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Surgical Neurology International 2021Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly...
BACKGROUND
Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly iatrogenic or traumatic in nature. Treatment is dependent on underlying cause and physical exam.
CASE DESCRIPTION
Herein, we describe the second case in the literature of spontaneous holocord PNR in a young patient without risk factors. A 22-year-old male with no past medical history presented to the hospital for 2 days of vomiting and cramping in his hands and feet secondary to severe dehydration. He recently started a new job as a manual laborer and had to leave work early 2 days prior due to overexertion working outside in heat ranging from 100 to 120 degrees Fahrenheit. CT abdomen and pelvis demonstrated spontaneous pneumomediastinum and extramedullary PNR extending upward from L3 throughout the thoracic spine to the upper limit of the scan. Subsequent CT cervical and thoracic spine showed the full length of the extradural air from C2-T12 and again at L3.
CONCLUSION
Spontaneous PNR is an uncommon, typically self-limited condition in which air is introduced into the spinal axis. Anatomic predisposition makes the extradural, dorsal cord in the cervicothoracic region the most common location. Patients are rarely symptomatic, and treatment is supportive in nature once secondary causes with high rates of morbidity and mortality are ruled out.
PubMed: 34992919
DOI: 10.25259/SNI_1046_2021 -
Cureus Oct 2021Antipsychotic medications are used in the management of schizophrenia. Antipsychotic medications treat both positive and negative symptoms via the dopamine D2 receptor...
Antipsychotic medications are used in the management of schizophrenia. Antipsychotic medications treat both positive and negative symptoms via the dopamine D2 receptor and serotonin 5-HT2A blockade pathway. Side effects include hyperprolactinemia, prolonged QTc, and neuroleptic malignant syndrome. However, antipsychotic medication-induced hyperthermia potentiating a cerebrovascular accident (CVA) is a rare side effect that is less well known. A 47-year-old male presented to the emergency department (ED) via emergency medical services for altered mental status. He was given naloxone without improvement in mental status. His glucose was 110 mg/dL. Upon presentation to the ED, he was hyperthermic (106.7 degrees Fahrenheit) and tachycardic (heart rate of 160's beats/minute). Home medications included risperidone and fluphenazine. After the resolution of his hyperthermia, he had a right-sided facial droop concerning a cerebrovascular accident. Magnetic resonance imaging (MRI) of the brain confirmed an early/acute subacute right cerebellar infarction. The patient received optimal treatment; his mental status returned to baseline, and he was discharged home without antipsychotic medications. Patients who are prescribed antipsychotics should be aware of the potentially fatal adverse events that can occur from these medications. Thermoregulation may be impaired in these patients, resulting in significant hyperthermia, in which case antipsychotic medications should be discontinued.
PubMed: 34659926
DOI: 10.7759/cureus.18651 -
SAGE Open Medical Case Reports 2021Clinicians and researchers have reported an array of neurological abnormalities in coronavirus disease 2019 (COVID-19), and while serotonin excess has been observed we...
Clinicians and researchers have reported an array of neurological abnormalities in coronavirus disease 2019 (COVID-19), and while serotonin excess has been observed we are unaware of reports of central nervous system serotonin toxicity in COVID-19. We present two cases that resemble serotonin syndrome in COVID-19, but without identifiable inciting medications. A 54-year-old with multiple sclerosis and diabetes mellitus presented with altered mental status. His altered sensorium was attributed to diabetic ketoacidosis, but his condition quickly deteriorated with fever to 105 degrees Fahrenheit, rigidity in all extremities, inducible clonus, and hyperreflexia. He was intubated and was treated for possible meningitis and seizure. Neurologic workup was negative for acute pathology. Despite acetaminophen, his core temperature remained elevated to 105 degrees Fahrenheit. He was treated with external cooling and cyproheptadine and within 48 h, his fever, rigidity, hyperreflexia, and clonus resolved. He was extubated and discharged home on day 14. A 72-year-old with hyperlipidemia was admitted with tremors, 4 days after testing positive for COVID-19. His symptoms rapidly worsened, and he was transferred to the Intensive Care Unit on day 3 , febrile to 104.4 degrees Fahrenheit, heart rate of 180 beats per minute, and apparent whole body myoclonus. He was intubated and developed fever refractory to acetaminophen requiring external cooling. Extensive neurologic workup was negative. He received cyproheptadine and slowly improved. He was extubated and discharged to rehab on day 11. These cases represent a unique presentation in COVID-19 that must be considered and requires a high index of suspicion.
