Size-Dependent High-Pressure Behavior of Pure and Eu3+-Doped Y2O3 Nanoparticles: Insights from Experimental and Theoretical Investigations.

We report a joint high-pressure experimental and theoretical study of the structural, vibrational, and photoluminescent properties of pure and Eu3+-doped cubic Y2O3 nanoparticles with two very different average particle sizes. We compare the results of synchrotron X-ray diffraction, Raman scattering, and photoluminescence measurements in nanoparticles with ab initio density-functional simulations in bulk material with the aim to understand the influence of the average particle size on the properties of pure and doped Y2O3 nanoparticles under compression. We observe that the high-pressure phase behavior of Y2O3 nanoparticles depends on the average particle size, but in a different way to that previously reported. Nanoparticles with an average particle size of ~37 nm show the same pressure-induced phase transition sequence on upstroke and downstroke as the bulk sample; however, nanoparticles with an average particle size of ~6 nm undergo an irreversible pressure-induced amorphization above 16 GPa that is completed above 24 GPa. On downstroke, 6 nm nanoparticles likely consist of an amorphous phase.

A Study on the Correlations Between Comorbid Disease Conditions and Central and Peripheral Neurological Manifestations of COVID-19.

Background Medical comorbidities and neurological manifestations are commonly associated with COVID-19, though specific relationships remain unclear. Objective The aim of this study is to investigate the relationship between medical comorbidities and neurological manifestations in patients with COVID-19. Methods We reviewed medical comorbidities and COVID-19-related central nervous system (CNS) and peripheral nervous system (PNS) manifestations in 484 consecutive patients with COVID-19. Results Neurological manifestations were seen in 345 (71%) of 484 COVID-19 patients. CNS manifestations included headaches (22%), altered mental status (19%), dizziness (8%), gait imbalance (5%), strokes (four patients, <1%), and seizures (two patients, <1%). PNS manifestations included myalgia (31%), hypogeusia (8%), hyposmia (6%), critical illness myopathy (nine patients, 2%), visual disturbance (six patients, 1%), rhabdomyolysis (four patients, <1%), and nerve pain (one patient, <1%). There were 153 (32%) patients with CNS manifestations, 98 (20%) patients with PNS manifestations, and 94 (19%) patients with combined CNS and PNS manifestations. Comorbidities such as cardiac disease (22%), dementia (17%), hypertension (16%), and chronic obstructive pulmonary disease (COPD; 13%) were significantly associated with CNS manifestations. No comorbidities were associated with PNS manifestations. Conclusion Neurological manifestations were common in our sample of 484 COVID-19 patients, with headache and altered mental status being the most common CNS manifestations and myalgia being the most common PNS manifestation. Cardiac disease, dementia, hypertension, and COPD were more common in patients with CNS manifestations. Providers should be vigilant about the possible emergence of CNS manifestations in COVID-19 patients with these comorbid conditions.

A Novel Trial of Mirabegron and Behavioral Modification Including Pelvic Floor Exercise for Overactive Bladder in Parkinson's Disease (MAESTRO).

Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's disease. Treatment of overactive bladder in these patients has included antimuscarinic anticholinergics, raising concerns about the possibility of exacerbating cognitive impairment or constipation. Mirabegron (Myrbetriq), a ß3-receptor agonist, provides relief of OAB without increasing cognitive impairment. While prior studies have examined the effect of mirabegron on OAB in a variety of patient populations, this study is the first controlled, prospective study investigating the effect of mirabegron on overactive bladder in patients with Parkinson's disease. By studying effective treatments for overactive bladder, this trial emphasizes the importance of antimicrobial stewardship so that lower urinary tract symptoms are not treated as lower urinary tract infections with antimicrobials and instead overactive bladder can be treated appropriately with medication. The MAESTRO study compared the effect of adding mirabegron to behavioral modification (including pelvic floor exercises) to behavior modification alone. Results from this novel study show that both the mean absolute change in the volume of micturition (objective measure) and the mean percent change increased significantly between visits two and three in the experimental group using mirabegron. Moreover, improvements in micturition in this study indicate that a larger-scale study of mirabegron with pelvic floor exercises and behavior modification is warranted.

Altered mental status in 71 deaths due to COVID-19.

