MRNA-1273 COVID-19 Vaccine Leading To Anti-LGI1 Limbic Encephalitis Flare

Introduction: Here, we discuss a patient with a past medical history of Anti-LGI1 limbic encephalitis that presented with seizure-like activity approximately three weeks after the administration of the mRNA-1273 COVID-19 vaccine. Case Description: A 75-year-old male with a history of Anti-LGI1 limbic encephalitis presented to our hospital with bilateral, truncal myoclonus and lateral nystagmus. EEG showed periodic lateralized epileptiform discharges. Brain MRI was unremarkable. The lumbar puncture was not suggestive of meningoencephalitis and the patient was diagnosed with a clinical relapse of Anti-LG1 limbic encephalitis, started on IVIG, methylprednisolone, azathioprine, and antiseizure medications. After the absence of seizure activity was documented, he was discharged with instructions to follow up with neurology and advised to withhold the second dose of the COVID-19 vaccine. Discussion: Our patient was previously diagnosed with Anti-LGI1 in 2011and had been clinically stable without seizures since 2016. His relapse could have been triggered by an immunological response to the COVID-19 vaccine. Although vaccine administration does not pose a more prominent danger than natural SARS-CoV-2 infection, the temporal association raises the possibility of the vaccine as a trigger for the patient’s autoimmune limbic encephalitis relapse. Unfortunately, little is known about how to predict, prevent or ameliorate these events in certain immunologically predisposed individuals or if the temporal association reported here represents an adverse event of the mRNA-1273 COVID-19 vaccine. Ongoing reporting and further research are warranted to evaluate if this association can be confirmed, and if so, understand if there is a plausible underlying immunological mechanism

Coccidioides immitis presenting with acute hydropneumothorax in an immunocompetent patient from South Texas

Coccidioidomycosis is a disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii that predominates in dry climates and it is endemic in Southern California and Arizona. Coccidioides is also found in parts of West Texas and a long the Rio Grande River, however, incidence tends to decrease in areas close to the Gulf of Mexico due to increased humidity. Coccidioidomycosis is more commonly a subclinical and self-limited disease in up to sixty percent of cases. Acute pneumonia (Valley fever), extra thoracic disseminated infection and complications occur more frequently in immunocompromised hosts. We present a case of severe coccidiomycosis in an immunocompetent host who lived in central California for two months, 2 years prior to manifesting severe respiratory compromise. Clinicians should be able to recognize differential diagnoses for cavitary-like lung lesions, paying close attention to social history and CDC epidemiology data

Bactrim, Spironolactone and Lisinopril. Stay Away! A Dangerous Cocktail for Hyperkalemia

Introduction: Hyperkalemia is a potentially life-threatening complication of several medications, particularly in situations of polypharmacy. Trimethoprim/sulfamethoxazole (TMP-SMX) is a first line antibiotic for outpatient treatment of MRSA for skin and soft tissue infections that can enhance the hyperkalemic effects of spironolactone and Angiotensin receptor inhibitors (ACEI). Case Presentation: A 53-year-old female with history of HTN, stage 3 CKD, CHF, hypercholesterolemia and DM II, chronic left foot ulcer presented to our local hospital with generalized malaise, severe lower extremity weakness and heaviness of 2 days duration. She normally uses a walker but has had increasing difficulty standing from a seated position. Her medications included: spironolactone, carvedilol, lisinopril, amlodipine, aspirin, atorvastatin, and insulin and had been started on TMP-SMX for the management of an infected chronic ulcer. Physical exam was significant for a blood pressure of 182/87 mm Hg, BMI of 52, lethargy, dry oral mucous membranes, and nonsignificant musculoskeletal examination. The laboratory results revealed significantly elevated potassium levels at 8.6 mmol/L; GFR of 31 and creatinine: 1.79 mg/dL. EKG revealed tall, peaked T-waves with widened QRS complexes in the precordial leads and a right BBB. TMP-SMX, spironolactone and lisinopril were discontinued, and the patient was started on a hyperkalemia treatment protocol. The patient improved rapidly over the next 3 days with resolution of the ECG changes, improved muscle strength and the potassium level was back to normal limits by the time of discharge. Conclusion: Clinicians and pharmacists should be aware of the enhanced hyperkalemic effects of TMP-SMX, spironolactone and lisinopril and should avoid this combination

A communal catalogue reveals Earth's multiscale microbial diversity

Our growing awareness of the microbial world's importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth's microbial diversity.Peer reviewe

A communal catalogue reveals Earth’s multiscale microbial diversity

Our growing awareness of the microbial world’s importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth’s microbial diversity

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Stable or improved neurological manifestations during miglustat therapy in patients from the international disease registry for Niemann-Pick disease type C: an observational cohort study