PubMed: 34290872
DOI: 10.1177/2050313X211032089 -
PloS One 2021Intensity and duration of the COVID-19 pandemic, and planning required to balance concerns of saving lives and avoiding economic collapse, could depend significantly on...
IMPORTANCE
Intensity and duration of the COVID-19 pandemic, and planning required to balance concerns of saving lives and avoiding economic collapse, could depend significantly on whether SARS-CoV-2 transmission is sensitive to seasonal changes.
OBJECTIVE
Hypothesis is that increasing temperature results in reduced SARS CoV-2 transmission and may help slow the increase of cases over time.
SETTING
Fifty representative Northern Hemisphere countries meeting specific criteria had sufficient COVID-19 case and meteorological data for analysis.
METHODS
Regression was used to find the relationship between the log of number of COVID-19 cases and temperature over time in 50 representative countries. To summarize the day-day variability, and reduce dimensionality, we selected a robust measure, Coefficient of Time (CT), for each location. The resulting regression coefficients were then used in a multivariable regression against meteorological, country-level and demographic covariates.
RESULTS
Median minimum daily temperature showed the strongest correlation with the reciprocal of CT (which can be considered as a rate associated with doubling time) for confirmed cases (adjusted R2 = 0.610, p = 1.45E-06). A similar correlation was found using median daily dewpoint, which was highly colinear with temperature, and therefore was not used in the analysis. The correlation between minimum median temperature and the rate of increase of the log of confirmed cases was 47% and 45% greater than for cases of death and recovered cases of COVID-19, respectively. This suggests the primary influence of temperature is on SARS-CoV-2 transmission more than COVID-19 morbidity. Based on the correlation between temperature and the rate of increase in COVID-19, it can be estimated that, between the range of 30 to 100 degrees Fahrenheit, a one degree increase is associated with a 1% decrease-and a one degree decrease could be associated with a 3.7% increase-in the rate of increase of the log of daily confirmed cases. This model of the effect of decreasing temperatures can only be verified over time as the pandemic proceeds through colder months.
CONCLUSIONS
The results suggest that boreal summer months are associated with slower rates of COVID-19 transmission, consistent with the behavior of a seasonal respiratory virus. Knowledge of COVID-19 seasonality could prove useful in local planning for phased reductions social interventions and help to prepare for the timing of possible pandemic resurgence during cooler months.
Topics: COVID-19; Hot Temperature; Humans; Meteorological Concepts; Pandemics; SARS-CoV-2; Seasons; Weather
PubMed: 33596214
DOI: 10.1371/journal.pone.0246167 -
Environmental Entomology Feb 2021As the mean temperature and the duration of the growing season decline with elevation, growth of immature insects should initiate at a lower temperature, but it should...
As the mean temperature and the duration of the growing season decline with elevation, growth of immature insects should initiate at a lower temperature, but it should also be faster to complete development prior to season's end. Although flightless, Mormon crickets migrate in large aggregations across broad spatial and elevational distances that might limit adaptations to local environments. In addition, selection to be active at cooler temperatures might limit selection to maximize growth rate. I measured growth rate in controlled environments for nymphs from three populations that vary in altitude (87-2,688 m) but are similar in latitude (43.2-45.7°N). Growth rate increased significantly with mean rearing temperature between 22 and 30°C. The intercept of the regression of growth rate on temperature increased with elevation, whereas the slope did not change significantly. For any given rearing temperature, growth rate increased with elevation, which suggests that selection to initiate growth at cooler temperatures did not compromise growth rate. Body mass did not differ between the two lower elevations, whereas the highest elevation population had smaller hatchlings and adults. Critical thermal minimum (base temperature) declined with elevation (0.7°C per 1,000 m), and the degree days were 509 across all elevations. For pest management, a base temperature from midelevation of 15.3°C (60°F) and growing degree days of 509 (equivalent to 916 Fahrenheit-based degree days) are reasonable estimates for applications from sea level to 2,700 m.
