Treatment Response to Hydroxychloroquine and Antibiotics for mild to moderate COVID-19: a retrospective cohort study from South Korea

ObjectivesTo assess the efficacy of hydroxychloroquine on mild-moderate COVID-19 patients in South Korea. MethodsA retrospective cohort study of the 358 laboratory-confirmed SARS-CoV-2 (COVID-19) patients was conducted. 226 patients met inclusion criteria for analysis. Propensity score matching (PSM) and Cox regression method were utilized to control and adjust for confounding factors. Mild to moderate COVID-19 patients were managed with hydroxychloroquine (HQ) plus antibiotics (n = 31) or conservative treatment (n = 195). ResultsKaplan-Meier curves drawn using propensity score-matched data revealed no differences between the length of time to viral clearance and duration of hospital stay between the two treatment arms (p=0.18, p=0.088). Multivariable Cox regression analysis similarly showed that time to viral clearance(Hazard ratio (HR) 0.97, [95%-confidence interval (CI): 0.57-1.67]) and symptom duration(HR 1.05, [95%-CI: 0.62-1.78]) were not different between groups. No severe adverse event or death was observed in either group. ConclusionsHQ with antibiotics was not associated with better clinical outcomes in terms of time to viral clearance, length of hospital stay, and duration of symptoms compared to conservative treatment alone. Large prospective randomized trials are necessary for definitive conclusions.

Treatment Response to Hydroxychloroquine, Lopinavir/Ritonavir, and Antibiotics for Moderate COVID 19: A First Report on the Pharmacological Outcomes from South Korea

The authors have withdrawn this manuscript because of the controversy about hydroxychloroquine and potential changes in results after peer-review, the authors intend to share their results in formal publication. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.

Sequential Changes of CX3CR1 in Dorsal Root Ganglion in a Rat Model of Lumbar Disc Herniation

OBJECTIVE: To investigate the pain-related behaviors and the changes of CX3CR1 expression in the dorsal root ganglion (DRG) in a rat model of lumbar disc herniation. METHOD: A total of 90 male Sprague-Dawley rats were used. A laminectomy was performed to expose left L5 nerve roots and corresponding DRG. Autologous nucleus puplosus was implanted on the left L5 nerve root proximal to the DRG without mechanical compression. Sham operation was also done with the same procedure as mentioned above. Thermal hyperalgesia and mechanical allodynia were assessed at 1, 5, 10, 20 and 30 days after surgery. Real time PCR and immunohistochemistry after behavioral test were performed. RESULTS: In the lumbar disc herniation rats, significant reduction of thermal withdrawal latency indicating thermal hyperalgesia was shown on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and peaked on day 10 (p<0.05) and maintained throughout day 30 (p<0.05). The reduction of mechanical allodynia threshold, indicating mechanical allodynia, was observed on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and continued throughout day 30 (p<0.01). Real time PCR showed the decrease in mRNA expression of CX3CR1 in the ipsilateral DRG on day 1 (p<0.05) and the significant increase on day 20 (p<0.05). The immunoreactivity for CX3CR1 was also increased in ipsilateral DRG on day 10 and 20. CONCLUSION: These data suggest that lumbar disc herniation induces thermal hyperalgesia and mechanical allodynia and upregulates the expression of CX3CR1 in dorsal root ganglion. Expression of CX3CR1 might be associated with subacute neuropathic pain after intervertebral disc herniation.

Effects of Continuous Repetitive Transcranial Magnetic Stimulation on Pain Response in Spinal Cord Injured Rat

OBJECTIVE: To investigate the effects of continuous repetitive transcranial magnetic stimulation (rTMS) on pain response in spinal cord injured rat. METHOD: Forty Sprague-Dawley rats (200~250 grams, female) were used. Thoracic spinal cord (T9) was contused using New York University (NYU) spinal cord impactor. Ten gram weight rod was dropped from a height of 25 mm to produce spinal cord contusion model with moderate injury. The animals were randomly assigned to two groups: one exposed to real magnetic stimulation (real-rTMS group) and the other not exposed to magnetic stimulation (sham-rTMS group). rTMS was applied for 8 weeks. To assess the effect of continuous rTMS on below-level pain responses after spinal cord injury (SCI), the hindpaw withdrawal response for thermal stimuli, cold stimuli and mechanical stimuli were compared between two groups. RESULTS: Behavioral response for pain showed that hindpaw withdrawal response for cold stimuli was reduced significantly from 4 weeks after SCI in real-rTMS group compared with sham group (p<0.05). CONCLUSION: These results suggest that continuous rTMS may have beneficial effects on attenuation of cold allodynia after SCI, and it might be an additional non-invasive therapeutic method in patients with chronic neuropathic pain after SCI.

Detection of Saliva Aspiration Using Salivagram in Bedridden Patients with Brain Lesion

OBJECTIVE: To investigate the aspiration of saliva itself in bedridden patients with brain lesion using the response of radionuclide salivagram, and its association with patient characteristics and clinical factors. METHOD: Thirty two patients (21 men and 11 women) in bedridden state with brain lesion were performed the radionuclide salivagram. (99m)Tc sulfur colloid (1.0 mCi in a drop of saline) was instilled into patients' tongue with supine position. The sequential images were obtained at first 5 minutes and 10 minutes interval for 1 hour, and evaluated the presence of saliva aspiration as the entrance of tracer into major airways or lung parenchyma. The characteristics of patients and the states of cooperation, drooling, tracheostomy, and method of feed were also assessed. RESULTS: Seven out of 32 subjects exhibited positive response of saliva aspiration by radionuclide salivagram. Men, uncooperative, and anterior drooling was significantly associated with positive finding of salivagram (p<0.05). CONCLUSION: In bedridden patients with brain lesion, it seems that radionuclide salivagram may be one of methods for detection of the aspiration of saliva itself.

