of HTMA-PFP and HTMA-PFNT were used to quantify the affinity of these polyelectrolytes for the model lipid membranes, while quenching experiments were employed to evaluate their selectivity to each lipid system. In addition, fluorescence microscopy experiments were performed to check the ability of polyelectrolytes to label the vesicles without affecting their integrity. Results showed that both polyelectrolytes rapidly label the model vesicles but they preferentially bind to those mimicking bacterial membranes, HTMA-PFNT being much more selective to this type of membranes than HTMA-PFP. Preliminary experiments with living bacteria and mammalian cells support this conclusion, showing that in samples with both types of cells together, HTMA-PFNT only images the bacterial cells, thus evidencing its potential use for the selective recognition and imaging of bacterial presence.

Spatial Distribution of Phase Singularities in Optical Random Vector Waves.

Phase singularities are dislocations widely studied in optical fields as well as in other areas of physics. With experiment and theory we show that the vectorial nature of light affects the spatial distribution of phase singularities in random light fields. While in scalar random waves phase singularities exhibit spatial distributions reminiscent of particles in isotropic liquids, in vector fields their distribution for the different vector components becomes anisotropic due to the direct relation between propagation and field direction. By incorporating this relation in the theory for scalar fields by Berry and Dennis [Proc. R. Soc. A 456, 2059 (2000)], we quantitatively describe our experiments.

Optically induced metal-to-dielectric transition in Epsilon-Near-Zero metamaterials.

Epsilon-Near-Zero materials exhibit a transition in the real part of the dielectric permittivity from positive to negative value as a function of wavelength. Here we study metal-dielectric layered metamaterials in the homogenised regime (each layer has strongly subwavelength thickness) with zero real part of the permittivity in the near-infrared region. By optically pumping the metamaterial we experimentally show that close to the Epsilon-Near-Zero (ENZ) wavelength the permittivity exhibits a marked transition from metallic (negative permittivity) to dielectric (positive permittivity) as a function of the optical power. Remarkably, this transition is linear as a function of pump power and occurs on time scales of the order of the 100 fs pump pulse that need not be tuned to a specific wavelength. The linearity of the permittivity increase allows us to express the response of the metamaterial in terms of a standard third order optical nonlinearity: this shows a clear inversion of the roles of the real and imaginary parts in crossing the ENZ wavelength, further supporting an optically induced change in the physical behaviour of the metamaterial.

Enhanced Nonlinear Refractive Index in ε-Near-Zero Materials.

New propagation regimes for light arise from the ability to tune the dielectric permittivity to extremely low values. Here, we demonstrate a universal approach based on the low linear permittivity values attained in the ε-near-zero (ENZ) regime for enhancing the nonlinear refractive index, which enables remarkable light-induced changes of the material properties. Experiments performed on Al-doped ZnO (AZO) thin films show a sixfold increase of the Kerr nonlinear refractive index (n_{2}) at the ENZ wavelength, located in the 1300 nm region. This in turn leads to ultrafast light-induced refractive index changes of the order of unity, thus representing a new paradigm for nonlinear optics.

Migraine with aura: which patients are most at risk of stroke?

The complex association between migraine (M) and ischemic stroke (IS) is discussed. Epidemiological studies and meta-analyses show that M with aura (MA) and not M without aura, doubles the risk of IS. The risk is higher for female gender, young age and higher headache attacks frequency. Smoking habit and oral contraceptives, especially if associated, increase stroke risk. The underlying pathogenetic mechanisms are not completely understood, but it is hypothesized that a particular brain susceptibility to cortical spread depression could explain the association between MA and IS. The absolute risk of IS in migraineurs is relatively low and an antithrombotic primary prevention is not indicated, but it is mandatory to investigate and treat associated risk factors for IS and, in young MA women, consider only progestinic oral contraceptives, if needed, and smoking cessation.

Global health care use by patients with type-2 diabetes: Does the type of comorbidity matter?

