COVID-19 related fatigue: which role for rehabilitation in post-COVID-19 patients? A case series

AIM: of this paper was to characterize the impact of rehabilitation in reducing fatigue in a series of Coronavirus Disease 2019 (COVID-19) free patients, attested by two negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) swab tests. We described 7 post-COVID-19 patients, mean aged 65.7\ub111.9 years, referred to a Northern-Italy Rehabilitation Unit due to generalized muscle weakness. They came from specialized COVID-19 Unit after two negative SARS-CoV-2 swab tests. The 57.1% suffered from severe dyspnoea affecting activities of daily living. We noticed that almost all patients (85.7%) showed a perception of exertion, but only Case 2, that needed intensive care unit in the acute phase, presented a severe fatigue (Borg Category Ratio 10 scale=7). After the rehabilitation treatment the 71.4% showed no fatigue and the other 2 cases reported only a very light perception of exertion. This case series suggested that, starting from an adequate assessment of functional complications, a patient-tailored rehabilitation intervention should be planned for reducing fatigue and improving functioning in COVID-19 free patients. This article is protected by copyright. All rights reserved

Epidemiological and clinical characteristics of 492 patients in a vegetative state in 29 Italian rehabilitation units. What about outcome?

Recent studies on recovery of consciousness of subjects in a vegetative state (VS) admitted to rehabilitation units have focused mainly on the identification of prognostic factors, whereas few studies have focused on outcome. The aim of this study was to compare demographic and clinical data and report functional outcome of patients in a VS due to severe acquired brain injury (ABI) of different aetiologies. The study was a retrospective multicentre cohort study and involved 492 patients in a VS due to traumatic (TBI) or non-traumatic (NTBI) severe ABI admitted to 29 Italian rehabilitation units. Demographic and clinical data recorded included age, gender, aetiology, Glasgow Coma Scale score; onset-to-admission interval; length of stay in the rehabilitation unit; the department from which they were referred; and the presence of percutaneous endoscopic gastrostomy or tracheostomy. Recovery of consciousness and disability were evaluated using a discharge Disability Rating Scale. At discharge, 53.11% patients had emerged from VS, with TBI subjects significantly more likely to recover consciousness than NTBI ones. Subjects with NTBI had a significantly worse prognosis than those with TBI, and within the NTBI group, subjects with a cerebrovascular aetiology had a better outcome than those with an anoxic aetiology. Among the patients who emerged from VS, 71.30% of TBI and 83.06% of NTBI subjects presented extremely severe disability. Only 37.93% of subjects affected by TBI and 17.44% of those affected by NTBI who presented extremely severe disability returned home after their rehabilitation stay. Even though almost a half of the patients emerged from VS, a large number of these subjects showed severe disability, often making it impossible for them to return home. This situation has a major impact on the healthcare system

Selective capture of anti‐N‐glucosylated NTHi adhesin peptide antibodies by a multivalent dextran conjugate

International audienceTentacle-like polymers decorated with several copies of peptide antigens can be interesting tools to increase the ability to capture circulating antibodies in patient sera, using cooperative effects for stronger avidity. We previously showed that antibodies from multiple sclerosis (MS) patient sera preferentially recognize hyperglucosylated adhesin protein HMW1 of non-typeable Haemophilus influenzae (NTHi) . We selected the C-terminal HMW1(1347-1354) minimal epitope and prepared the diglucosylated analogue Ac-KAN(Glc)VTLN(Glc)TTG-K(N 3 )-NH 2 to graft a 40 kDa dextran scaffold modified with glycidyl-propargyl moieties to perform a copper catalysed alkyne-azide coupling reaction (CuAAC). Quantitative NMR measurements allowed to characterize the peptide loading (19.5%) on the multivalent dextran conjugate. This novel polymeric structure displayed optimal capturing properties of both IgG and, more interestingly, IgM antibodies in MS sera. Specific antibodies from a representative MS serum, were successfully depleted using a sepharose resin bearing the new glucosylated multivalent conjugate, as confirmed by ELISA. These results may offer a promising proof-of-concept for the selective purification of high affinity autoantibodies from sera of patients affected by autoimmune patients, in general, and of specific high affinity antibodies against a minimal glycosylated epitope Asn(Glc) from sera of multiple sclerosis (MS) patients, in particular