Topics: Acclimatization; Altitude; Animals; Gryllidae; Temperature
PubMed: 33219677
DOI: 10.1093/ee/nvaa151 -
International Journal For Quality in... Feb 2021The emergence of coronavirus disease of 2019 (COVID-19) highlights the necessity of rapidly identifying and isolating potentially infected individuals. Evaluating this...
QUALITY ISSUE
The emergence of coronavirus disease of 2019 (COVID-19) highlights the necessity of rapidly identifying and isolating potentially infected individuals. Evaluating this preparedness requires an assessment of the full clinical system, from intake to isolation.
INITIAL ASSESSMENT
Unannounced Standardized Patients (USPs) present a nimble, sensitive methodology for assessing this readiness.
CHOICE OF SOLUTION
Pilot the USP methodology, which employs an actor trained to present as a standardized, incognito potentially infected patient, to assess clinical readiness for potential COVID-19 patients at an urban, community safety-net clinic.
IMPLEMENTATION
The USP was trained to present at each team's front desk with the complaint of feeling unwell (reporting a fever of 101 degrees Fahrenheit in the past 24 hours) and exposure to a roommate recently returned from Beijing. The USP was trained to complete a behaviorally anchored assessment of the care she received from the clinical system.
EVALUATION
There was clear variation in care USPs received; some frontline clerical staff followed best practices; others did not. Signage and information on disease spread prevention publicly available was inconsistent. Qualitative comments shared by the USPs and those gathered during group debrief reinforced the experiences of the USPs and hospital leadership.
LESSONS LEARNED
USPs revealed significant variation in care practices within a clinical system. Utilization of this assessment methodology can provide just-in-time clinical information about readiness and safety practices, particularly during emerging outbreaks. USPs will prove especially powerful as clinicians and systems return to outpatient visits while remaining vigilant about potentially infected individuals.
Topics: COVID-19; Disaster Planning; Humans; New York City; Pandemics; Patient Isolation; Patient Simulation; Pilot Projects; SARS-CoV-2; Safety-net Providers
PubMed: 32991675
DOI: 10.1093/intqhc/mzaa116 -
Annals of Science Oct 2020Accounts of how the concept of temperature has evolved typically cast the story as ancillary to the history of the thermometer or the history of the concept of heat. But...
Accounts of how the concept of temperature has evolved typically cast the story as ancillary to the history of the thermometer or the history of the concept of heat. But then, because the history of temperature is not treated as a subject in its own right, modern associations inadvertently get read back into the historical record. This essay attempts to lay down an authoritative record not of what people in the past thought about what we call 'temperature' but of what they thought about what they called 'temperature' (or one of its cognates), from medieval times to today. It is found that invention of the thermometer had little impact on the concept of temperature. Much more significant were Fahrenheit's invention of a reliable instrument and William Thomson's effort to make a degree of temperature a unit of measure. Overlapping definitions of temperature then emerged in the late nineteenth century, and twentieth-century scientific developments forced physicists to reconsider temperature's conceptual boundaries. It turns out that the concept of temperature has evolved through stages that correspond to four increasingly sophisticated types of measurement. Its maturity sheds light on the philosophy of conceptual change.
Topics: Historiography; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Philosophy; Physics; Temperature
PubMed: 32981446
DOI: 10.1080/00033790.2020.1817980 -
Cureus Jun 2020Cardiac manifestations of coronavirus disease 19 (COVID-19), including arrhythmia, have been described in the literature. However, to our knowledge, association of...
