Diagnosis and management of Guillain–Barré syndrome in ten steps

Guillain–Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae

ICAR: endoscopic skull‐base surgery

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Limits to Ambulatory Displacement of Coconut Mites in Absence and Presence of Food-Related Cues

Ambulatory movement of plant-feeding mites sets limits to the distances they can cover to reach a new food source. In absence of food-related cues these limits are determined by survival, walking activity, walking path tortuosity and walking speed, whereas in presence of food the limits are also determined by the ability to orient and direct the path towards the food source location. For eriophyoid mites such limits are even more severe because they are among the smallest mites on earth, because they have only two pairs of legs and because they are very sensitive to desiccation. In this article we test how coconut mites (Aceria guerreronis Keifer) are constrained in their effective displacement by their ability to survive in absence of food (meristematic tissue under the coconut perianth) and by their ability to walk and orient in absence or presence of food-related cues. We found that the mean survival time decreased with increasing temperature and decreasing humidity. Under climatic conditions representative for the Tropics (27 °C and 75 % relative humidity) coconut mites survived on average for 11 h and covered 0.4 m, representing the effective linear displacement away from the origin. Within a period of 5 h, coconut mites collected from old fruits outside the perianth moved further away from the origin than mites collected under the perianth of young fruits. However, in the presence of food-related cues coconut mites traveled over 30 % larger distances than in absence of these cues. These results show that ambulatory movement of eriophyoid mites may well bring them to other coconuts within the same bunch and perhaps also to other bunches on the same coconut palm, but it is unlikely to help them move from palm to palm, given that palms usually do not touch each other

Desenvolvimento e estado nutricional da beterraba em função da omisão de nutrientes Effect of macronutrient omission on growth and nutritional status on table beet

Com o objetivo de avaliar o efeito da omissão de macronutrientes no desenvolvimento e no estado nutricional da beterraba, assim como descrever sintomas visuais de deficiência nutricional, um experimento foi conduzido em casa de vegetação da UNESP, Campus de Jaboticabal, SP. O delineamento experimental foi inteiramente casualizado, com sete tratamentos, que corresponderam à solução completa (macro e micronutrientes) e à omissão individual de N, P, K, Ca, Mg e S, com três repetições. Avaliou-se a altura das plantas, o número de folhas, a área foliar, a matéria seca da parte aérea, da raiz e planta inteira, os teores dos macronutrientes da parte aérea e raiz e descritos as desordens nutricionais. As omissões individuais de N, P, K e Ca foram as mais limitantes para o crescimento vegetativo da beterraba, reduzindo consideravelmente a altura, o número de folhas e as matérias secas de parte aérea, raiz e planta inteira. Foram observados sintomas de deficiência nutricional de cada elemento. Os teores dos macronutrientes na parte aérea do tratamento completo e com omissão dos nutrientes foram respectivamente: N = 32,9 - 13,8; P = 9,0 - 0,8; K = 126,0 - 15,1; Ca = 12,0 - 1,0; Mg = 10,1 - 0,7; S = 3,6 - 1,2 g kg-1.<br>An experiment was conducted under greenhouse conditions, in Jaboticabal, São Paulo State, Brazil, to evaluate the effects of macronutrient omission on beet nutritional status and development, as well as to describe nutritional deficiency symptoms. The experiment was arranged in completely randomized design with three replications and seven treatments, corresponding to complete nutritive solution (macro and micronutrients) and individual N, P, K, Ca, Mg and S omission. Plant height, number of leaves, leaf area, shoot, root and whole plant dry mass and macronutrient levels were determined and nutritional deficiency symptoms were described. Individual omissions of N, P, K or Ca were the most limiting for beet growth, considerably reducing plant height, number of leaves, and shoot, root and whole plant dry mass. Nutritional deficiency symptoms were observed for each element. Shoot macronutrient levels in control and nutrient omission treatments were, respectively: N = 32.9 - 13.8; P = 9.0 - 0.8; K = 126.0 - 15.1; Ca = 12.0 - 1.0; Mg = 10.1 - 0.7; S = 3.6 - 1.2 g kg-1