Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely

Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely

Quality of surface and ground waters for domestic and irrigation purposes in CKD/CKDu prevalent areas in Moneragala District, Sri Lanka

Total of 152 water samples from CKD/CKDu endemic areas and 30 water samples from non-CKDu prevalent areas in the Moneragala District were collected separately. pH values of water samples varied from 5.04 to 8.37 which are within the permissible limit prescribed by World Health Organization. More than 15% of water samples showed low Dissolved Oxygen (DO) values indicating heavy contamination by organic matter. Electrical conductivity was high ranging between 32 and 2865 μS/cm indicating higher mineralization in groundwater. The major ion chemistry reveals that the array of abundance of cations was variable as Na+ > Ca2+ > Mg2+ > K+ in dug wells, Ca2+ > Na+ > Mg2+ > K2+ in tube wells and Ca2+> Na+ > K+> Mg2+ in surface waters, while anions varied as HCO3->Cl->SO42->F- in water samples in both seasons. Computed WQI, 43%, 33%, and 82% for dug wells, tube wells and surface water respectively were in good water quality in this area, while waters in 30% and 25% of dug and tube wells respectively exceeded the value of 100 showing not suitable category. Considering irrigation quality, 88%, 93% and 96% of dug, tube and surface waters respectively were less than the permissible level. SAR values in the study area ranged from 0.08 to 4.91 meq/L by showing no danger of sodium as per SAR. The bulk of studied waters are appropriate for irrigation according to Residual Sodium Carbonate (RSC). Considering KR and PI, majority of water samples of the study area are suitable for irrigation purposes

Recovery of the Hypothalamo-Pituitary-Adrenal Axis After Transsphenoidal Adenomectomy for Non-ACTH-Secreting Macroadenomas

Context: Secondary adrenal insufficiency is a potential complication of transsphenoidal adenomectomy (TSA). Most centers test recovery of the hypothalamo-pituitary-adrenal (HPA) axis after TSA, but, to our knowledge, there are no data predicting likelihood of recovery or the frequency of later recovery of HPA function. Objective: To assess timing and predictors of HPA axis recovery after TSA. Design: Single-center, retrospective analysis of consecutive pituitary surgeries performed between February 2015 and September 2018. Patients: Patients (N = 109) with short Synacthen test (SST) data before and at sequential time points after TSA. Main outcome measures: Recovery of HPA axis function at 6 weeks, and 3, 6, and 9 to12 months after TSA. Results: Preoperative SST indicated adrenal insufficiency in 21.1% Among these patients, 34.8% recovered by 6 weeks after TSA. Among the 65.2% (n = 15) remaining, 13.3% and 20% recovered at 3 months and 9 to 12 months, respectively. Of the 29% of patients with adrenal insufficiency at the 6-week SST, 16%, 12%, and 6% subsequently recovered at 3, 6, and 9 to 12 months, respectively. Preoperative SST 30-minute cortisol, postoperative day 8 cortisol, and 6-week postoperative SST baseline cortisol levels above or below 430 nmol/L [15.5 μg/dL; AUC ROC, 0.86]; 160 nmol/L (5.8 μg/dL; AUC ROC, 0.75); and 180 nmol/L (6.5 μg/dL; AUC ROC, 0.88), were identified as cutoffs for predicting 6-week HPA recovery. No patients with all three cutoffs below the threshold recovered within 12 months after TSA, whereas 92% with all cutoffs above the threshold recovered HPA function within 6 weeks (OR, 12.200; 95% CI, 5.268 to 28.255). Conclusion: HPA axis recovery can occur as late as 9 to 12 months after TSA, demonstrating the need for periodic reassessment of patients who initially have SST-determined adrenal insufficiency after TSA. Pre- and postoperative SST values can guide which patients are likely to recover function and potentially avoid unnecessary lifelong glucocorticoid replacement.</br

Recovery of the Hypothalamo-Pituitary-Adrenal Axis After Transsphenoidal Adenomectomy for Non-ACTH-Secreting Macroadenomas

CONTEXT: Secondary adrenal insufficiency is a potential complication of transsphenoidal adenomectomy (TSA). Most centers test recovery of the hypothalamo-pituitary-adrenal (HPA) axis after TSA, but, to our knowledge, there are no data predicting likelihood of recovery or the frequency of later recovery of HPA function. OBJECTIVE: To assess timing and predictors of HPA axis recovery after TSA. DESIGN: Single-center, retrospective analysis of consecutive pituitary surgeries performed between February 2015 and September 2018. PATIENTS: Patients (N = 109) with short Synacthen test (SST) data before and at sequential time points after TSA. MAIN OUTCOME MEASURES: Recovery of HPA axis function at 6 weeks, and 3, 6, and 9 to12 months after TSA. RESULTS: Preoperative SST indicated adrenal insufficiency in 21.1% Among these patients, 34.8% recovered by 6 weeks after TSA. Among the 65.2% (n = 15) remaining, 13.3% and 20% recovered at 3 months and 9 to 12 months, respectively. Of the 29% of patients with adrenal insufficiency at the 6-week SST, 16%, 12%, and 6% subsequently recovered at 3, 6, and 9 to 12 months, respectively. Preoperative SST 30-minute cortisol, postoperative day 8 cortisol, and 6-week postoperative SST baseline cortisol levels above or below 430 nmol/L [15.5 μg/dL; AUC ROC, 0.86]; 160 nmol/L (5.8 μg/dL; AUC ROC, 0.75); and 180 nmol/L (6.5 μg/dL; AUC ROC, 0.88), were identified as cutoffs for predicting 6-week HPA recovery. No patients with all three cutoffs below the threshold recovered within 12 months after TSA, whereas 92% with all cutoffs above the threshold recovered HPA function within 6 weeks (OR, 12.200; 95% CI, 5.268 to 28.255). CONCLUSION: HPA axis recovery can occur as late as 9 to 12 months after TSA, demonstrating the need for periodic reassessment of patients who initially have SST-determined adrenal insufficiency after TSA. Pre- and postoperative SST values can guide which patients are likely to recover function and potentially avoid unnecessary lifelong glucocorticoid replacement

First Documented Attack on a Live Human by a Cookiecutter Shark (Squaliformes, Dalatiidae: Isistius sp.)

v. ill. 23 cm.Also available through BioOne: http://www.bioone.org/doi/abs/10.2984/65.3.365QuarterlyAn adult long-distance swimmer attempting to cross the ‘Alenuihähä Channel between the Hawaiian islands of Hawai‘i and Maui was twice bitten by a cookiecutter shark (Squaliformes, Dalatiidae, Isistius sp.). One of these bites presented as an open, round, concave wound typically observed in cookiecutter shark bites inflicted by members of this genus on a broad spectrum of large biota such as marine mammals, elasmobranchs, and bony fishes. The open wound was debrided, subjected to negative pressure wound therapy, and a split thickness skin graft harvested from the left thigh. Postoperative recovery was complicated by delayed healing of the inferior portion of the graft, and cultures and biopsy were normal skin flora and normal tissue, respectively. At 6 months after the incident, the area appeared to be healing with a stable eschar, and by 9 months the wound was healed. Humans entering pelagic waters at twilight and nighttime hours in areas of Isistius sp. occurrence should do so knowing that cookiecutter sharks are a potential danger, particularly during periods of strong moonlight, in areas of man-made illumination, or in the presence of bioluminescent organisms