AIM: To identify patterns of health care use among diabetic patients with multimorbidity across primary, specialised, hospital and emergency care, depending on their type of chronic comorbidity. METHODS: Longitudinal study of a population-based retrospective cohort conformed by adult patients with type-2 diabetes assigned to any of the primary care centres in Aragon during 2010 and 2011 (n=65,716). Negative binomial regressions were run to model the effect of the type of comorbidity on the number of visits to each level of care. Comorbidities were classified as concordant, discordant or mental based on expert consensus and depending on whether they shared the same overall pathophysiologic risk profile and disease management plan designed for type-2 diabetes. RESULTS: Mental comorbidity was independently associated with total and unplanned admissions (incidence rate ratio [IRR]:1.25; 95% confidence interval [CI]:1.12-1.39, IRR:1.21; 95% CI:1.06-1.39), average length of stay (IRR:1.47; 95% CI:1.25-1.73), and total and priority emergency room visits (IRR:1.26; 95% CI:1.17-1.35, IRR:1.30; 95% CI:1.18-1.42). Patients with discordant comorbidities showed the strongest associations with the number of visits to specialists (IRR:1.38; 95% CI:1.33-1.43) and to different specialties (IRR:1.36; 95% CI:1.32-1.39). Differences regarding GP visits were lower but still significant for patients with discordant comorbidity (IRR:1.08; 95% CI:1.06-1.11), but especially for those with mental comorbidity (IRR:1.17; 95% CI:1.14-1.21). CONCLUSION: In patients with type-2 diabetes, the coexistence of mental comorbidity significantly increases the use of unplanned hospital services, and discordant comorbidities have an important effect on specialised care use. Differences with respect to primary care use are not as prominent.

Atopic dermatitis guideline. Position paper from the Latin American Society of Allergy, Asthma and Immunology.

As in other regions, the incidence of atopic dermatitis in Latin America has been increasing in recent years. Although there are several clinical guidelines, many of their recommendations cannot be universal since they depend on the characteristics of each region. Thus, we decided to create a consensus guideline on atopic dermatitis applicable in Latin America and other tropical regions, taking into account socio-economic, geographical, cultural and health care system characteristics. The Latin American Society of Allergy Asthma and Immunology (SLAAI) conducted a systematic search for articles related to the pathophysiology, diagnosis and treatment of dermatitis using various electronic resources such as Google, Pubmed, EMBASE (Ovid) and Cochrane data base. We have also looked for all published articles in Latin America on the subject using LILACS (Latin American and Caribbean Literature on Health Sciences) database. Each section was reviewed by at least two members of the committee, and the final version was subsequently approved by all of them, using the Delphi methodology for consensus building. Afterward, the final document was shared for external evaluation with physicians, specialists (allergists, dermatologists and pediatricians), patients and academic institutions such as universities and scientific societies related to the topic. All recommendations made by these groups were taken into account for the final drafting of the document. There are few original studies conducted in Latin America about dermatitis; however, we were able to create a practical guideline for Latin America taking into account the particularities of the region. Moreover, the integral management was highlighted including many of the recommendations from different participants in the health care of this disease (patients, families, primary care physicians and specialists). This practical guide presents a concise approach to the diagnosis and management of atopic dermatitis that can be helpful for medical staff, patients and their families in Latin America.

La incidencia de dermatitis atópica en Latinoamérica muestra un incremento constante, si bien existen muchas guías clínicas de dermatitis atópica, muchas de las recomendaciones no pueden ser válidas de manera universal debido a las particularidades de cada región. Por ello, nos propusimos crear una guía de consenso de dermatitis atópica válida para Latinoamérica y otras regiones tropicales, que tome en cuenta las características socioeconómicas, geográficas, culturales y de los sistemas de salud. La Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI) realizó una búsqueda sistemática de artículos relacionados con la fisiopatología, el diagnóstico y el tratamiento de la dermatitis atópica usando diversas fuentes electrónicas, como Google, Pubmed, EMBASE (Ovid) y Cochrane. También realizamos una búsqueda extensa de las publicaciones realizadas en Latinoamérica utilizando el buscador LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud). Cada sección fue revisada por al menos dos miembros del comité y luego una versión final fue aprobada por todos los participantes, utilizando la metodología Delphi para la construcción de consensos. Finalmente, el documento final fue compartido para la evaluación externa por médicos, otros especialistas (alergólogos, dermatólogos, pediatras), pacientes e instituciones académicas, como universidades y sociedades científicas relacionadas con el tema. Todas las recomendaciones dadas por estos grupos se tomaron en cuenta y se incluyeron en la versión final del documento. Existen pocos estudios realizados en Latinoamérica acerca de dermatitis; sin embargo, fue posible crear una guía que considera las particularidades de la región tropical. Además, destacó el tratamiento integral porque se consideraron muchas de las recomendaciones ofrecidas por los diferentes participantes en el tratamiento de esta enfermedad (pacientes, familiares, médicos de atención primaria, especialistas). atópica, muchas de las recomendaciones no pueden ser válidas de manera universal debido a las particularidades de cada región. Por ello, nos propusimos crear una guía de consenso de dermatitis atópica válida para Latinoamérica y otras regiones tropicales, que tome en cuenta las características socioeconómicas, geográficas, culturales y de los sistemas de salud. La Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI) realizó una búsqueda sistemática de artículos relacionados con la fisiopatología, el diagnóstico y el tratamiento de la dermatitis atópica usando diversas fuentes electrónicas, como Google, Pubmed, EMBASE (Ovid) y Cochrane. También realizamos una búsqueda extensa de las publicaciones realizadas en Latinoamérica utilizando el buscador LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud). Cada sección fue revisada por al menos dos miembros del comité y luego una versión final fue aprobada por todos los participantes, utilizando la metodología Delphi para la construcción de consensos. Finalmente, el documento final fue compartido para la evaluación externa por médicos, otros especialistas (alergólogos, dermatólogos, pediatras), pacientes e instituciones académicas, como universidades y sociedades científicas relacionadas con el tema. Todas las recomendaciones dadas por estos grupos se tomaron en cuenta y se incluyeron en la versión final del documento. Existen pocos estudios realizados en Latinoamérica acerca de dermatitis; sin embargo, fue posible crear una guía que considera las particularidades de la región tropical. Además, destacó el tratamiento integral porque se consideraron muchas de las recomendaciones ofrecidas por los diferentes participantes en el tratamiento de esta enfermedad (pacientes, familiares, médicos de atención primaria, especialistas).