Cardiac manifestations of coronavirus disease 19 (COVID-19), including arrhythmia, have been described in the literature. However, to our knowledge, association of COVID-19 with bradycardia has not been reported. This case study describes sinus bradycardia as a potential manifestation of COVID-19. This is a retrospective case series of four patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to St. Luke's University Health Network ICU between 24 March 2020 and 5 April 2020. Medical records of these patients were reviewed using the EPIC electronic health record system. Demographic, clinical, laboratory, and treatment data were reviewed against periods of bradycardia in each patient. The patient group comprised two males and two females. Two patients had pre-existing cardiovascular (CV) comorbidities but no history of arrythmias. Heart rates ranged between 66 and 88 beats/min on admission. The lowest rates during bradycardia were between 42 and 49 beats/min. The onset of sinus bradycardia in patients 1, 2, and 3 were day nine, 15, and five of illness, respectively. Patient 4 had three episodes of bradycardia, starting on day 10 of illness. Patients' bradycardia episodes lasted one to 14 days. During bradycardia, maximum body temperatures ranged between 99.9 and 100.2 degree Fahrenheit. Patients 2, 3, and 4 required vasopressors to maintain mean arterial pressure > 65 mmHg during episodes. All four patients were on propofol at some point during bradycardia with patients 1, 2, and 3 also receiving dexmedetomidine. There was no consistent correlation of these medications with bradycardia. Electrocardiogram (ECG) findings included sinus bradycardia. Prolonged QTc interval observed in patient 2 on admission improved during bradycardia. Transient sinus bradycardia is a possible manifestation of COVID-19 and is important for close CV surveillance. Etiology can be multifactorial, but severe hypoxia, inflammatory damage of cardiac pacemaker cells, and exaggerated response to medications are possible triggers. High levels of pro-inflammatory cytokines may act directly on the sinoatrial (SA) node contributing to the development of bradycardia. This may be a warning sign of the onset of a serious cytokine storm. An increased awareness of possible exaggerated bradycardia response is important to consider with the use of empiric medications which have arrhythmogenic effects.
PubMed: 32550090
DOI: 10.7759/cureus.8599 -
The Science of the Total Environment Aug 2020In this study, we aimed at analyzing the associations between transmission of and deaths caused by SARS-CoV-2 and meteorological variables, such as average temperature,...
In this study, we aimed at analyzing the associations between transmission of and deaths caused by SARS-CoV-2 and meteorological variables, such as average temperature, minimum temperature, maximum temperature, and precipitation. Two outcome measures were considered, with the first aiming to study SARS-CoV-2 infections and the second aiming to study COVID-19 mortality. Daily data as well as data on SARS-CoV-2 infections and COVID-19 mortality obtained between December 1, 2019 and March 28, 2020 were collected from weather stations around the world. The country's population density and time of exposure to the disease were used as control variables. Finally, a month dummy variable was added. Daily data by country were analyzed using the panel data model. An increase in the average daily temperature by one degree Fahrenheit reduced the number of cases by approximately 6.4 cases/day. There was a negative correlation between the average temperature per country and the number of cases of SARS-CoV-2 infections. This association remained strong even with the incorporation of additional variables and controls (maximum temperature, average temperature, minimum temperature, and precipitation) and fixed country effects. There was a positive correlation between precipitation and SARS-CoV-2 transmission. Countries with higher rainfall measurements showed an increase in disease transmission. For each average inch/day, there was an increase of 56.01 cases/day. COVID-19 mortality showed no significant association with temperature.
Topics: Betacoronavirus; COVID-19; Climate; Coronavirus Infections; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32353724
DOI: 10.1016/j.scitotenv.2020.138997 -
Case Reports in Infectious Diseases 2020. , an anaerobic Gram-negative bacillus, is a rare cause of opportunistic infections affecting premature infants to seniors. We present a 34-year-old man who was...
. , an anaerobic Gram-negative bacillus, is a rare cause of opportunistic infections affecting premature infants to seniors. We present a 34-year-old man who was presented for the management of diabetic ketoacidosis and developed bacteremia after one week of hospitalization. . A 34-year-old African-American male with uncontrolled diabetes mellitus type I and recurrent skin infections was admitted with diabetic ketoacidosis. He had left upper extremity abscess, preliminary wound cultures were positive for Gram-positive cocci, and an initial set of blood cultures were negative. He was started empirically on vancomycin. One week after admission, he started having chills followed by a recurrent increase in body temperature to 102 degrees Fahrenheit. The wound was healing, without active infection. Chest X-ray and CT scan of abdomen and pelvis to rule out infection were negative. Repeat blood cultures showed in both the tubes. The patient was successfully treated with intravenous ceftriaxone, and he recovered fully without any complication. . is a bacteria associated with plants; however, it can infect humans and vertebrate animals. The outcome seems favourable with the institution of appropriate antibiotics even in immunocompromised patients.
PubMed: 32313708
DOI: 10.1155/2020/7890305