OBJECTIVE: The purpose of this study was to investigate the occurrence of neurologic symptoms with a focus on altered mental status in a sample of deaths due to COVID-19. METHODS: We reviewed neurologic symptoms in 71 deaths due to COVID-19 at the first US hospital with reported cases, of which 66 (93%) had medical comorbidities, 47 (66%) came from assisted living facilities or nursing homes and 35 (49%) had baseline dementia. RESULTS: Sixty-one patients (86%) demonstrated neurologic symptoms at hospital admission. Altered mental status was seen in 47 patients (66%) and represented the most common neurologic symptom. Seven patients (10%) were comatose at hospital admission and 5 (7%) presented with altered mental status without respiratory symptoms. Three patients had seizures and two had strokes. Hypertension (61%), cardiovascular disease (59%), and dementia (49%) were the most common comorbidities associated with death due to COVID-19 in our sample. CONCLUSIONS: Neurologic symptoms, particularly altered mental status, are very common in COVID-19 patients with high risk of mortality. In a small subset of patients, altered mental status is the defining feature of disease presentation. A mental status examination should be incorporated in the medical assessment of COVID-19.

Aortopulmonary window: Clues to fetal diagnosis.

Being a planar structure, fetal diagnosis of aorto-pulmonary window poses great challenge. A few echocardiographic signs can help to clinch the diagnosis.

Depression and Anxiety in Parkinson Disease.

Depression and anxiety are common neuropsychiatric manifestations of Parkinson disease. However, they are often under-recognized because the somatic symptoms of depression often overlap with the motor symptoms of Parkinson disease and there is low self-reporting. Clinicians need to be vigilant about early detection and treatment of anxiety and depression in the patient with Parkinson disease. The development of new therapeutic strategies, including diet, exercise, and counseling along with antidepressants provide a holistic approach to management.

Management of lower urinary tract symptoms in Parkinson's disease in the neurology clinic.

This clinical review aims to evaluate lower urinary tract symptoms (LUTS) in Parkinson's disease (PD) patients and the current treatment options available for these symptoms in a neurology setting. The review also addresses when referral to urology is appropriate. A literature search was conducted using the keywords 'LUTS', 'non-motor symptoms', 'overactive bladder', 'Parkinson's disease' and 'urinary symptoms' using the Medline/Pubmed search engine. Data collected ranged from 2000 to present with emphasis on recent publications. This review was conducted because LUTS in PD has a major impact on quality of life and is associated with early institutionalization. Emphasis is placed on treating overactive bladder with conservative strategies and medical management in the neurology setting. Quality of life can be improved and institutionalization can be delayed with a multimodal approach to bladder care.

Optimizing the dose of hydroxyurea therapy for patients with ß-thalassemia intermedia (Hb E-ß-thalassemia): a single center study from Eastern India.

Over the past 20 years, hydroxyurea (HU) has emerged as an important therapeutic agent to augment Hb F and thus total hemoglobin (Hb) in Hb E [ß26(B8)Glu→Lys; HBB: c.79G > A]-ß-thalassemia (Hb E-ß-thal), albeit used in varying doses with little consensus on its optimal dose. We report the interim analysis findings of a broader study to assess the impact of Comprehensive Thalassemia Care, of which the present report was a part. Sixty-one Hb E-ß-thal patients who were transfusion independent or requiring occasional transfusions [ß-thal intermedia (ß-TI)] were randomized to one of two groups; A (n = 32) and B (n = 29) to receive 10 and 20 mg/kg/day HU, respectively. The primary objective of the study was to assess the differences in responses to different doses of HU. Secondary end points were to see the tolerability and safety of HU in different doses. Good response (GR) was defined as a rise of Hb by > 1.0 g/dL; intermediate response (IR) as a rise in Hb by 0.6-1.0 g/dL anytime during the study period. No response (NR): rise in Hb by < 0.5 g/dL in 12 weeks or drop in Hb level from the previous value. Over a follow-up period of 24 weeks, we had 18 (56.2%) GRs, nine (28.2%) IRs and five (15.6%) NRs, while the number of GRs, IRs and NRs in group B were five (17.2%) 12 (41.4%) and 12 (41.4%), respectively. Adverse effects were more common in group B, making this dose (20 mg/kg/day) of HU more myelo-suppressive than Hb F inducing.