Background: Niemann-Pick disease type C (NP-C) is a rare neurovisceral disease characterised by progressive neurological degeneration, where the rate of neurological disease progression varies depending on age at neurological onset. We report longitudinal data on functional disease progression and safety observations in patients in the international NPC Registry who received continuous treatment with miglustat. Methods: The NPC Registry is a prospective observational cohort of NP-C patients. Enrolled patients who received ≥1 year of continuous miglustat therapy (for ≥90 % of the observation period, with no single treatment interruption >28 days) were included in this analysis. Disability was measured using a scale rating the four domains, ambulation, manipulation, language and swallowing from 0 (normal) to 1 (worst). Neurological disease progression was analysed in all patients based on: 1) annual progression rates between enrolment and last follow up, and; 2) categorical analysis with patients categorised as 'improved/stable' if ≥3/4 domain scores were lower/unchanged, and as 'progressed' if <3 scores were lower/unchanged between enrolment and last follow-up visit. Results: In total, 283 patients were enrolled from 28 centers in 13 European countries, Canada and Australia between September 2009 and October 2013; 92 patients received continuous miglustat therapy. The mean (SD) miglustat exposure during the observation period (enrolment to last follow-up) was 2.0 (0.7) years. Among 84 evaluable patients, 9 (11 %) had early-infantile (<2 years), 27 (32 %) had late-infantile (2 to <6 years), 30 (36 %) had juvenile (6 to <15 years) and 18 (21 %) had adolescent/adult (≥15 years) onset of neurological manifestations. The mean (95%CI) composite disability score among all patients was 0.37 (0.32,0.42) at enrolment and 0.44 (0.38,0.50) at last follow-up visit, and the mean annual progression rate was 0.038 (0.018,0.059). Progression of composite disability scores appeared highest among patients with neurological onset during infancy or childhood and lowest in those with adolescent/adult-onset. Overall, 59/86 evaluable patients (69 %) were categorized as improved/stable and the proportion of improved/stable patients increased with age at neurological onset. Safety findings were consistent with previous data. Conclusions: Disability status was improved/stable in the majority of patients who received continuous miglustat therapy for an average period of 2 years

Propensión a dificultades del aprendizaje y problemas del desarrollo en universitarios de la Amazonía peruana

The study aimed to describe the propensity of Peruvian university students to learning difficulties, developmental problems and other difficulties related to university work. A descriptive investigation was carried out with two samples made up of 119 students belonging to the 2020-I semester and 169 from the 2020-II semester. The DASS-21 scale was used for anxiety, depression and stress; the Pittsburgh Sleep Quality Questionnaire, the Brief CBA Questionnaire, and the Questionnaire to Identify Learning, Sensory, and Motor Difficulties. The results indicate that students were more prone to difficulties related to sleep deprivation, difficulties with mathematics, non-pathological anxiety, difficulties with writing, spelling and reading comprehension and, lastly, visual limitations. Finally, it was concluded that there are learning difficulties, sleep deprivation, adjustment disorder with depressed mood states and permissible alcohol use disorder in university students in the Peruvian Amazon.El estudio tuvo como objetivo describir la propensión de estudiantes universitarios peruanos a las dificultades de aprendizaje, problemas del desarrollo y otras dificultades relacionadas al quehacer universitario. Se realizó una investigación descriptiva con dos muestras conformas por 119 estudiantes pertenecientes al semestre 2020-I y 169 del semestre 2020-II. Se utilizó la escala DASS-21 para ansiedad, depresión y estrés; el cuestionario de Pittsburg de calidad de sueño, el cuestionario breve CBA y el cuestionario para identificar las dificultades de aprendizaje, sensoriales y motores. Los resultados señalan que los estudiantes presentaron mayor propensión a las dificultades relacionadas con la privación de sueño, dificultades con las matemáticas, ansiedad no patológica, dificultades de la escritura, ortografía y comprensión lectora y, por último, limitaciones visuales. Finalmente, se concluyó que existen dificultades de aprendizaje, privación de sueño, trastorno de adaptación con estados de ánimo deprimido y el permisible trastorno por consumo de alcohol en los estudiantes universitarios de la Amazonía peruana

Características motivacionales y actitud hacia la ecoeficiencia en trabajadores de la universidad pública peruana

The investigation was aimed at establishing the association between the motivational characteristics and the eco-efficiency attitude among workers at the Peruvian public university. The study was carried out on the basis of the quantitative methodology, similarity corresponds to the type of correlational descriptive study with a sample of 148 participants. The data collection instruments included the Labor Motivation Cuestionary and the Ecoefficient Acttitud Cuestionario, composed in each case by 30 Likert-type items. According to the results, the motivational characteristics tend to favor the motivation of workers, the majority of them present a high disposition for the efficient use of resources and through the approach of Chi Cuadrado, an asymptotic (bilateral) significance is obtained below the level of significance (p&lt;0.05). It was concluded that there is dependence between the motivational characteristic variables with the attitude towards eco-efficiency in university workers. In that sense, motivational characteristics could help predict the attitude towards eco-efficiency.La investigación se orientó a establecer la asociación entre las características motivacionales y la actitud hacia la ecoeficiencia en los trabajadores de la universidad pública peruana. El estudio se realizó en base a la metodología cuantitativa, asimismo corresponde al tipo de estudio descriptivo correlacional con una muestra de 148 participantes. Los instrumentos de recolección de datos fueron el Cuestionario de Motivación Laboral y el Cuestionario de Actitud Ecoeficiente, compuestos en cada caso por 30 ítems de tipo Likert. Según los resultados, las características motivacionales tienden a favorecer la motivación de los trabajadores, la mayoría de ellos presentan una alta disposición hacia el uso eficiente de los recursos y mediante la prueba de Chi Cuadrado se obtuvo una significación asintótica (bilateral) inferior al nivel de significancia (p&lt;0,05). Se concluyó que existe dependencia entre las variables características motivacionales con la actitud hacia la ecoeficiencia en los trabajadores universitarios. En ese sentido, las características motivacionales podrían ayudar a predecir la actitud hacia la ecoeficiencia