ABSTRACT
Coronavirus disease 2019 (COVID-19) has been known to affect multiple organ systems, aside from the respiratory system. Increasing reports of post-infection neurological complications have been reported. Miller-Fisher syndrome, a rare variant of Guillain-Barré syndrome (GBS), has been reported after COVID-19 infection. We present the youngest known adult (26-year-old male) reported to have had COVID-19-associated Miller Fisher syndrome (MFS) with also the longest reported latency period (10 weeks) between infection and development of neurological symptoms (including dysphagia, horizontal diplopia, facial weakness, upper and lower extremity weakness, paresthesia). This is currently the second youngest reported case after the case of a seven-year-old child. The patient was treated with intravenous immunoglobulin and was ultimately transferred to a different facility for higher level of care. Most symptoms were resolved within four days. The patient reported resolution of neurologic symptoms with the exception of left-sided facial weakness at the one-year follow-up. As more reports of COVID-19-associated GBS and MFS appear in the future, we are likely to discover more variability than was previously known in GBS and MFS. With COVID-19 potentially affecting multiple systems, there could be increased variability to previously known conditions. Future studies may need to closely examine long-term follow-ups of patients previously diagnosed with COVID-19 as post-COVID complications become more prevalent.
ABSTRACT
COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has infected over 200 million people, causing over 4 million deaths. COVID-19 infection has been shown to lead to hypoxia, immunosuppression, host iron depletion, hyperglycemia secondary to diabetes mellitus, as well as prolonged hospitalizations. These clinical manifestations provide favorable conditions for opportunistic fungal pathogens to infect hosts with COVID-19. Interventions such as treatment with corticosteroids and mechanical ventilation may further predispose COVID-19 patients to acquiring fungal coinfections. Our literature review found that fungal coinfections in COVID-19 infected patients were most commonly caused by Aspergillus, Candida species, Cryptococcus neoformans, and fungi of the Mucorales order. The distribution of these infections, particularly Mucormycosis, was found to be markedly skewed towards low- and middle-income countries. The purpose of this review is to identify possible explanations for the increase in fungal coinfections seen in COVID-19 infected patients so that physicians and healthcare providers can be conscious of factors that may predispose these patients to fungal coinfections in order to provide more favorable patient outcomes. After identifying risk factors for coinfections, measures should be taken to minimize the dosage and duration of drugs such as corticosteroids, immunosuppressants, and antibiotics.
ABSTRACT
The process of ultrasound-assisted ion-exchange desorption of cocarboxylase (thiamine diphosphate (TDP)) from a strong acidic cation resin was studied. Kinetics studies revealed that ultrasound accelerates TDP desorption by 3 times. The optimal desorption parameters, viz. US power input, sonication time, eluent/resin ratio and the eluent (ammonium acetate buffer) concentration were established which were 15mW/cm3, 20min, 1:1 and 1M, respectively. The resin stability studies showed that the optimal ultrasonic power was less by the order than the resin degradation threshold which ensures durable and efficient resin exploitation during production. The resin sorption capacity remained unchanged even after 20 cycles of TDP sorption, ultrasonic desorption and resin regeneration. The recovery ratio of TDP was shown to increase non-linearly with decreasing the resin saturation factor, which can be attributed to diffusion limitations occurring during desorption. The optimal resin loading corresponding to more than 90 per cent of TDP recovery was found to be at the level of 10 per cent of the maximal sorption capacity. The study revealed 4-5-fold increase in concentrations of the recovered solutions, which together with process times shortening should result in considerable energy saving in downstream operations on production scale.