Ipsilateral Posterior Spinal Artery Infarction on Lower Medulla and Upper Cervical Spinal Cord: A case report

Spinal cord infarction is uncommon and accounts for only 1% of all strokes in comparison with cerebral infarction. Furthermore, posterior spinal cord infarction is particularly rare because of an anastomotic network of direct penetrating vessels and plexus of pial vessels fed by the paired posterior spinal arteries. We report a case of unilateral posterior spinal artery infarction on lower medulla and upper cervical spinal cord in a patient of 60-year-old woman. She complained of continuous headache for several weeks and suddenly presented right facial paresthesia, slow progression of motor weakness and proprioceptive sensory loss on right extremity, and voiding difficulty. Magnetic resonance and computed tomography imaging studies confirmed acute infarction at the right posterolateral aspect of the lower medulla and upper cervical cord (C1-2 level) with right vertebral artery hypoplasia. Transcranial doppler sonography also showed right vertebral artery hypoplasia rather than stenosis with atherosclerosis.

Effects of Functional Magnetic Stimulation on the Functional Recovery in a Rat Model of Spinal Cord Injury

OBJECTIVE: To investigate the effects of functional magnetic stimulation (FMS) on the functional recovery in a rat model of spinal cord injury (SCI). METHOD: Forty-five Sprague-Dawley rats (200~250 grams, female) were used. Rats were laminectomized and the T9 segment of spinal cord was contused using New York University (NYU) spinal impactor. Ten gram weight rod was dropped from a height of 25 mm to produce moderately contused spinal cord injury model. The animals were randomly assigned to 2 groups: one exposed to FMS (FMS group) and the other not exposed to FMS (non-FMS group). Transcranial functional magnetic stimulation was noninvasively applied for 4 weeks. To compare the results between FMS group and non-FMS group, motor functions were evaluated with the Basso, Beattie, and Bresnahan (BBB) locomtor rating scale and inclined plane test, and somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) were also recorded. RESULTS: There was a significant difference in locomotor recovery between FMS group and non-FMS group (p<0.05). Measurement of MEP was also indicated that amplitude of MEP in FMS group is larger than that in non-FMS group. CONCLUSION: These results indicate that FMS may have beneficial effects on motor recovery after spinal cord injury and the benefits of FMS could be an additional non-invasive therapeutic method for clinical trials in patients with spinal cord injury.

A Case of S1 Radiculopathy in Sacral Insufficiency Fracture without Fracture Line

Sacral insufficiency fractures are not uncommon cause of low back pain in elderly women with osteoporosis. The characteristics of sacral insufficiency fractures may not be related with neurological compromise. Their associated rate of neurological complication has been reported approximately 2%. The neurological complication, which is due to stretching or compression of nerve roots, is related with bony displacement. We present the case of an elderly women who developed S1 radiculopathy secondary to sacral insufficiency fracture with no evidence of fracture line.

The Discharge Destinations of Geriatric Stroke Patients Admitted in the University Hospitals

BACKGROUND: The purpose of this study is to investigate discharge destinations and outcomes of geriatric stroke patients in university hospitals, and to examine their correlates and variables. METHODS: A total of 24 subjects, who were admitted between January and June 2006 in two university hospitals in Daegu, were enrolled in this prospective study. Data on demographic factors, socioeconomic factors, clinical, functional status and discharge destinations of patients were documented. Pearson's chi square test and t-test were used for statistic analysis. RESULTS: Ten patients were discharged to the community(their own home: 7, offspring's home: 3) and 14 patients were discharged to other hospitals(rehabilitation hospitals or nursing home:12, oriental medicine hospitals: 2) Analysis revealed that discharge destinations had significant correlations with severity of cognitive function, severity of speech disturbance, admission FIM scores and discharge FIM scores(p<0.05). CONCLUSIONS: Large part(75%) of geriatric stroke patients could not return to pre-stroke living situations. Their discharge destinations were associated with cognitive function, speech disturbance, admission and discharge FIM scores. Recognizing these correlations could be helpful for appropriate intervention to geriatric stroke patients during admission for more comprehensive rehabilitational management.

Leigh Syndrome : Two cases report

Leigh syndrome is a subacute necrotizing encephalomyelopathy of infancy or early childhood. The clinical presentation can be highly variable. The classical presentations are central hypotonia, developmental regression or arrest, ataxia, ophthalmoplegia, and abnormal respiratory pattern. Diagnosis is usually confirmed by radiologic evidence of focal, bilateral and usually symmetric lesions of the both gray and white matter in the brain and the spinal cord. We experienced 2 cases of Leigh syndrome in a brother and sister.The first case, 4 year-old boy, was misdiagnosed as a cerebral palsy initially, but after acute infection, he revealed developmental regression and abnormal movement. His disease was confirmed by typical magnetic resonance imaging findings. The second case, 1 year-old girl with nystagmus, showed bilateral symmetric high signal intensity in globus pallidus on T2WI. We reported these cases with a brief review of the related literature.