MDS/AML Del(11)(q14) Share common morphological features despite different chromosomal breakpoints

In myelodysplatic syndromes and acute myeloid leukemia (MDS/AML) deletion of the 11q14 region is a rare chromosomal defect (incidence: 0.6-1.0%), included within the intermediate risk criteria by the International Prognostic Scoring System. No fluorescence in situ hybridization (FISH) study has yet been performed to identify a common breakpoint region (CBR). In our study through FISH with bacterial artificial chromosomes and commercial probes, we analyzed seven patients with MDS/AML harboring 11q14 deletion on conventional cytogenetic analysis. FISH revealed deletions in five patients and amplifications in two. Three patients with deletion carried a CBR, two had a deletion involving a more centromeric breakpoint. These five patients exhibited multilineage dysplasia, blast cells with large round nuclei, loose chromatin, small and abundant nucleoli, and vacuolated cytoplasm with very thin Auer bodies. In conclusion, the morphological features which occur independently of the extent of the deletion are of multilineage dysplasia in MDS and leukemic blasts strongly reactive to peroxidase in AML; despite the variable size of the deleted area, some patients harbor a CBR

Efficacy of therapeutic ultrasound and transcutaneous electrical nerve stimulation compared with botulinum toxin type a in the treatment of spastic equinus in adults with chronic stroke: a pilot randomized controlled trial.

BACKGROUND: Therapeutic ultrasound and transcutaneous electrical nerve stimulation (TENS) have been described as being effective in the treatment of spasticity. No previous study compared these physical modalities with a first-line treatment for spasticity, such as botulinum toxin type A. OBJECTIVE: To compare the effects of therapeutic ultrasound and TENS with botulinum toxin type A on spasticity after stroke. METHODS: Thirty patients with chronic stroke and spastic equinus were randomly assigned to 3 groups: 1 group received therapeutic ultrasound to the affected leg calf muscles, 1 group underwent TENS to the tibial nerve of the affected leg, and 1 group was injected with onabotulinum toxin A in the spastic gastrocnemius. All patients were evaluated immediately before treatment and 15, 30, and 90 days after the first clinical evaluation. The following outcome measures were considered: ankle passive dorsiflexion range of motion and the modified Ashworth scale. RESULTS: Patients injected with botulinum toxin type A had significantly better ankle passive range of motion than those treated with physical modalities at all posttreatment evaluations. At second and third posttreatment evaluations, the modified Ashworth scale indicated significantly greater improvement in patients injected with botulinum toxin type A than in those treated with physical modalities. No difference was found between groups treated with physical modalities. CONCLUSIONS: Our findings support the hypothesis that botulinum toxin type A is more effective than therapeutic ultrasound and TENS for treating focal spasticity in patients with chronic stroke

A community-built calibration system: The case study of quantification of metabolites in grape juice by qNMR spectroscopy

Nuclear Magnetic Resonance (NMR) is an analytical technique extensively used in almost every chemical laboratory for structural identification. This technique provides statistically equivalent signals in spite of using spectrometer with different hardware features and is successfully used for the traceability and quantification of analytes in food samples. Nevertheless, to date only a few internationally agreed guidelines have been reported on the use of NMR for quantitative analysis. The main goal of the present study is to provide a methodological pipeline to assess the reproducibility of NMR data produced for a given matrix by spectrometers from different manufacturers, with different magnetic field strengths, age and hardware configurations. The results have been analyzed through a sequence of chemometric tests to generate a community-built calibration system which was used to verify the performance of the spectrometers and the reproducibility of the predicted sample concentrations