Optical shock waves in silica aerogel.

Silica aerogels are materials well suited for high power nonlinear optical applications. In such regime, the non-trivial thermal properties may give rise to the generation of optical shock waves, which are also affected by the structural disorder due to the porous solid-state gel. Here we report on an experimental investigation in terms of beam waist and input power, and identify various regimes of the generation of wave-breaking phenomena in silica aerogels.

Developmental alterations in locomotor and anxiety-like behavior as a function of D1 and D2 mRNA expression.

The majority of smokers start smoking in adolescence, beginning a potentially lifelong struggle with nicotine use and abuse. In rodent models of the effects of nicotine, the drug has been shown to elicit both locomotor and anxiety-like behavioral effects. Research suggests that these behavioral effects may be due in part to dopamine (DA) receptors D1 and D2 in the mesolimbic system, specifically the nucleus accumbens (NAc). We examined early adolescent (P28), late adolescent (P45), and adult (P80) male Long-Evans rats in the elevated plus maze (EPM) under normal conditions and the open field (OF) post-nicotine in order to test locomotor and anxiety-like behavior. These behavioral findings were then correlated with expression of DA D1 and D2 mRNA levels as determined via in situ hybridization. Nicotine-induced locomotor behavior was found to be significantly different between age groups. After a single injection of nicotine, early adolescents exhibited increases in locomotor behavior, whereas both late adolescents and adults responded with decreases in locomotor behavior. In addition, it was found that among, early adolescents, open arm and center time in the EPM were negatively correlated with D2 mRNA expression. In contrast, among adults, distance traveled in the center and center time in the OF were negatively correlated with D2 mRNA expression. This study suggests that DA D2 receptors play a role in anxiety-like behavior and that the relationship between observed anxiety-like behaviors and D2 receptor expression changes through the lifespan.

Work stress and negative affectivity: a multi-method study.

BACKGROUND: In the literature negative affectivity (NA) is considered both a confounding variable as well as a predictive variable for work-related stress. However, a common limitation in this line of research relates to the use of self-report measures for determining NA, perceived stressors and psychophysical strain. AIMS: To test, using a multi-method study, a theoretical model that correlates NA, perceived interpersonal conflict (with co-workers and supervisors), psychophysical strain and medically certified sickness absences. METHODS: A multi-method prospective study was carried out on a sample of metalworkers. NA and interpersonal conflict were determined using self-report (Time 1), whereas psychophysical strain was determined by an occupational physician (Time 2). Data on medically certified sickness absences were collected from the company's database (Time 3). RESULTS: There were 326 participants. The results showed an association between NA and conflict with co-workers, as well as between NA and conflict with supervisors. Psychophysical strain could be predicted from NA and conflict with co-workers but not from conflict with supervisors. NA had a significant indirect effect on psychophysical strain through conflict with co-workers. Lastly, psychophysical strain predicted sickness absences from work. CONCLUSIONS: NA influenced psychophysical strain in the worker, both directly and indirectly, through perceived conflict with co-workers.