SARS-CoV-2 and Guillain-Barré syndrome: AIDP variant with a favourable outcome.

The spectrum of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), includes different neurologic manifestations of the central and peripheral nervous system. From March through April 2020, in two university hospitals located in western Switzerland, we examined three patients with Guillain-Barré syndrome (GBS) following SARS-CoV-2. These cases were characterized by a primary demyelinating electrophysiological pattern (Acute inflammatory demyelinating polyneuropathy or AIDP) and a less severe disease course compared to recently published case series. Clinical improvement was observed in all patients at week five. One patient was discharged from hospital after full recovery with persistence of minor neurological signs (areflexia). Two of the three patients remained hospitalized: one was able to walk and the other could stand up with assistance. We report three cases of typical GBS (AIDP) occurring after SARS-CoV-2 infection and presenting with a favourable clinical course. Given the interval between COVID-19-related symptoms and neurological manifestations (mean of 15 days) we postulate a secondary immune-mediated mechanism rather than direct viral damage

Neuropathies related to hepatitis E virus infection: A prospective, matched case-control study.

Acute hepatitis E virus (HEV) infection has recently emerged as a potential trigger for acute dysimmune neuropathies, but prospective controlled studies are lacking. To compare the frequency of concomitant acute HEV infection in patients with neuralgic amyotrophy (NA), Guillain-Barré syndrome (GBS), and Bell's palsy with a matched control population. Swiss multicenter, prospective, observational, matched case-control study over 3 years (September 2019-October 2022). Neurological cases with NA, GBS, or Bell's palsy were recruited within 1 month of disease onset. Healthy controls were matched for age, sex, geographical location, and timing of blood collection. Diagnostic criteria for acute hepatitis E were reactive serum anti-HEV IgM and IgG assays (ELISA test) and/or HEV RNA detection in serum by real-time polymerase chain reaction (RT-PCR). RT-PCR was performed on sera to confirm IgM positivity. We included 180 patients (59 GBS, 51 NA, 70 Bell's palsy cases) and corresponding matched controls (blood donors) with median age 51 years for both groups and equal gender distribution. Six IgM+ cases were detected in the NA, two in the GBS, and none in the Bell's palsy group. Two controls were anti-HEV IgM-positive. At disease onset, most cases with acute HEV infection had increased liver enzymes. A moderate association (p = 0.027, Fisher's exact test; Cramér's V = -0.25) was observed only between acute HEV infection and NA. This prospective observational study suggests an association between concomitant acute HEV infection and NA, but not with GBS or Bell's palsy

Guillain-Barre syndrome after SARS-CoV-2 infection in an international prospective cohort study

In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barre syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies.The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization.Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12-22).Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.Neurological Motor Disorder

Consumo, composição botânica e valor nutritivo da dieta de bovinos em pastos tropicais consorciados sob três taxas de lotação Consumption, botanical composition and nutritive value of the diet of cattle on mixed tropical pastures under three stocking rates

Foram avaliados o consumo, a composição botânica e o valor nutritivo da dieta de bovinos em pastagens de Brachiaria decumbens e Stylosanthes guianensis cv. Mineirão e de Brachiaria brizantha cv. Marandu e Stylosanthes guianensis cv. Mineirão, submetidas a três taxas de lotação. Adotou-se o delineamento experimental em blocos completos casualizados com os tratamentos no esquema de parcelas subdivididas, com duas repetições. Os tratamentos das parcelas constituíram um fatorial 2x3, sendo duas gramíneas (B. decumbens e B. brizantha cv. Marandu) em consorciação com S. guianensis cv. Mineirão e três taxas de lotação (0,8; 1,2 e 1,6 UA/ha), e as subparcelas, os meses de amostragem (julho e outubro de 1998, correspondendo à época seca; janeiro e abril de 1999, correspondendo à época das águas). Foram utilizados bezerros Nelore, desmamados, com peso vivo médio de 138 kg, no início do experimento. Não foi observado efeito da taxa de lotação sobre as variáveis estudadas. O consumo diário de MS foi maior em pastagens com B. brizantha, em outubro (no final da seca) e em abril (no final das águas), entretanto, dietas de melhor valor nutritivo foram obtidas em pastagens com B. decumbens. As dietas foram constituídas por mais de 80% de folhas de gramínea, enquanto a participação da leguminosa nas dietas foi de apenas 2,1%, com um índice de seleção de 0,08, indicando pouca aceitação deste componente da MS disponível pelos animais em pastejo.<br>The effects of three stocking rates on intake, botanical composition, and nutritive value of the diet of cattle on pastures of Brachiaria decumbens with Stylosanthes guianensis cv. Minerão and B. brizantha cv. Marandu with S. guianensis cv. Mineirão were evaluated. The experimental design was a randomized complete block with two field replications. The treatments were arranged as a 2 x 3 factorial with 2 grasses (B. decumbens and B. brizantha cv. Marandu) in association with S. guianensis cv. Minerão, three stocking rates (0.8, 1.2, and 1.6 AU/ha), and two sampling periods (July and October 1998, corresponding to the early and late dry season; and January and April 1999, corresponding to the mid and late rainy season). Weaned Nellore steers with an average initial weight 138 kg were used. There was no effect of stocking rate on the variables studied. Daily consumption of forage dry matter was higher on pastures with B. brizantha in October (late dry season) and in April (late rainy season). However, it was observed diets with higher nutritive value in B. decumbens pastures. More than 80% of the diet was composed of live grass leaves while legumes represented 2.1% of the diet, with a selection index of 0.08, indicating low contribution of this forage component to the grazing animals

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically