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Klug CA, Swift MW, Miller JB, Lyons JL, Albert A, Laskoski M, Hangarter CM. High resolution solid state NMR in paramagnetic metal-organic frameworks. Solid State Nucl Magn Reson 2022; 120:101811. [PMID: 35792451 DOI: 10.1016/j.ssnmr.2022.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
We study the metal-organic framework (MOF) ZIF-67 with 1H and 13C nuclear magnetic resonance (NMR). In addition to the usual orbital chemical shifts, we observe spinning sideband manifolds in the NMR spectrum due to hyperfine interactions of the paramagnetic cobalt with 1H and 13C. Both orbital and paramagnetic chemical shifts are in good agreement with values calculated from first principles, allowing high-confidence assignment of the observed peaks to specific sites within the MOF. Our measured resonance shifts, line shapes, and spin lattice relaxation rates are also consistent with calculated values. We show that molecules in the pores of the MOF can exhibit high-resolution NMR spectra with fast spin lattice relaxation rates due to dipole-dipole couplings to the Co2+ nodes in the ZIF-67 lattice, showcasing NMR spectroscopy as a powerful tool for identification and characterization of "guests" that may be hosted by the MOF in electrochemical and catalytic applications.
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Affiliation(s)
- C A Klug
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA.
| | - M W Swift
- Materials Science Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - J B Miller
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - J L Lyons
- Materials Science Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - A Albert
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - M Laskoski
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - C M Hangarter
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA
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Abstract
PURPOSE OF REVIEW This article discusses meningitis and encephalitis infections caused by viruses, excluding herpes family and human immunodeficiency virus (HIV). RECENT FINDINGS The viral infections of the nervous system detailed in this article have no specific treatment other than supportive care. However, many of the viruses discussed are highly preventable by vaccination, proper skin protection against transmitting vectors, and postexposure prophylaxis. SUMMARY While meningitis and encephalitis caused by viruses may have some clinical overlap, the management and outcomes can be highly disparate, making distinction between the two imperative. Furthermore, despite their relative rarity in terms of clinical disease, many of the viral infections discussed herein are highly preventable. Given the morbidity and mortality attached to such infections, provider and patient education are the best approach available to prevent these potentially devastating illnesses.
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Abstract
The epidemiology of spinal cord disease in human immunodeficiency virus (HIV) infection is largely unknown due to a paucity of data since combination antiretroviral therapy (cART). HIV mediates spinal cord injury indirectly, by immune modulation, degeneration, or associated infections and neoplasms. The pathologies vary and range from cytotoxic necrosis to demyelination and vasculitis. Control of HIV determines the differential for all neurologic presentations in infected individuals. Primary HIV-associated acute transverse myelitis, an acute inflammatory condition with pathologic similarities to HIV encephalitis, arises in early infection and at seroconversion. In contrast, HIV vacuolar myelopathy and opportunistic infections predominate in uncontrolled disease. There is systemic immune dysregulation as early as primary infection due to initial depletion of gut-associated lymphoid tissue CD4 cells and allowance of microbial translocation across the gut that never fully recovers throughout the course of HIV infection, regardless of how well controlled. The subsequent proinflammatory state may contribute to spinal cord diseases observed even after cART initiation. This chapter will highlight an array of spinal cord pathologies classified by stage of HIV infection and immune status.
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Affiliation(s)
- Seth N Levin
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jennifer L Lyons
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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AbdelRazek MA, Gutierrez J, Mampre D, Cervantes-Arslanian A, Ormseth C, Haussen D, Thakur KT, Lyons JL, Smith BR, O'Connor O, Willey JZ, Mateen FJ. Intravenous Thrombolysis for Stroke and Presumed Stroke in Human Immunodeficiency Virus-Infected Adults: A Retrospective, Multicenter US Study. Stroke 2018; 49:228-231. [PMID: 29273597 DOI: 10.1161/strokeaha.117.019570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/04/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Human immunodeficiency virus (HIV) infection has been shown to increase both ischemic and hemorrhagic stroke risks, but there are limited data on the safety and outcomes of intravenous thrombolysis with tPA (tissue-type plasminogen activator) for acute ischemic stroke in HIV-infected patients. METHODS A retrospective chart review of intravenous tPA-treated HIV patients who presented with acute stroke symptoms was performed in 7 large inner-city US academic centers (various search years between 2000 and 2017). We collected data on HIV, National Institutes of Health Stroke Scale score, ischemic stroke risk factors, opportunistic infections, intravenous drug abuse, neuroimaging findings, and modified Rankin Scale score at last follow-up. RESULTS We identified 33 HIV-infected patients treated with intravenous tPA (mean age, 51 years; 24 men), 10 of whom were stroke mimics. Sixteen of 33 (48%) patients had an HIV viral load less than the limit of detection while 10 of 33 (30%) had a CD4 count <200/mm3. The median National Institutes of Health Stroke Scale score at presentation was 9, and mean time from symptom onset to tPA was 144 minutes (median, 159). The median modified Rankin Scale score for the 33-patient cohort was 1 and for the 23-patient actual stroke cohort was 2, measured at a median of 90 days poststroke symptom onset. Two patients had nonfatal hemorrhagic transformation (6%; 95% confidence interval, 1%-20%), both in the actual stroke group. Two patients had varicella zoster virus vasculitis of the central nervous system, 1 had meningovascular syphilis, and 7 other patients were actively using intravenous drugs (3 cocaine, 1 heroin, and 3 unspecified), none of whom had hemorrhagic transformation. CONCLUSIONS Most HIV-infected patients treated with intravenous tPA for presumed and actual acute ischemic stroke had no complications, and we observed no fatalities. Stroke mimics were common, and thrombolysis seems safe in this group. We found no data to suggest an increased risk of intravenous tPA-related complications because of concomitant opportunistic infections or intravenous drug abuse.
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Affiliation(s)
- Mahmoud A AbdelRazek
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Jose Gutierrez
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - David Mampre
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Anna Cervantes-Arslanian
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Cora Ormseth
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Diogo Haussen
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Kiran T Thakur
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Jennifer L Lyons
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Bryan R Smith
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Owen O'Connor
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Joshua Z Willey
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.)
| | - Farrah J Mateen
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.).
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Affiliation(s)
- Jennifer L Lyons
- From the Departments of Neurology (J.L.L., T.A.C.), Radiology (P.W.S.), and Pathology (M.M.A.), Harvard Medical School, the Department of Neurology, Brigham and Women's Hospital (J.L.L.), and the Departments of Neurology (T.A.C.), Radiology (P.W.S.), and Pathology (M.M.A.), Massachusetts General Hospital - all in Boston
| | - Pamela W Schaefer
- From the Departments of Neurology (J.L.L., T.A.C.), Radiology (P.W.S.), and Pathology (M.M.A.), Harvard Medical School, the Department of Neurology, Brigham and Women's Hospital (J.L.L.), and the Departments of Neurology (T.A.C.), Radiology (P.W.S.), and Pathology (M.M.A.), Massachusetts General Hospital - all in Boston
| | - Tracey A Cho
- From the Departments of Neurology (J.L.L., T.A.C.), Radiology (P.W.S.), and Pathology (M.M.A.), Harvard Medical School, the Department of Neurology, Brigham and Women's Hospital (J.L.L.), and the Departments of Neurology (T.A.C.), Radiology (P.W.S.), and Pathology (M.M.A.), Massachusetts General Hospital - all in Boston
| | - Marwan M Azar
- From the Departments of Neurology (J.L.L., T.A.C.), Radiology (P.W.S.), and Pathology (M.M.A.), Harvard Medical School, the Department of Neurology, Brigham and Women's Hospital (J.L.L.), and the Departments of Neurology (T.A.C.), Radiology (P.W.S.), and Pathology (M.M.A.), Massachusetts General Hospital - all in Boston
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Bank AM, Saadi A, McKee KE, Mejia NI, Lyons JL. Opinion and Special Articles: Creation of a diversity and inclusion certificate program for neurology residents. Neurology 2017; 89:e146-e148. [DOI: 10.1212/wnl.0000000000004387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gonzalez DA, Scharoun SM, Cinelli ME, Bryden PJ, Lyons JL, Roy EA. Object-Tool-Actor Interaction: Object Information Drives Intended Action. J Mot Behav 2017; 50:80-95. [PMID: 28350231 DOI: 10.1080/00222895.2017.1283293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tool use is typically explored via actor-tool interactions. However, the target-object (that which is being acted on) may influence perceived action possibilities and thereby guide action. Three different tool-target-object pairings were tested (Experiment 1). The hammering action demonstrated the greatest sensitivity and therefore subsequently used to further investigate target-object pairings. The hammer was removed as an option and instructions were provided using pictorial (Experiment 2), written (Experiment 3), and both pictorial and written formats (Experiment 4). The designed tool is chosen when available (Experiment 1) and when removed as a choice (i.e., the hammer), participants perform the same action associated with the designed tool (i.e., hammering) regardless of instruction method (Experiments 2, 3, and 4).
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Affiliation(s)
- Dave A Gonzalez
- a Department of Kinesiology , University of Waterloo , Ontario , Canada
| | - Sara M Scharoun
- b School of Physical and Health Education , Nipissing University , North Bay , Ontario , Canada
| | - M E Cinelli
- c Department of Kinesiology and Physical Education , Wilfrid Laurier University , Waterloo , Ontario , Canada
| | - P J Bryden
- c Department of Kinesiology and Physical Education , Wilfrid Laurier University , Waterloo , Ontario , Canada
| | - J L Lyons
- d Department of Kinesiology , McMaster University , Hamilton , Ontario , Canada
| | - Eric A Roy
- a Department of Kinesiology , University of Waterloo , Ontario , Canada
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Abstract
The clinician who is evaluating a patient with a suspected central nervous system infection often faces a large differential diagnosis. There are several signs, symptoms, geographical clues, and diagnostic testing, such as cerebrospinal fluid abnormalities and magnetic resonance imaging abnormalities, which can be helpful in identifying the etiological agent. By taking a systematic approach, one can often identify life-threatening, common, and/or treatable etiologies. Here the authors describe some of the pearls and pitfalls in diagnosing and treating acute infectious meningitis and encephalitis.
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Affiliation(s)
- Amanda L Piquet
- Division of Neuroimmunology, Department of Neurology, University of Utah Hospital, Salt Lake City, Utah
| | - Jennifer L Lyons
- Division of Neurological Infections and Inflammatory Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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Patel KP, Vaidya A, Gibson CJ, Henrich TJ, Lyons JL. INTERACTIVE MEDICAL CASE. A Woman with Dyspnea and Altered Mental Status. N Engl J Med 2016; 374:e29. [PMID: 27276581 DOI: 10.1056/nejmimc1510029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Piantadosi A, Rubin DB, McQuillen DP, Hsu L, Lederer PA, Ashbaugh CD, Duffalo C, Duncan R, Thon J, Bhattacharyya S, Basgoz N, Feske SK, Lyons JL. Emerging Cases of Powassan Virus Encephalitis in New England: Clinical Presentation, Imaging, and Review of the Literature. Clin Infect Dis 2016; 62:707-713. [PMID: 26668338 PMCID: PMC4850925 DOI: 10.1093/cid/civ1005] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 11/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Powassan virus (POWV) is a rarely diagnosed cause of encephalitis in the United States. In the Northeast, it is transmitted by Ixodes scapularis, the same vector that transmits Lyme disease. The prevalence of POWV among animal hosts and vectors has been increasing. We present 8 cases of POWV encephalitis from Massachusetts and New Hampshire in 2013-2015. METHODS We abstracted clinical and epidemiological information for patients with POWV encephalitis diagnosed at 2 hospitals in Massachusetts from 2013 to 2015. We compared their brain imaging with those in published findings from Powassan and other viral encephalitides. RESULTS The patients ranged in age from 21 to 82 years, were, for the most part, previously healthy, and presented with syndromes of fever, headache, and altered consciousness. Infections occurred from May to September and were often associated with known tick exposures. In all patients, cerebrospinal fluid analyses showed pleocytosis with elevated protein. In 7 of 8 patients, brain magnetic resonance imaging demonstrated deep foci of increased T2/fluid-attenuation inversion recovery signal intensity. CONCLUSIONS We describe 8 cases of POWV encephalitis in Massachusetts and New Hampshire in 2013-2015. Prior to this, there had been only 2 cases of POWV encephalitis identified in Massachusetts. These cases may represent emergence of this virus in a region where its vector, I. scapularis, is known to be prevalent or may represent the emerging diagnosis of an underappreciated pathogen. We recommend testing for POWV in patients who present with encephalitis in the spring to fall in New England.
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MESH Headings
- Acyclovir/therapeutic use
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antibodies, Viral/cerebrospinal fluid
- Antiviral Agents/therapeutic use
- Brain/diagnostic imaging
- Brain/pathology
- Brain/virology
- Encephalitis Viruses, Tick-Borne/drug effects
- Encephalitis Viruses, Tick-Borne/immunology
- Encephalitis Viruses, Tick-Borne/pathogenicity
- Encephalitis, Tick-Borne/diagnosis
- Encephalitis, Tick-Borne/diagnostic imaging
- Encephalitis, Tick-Borne/epidemiology
- Encephalitis, Tick-Borne/virology
- Female
- Flavivirus/drug effects
- Flavivirus/immunology
- Flavivirus/pathogenicity
- Humans
- Ixodes/virology
- Magnetic Resonance Imaging
- Male
- Massachusetts/epidemiology
- Meningitis, Bacterial/drug therapy
- Middle Aged
- New Hampshire/epidemiology
- Prevalence
- Seasons
- United States/epidemiology
- Young Adult
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Affiliation(s)
- Anne Piantadosi
- Division of Infectious Disease, Massachusetts General Hospital
| | - Daniel B Rubin
- Department of Neurology, Brigham and Women's Hospital, Boston
| | - Daniel P McQuillen
- Department of Infectious Diseases, Lahey Hospital & Medical Center, Tufts University School of Medicine, Burlington
| | | | | | - Cameron D Ashbaugh
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chad Duffalo
- Christiana Care Health System, Division of Infectious Diseases, Newark, Delaware
| | - Robert Duncan
- Department of Infectious Diseases, Lahey Hospital & Medical Center, Tufts University School of Medicine, Burlington
| | - Jesse Thon
- Department of Neurology, Brigham and Women's Hospital, Boston
| | | | - Nesli Basgoz
- Division of Infectious Disease, Massachusetts General Hospital
| | - Steven K Feske
- Department of Neurology, Brigham and Women's Hospital, Boston
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Lyons JL, Van de Walle CG. Surprising stability of neutral interstitial hydrogen in diamond and cubic BN. J Phys Condens Matter 2016; 28:06LT01. [PMID: 26790459 DOI: 10.1088/0953-8984/28/6/06lt01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In virtually all semiconductors and insulators, hydrogen interstitials ([Formula: see text]) act as negative-U centers, implying that hydrogen is never stable in the neutral charge state. Using hybrid density functional calculations, we find a different behavior for [Formula: see text] in diamond and cubic BN. In diamond, [Formula: see text] is a very strong positive-U center, and the [Formula: see text] charge state is stable over a Fermi-level range of more than 2 eV. In cubic BN, a III-V compound similar to diamond, we also find positive-U behavior, though over a much smaller Fermi-level range. These results highlight the unique behavior of [Formula: see text] in these covalent wide-band-gap semiconductors.
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Affiliation(s)
- J L Lyons
- Materials Department, University of California, Santa Barbara, CA 93106-5050, USA
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Affiliation(s)
- Jennifer L Lyons
- Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - Sean X Zhang
- Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, MD, USA.,Division of Medical Microbiology, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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Abstract
PURPOSE OF REVIEW This article reviews the common infectious etiologies of spinal cord dysfunction that span the globe epidemiologically and vary pathophysiologically. RECENT FINDINGS Many microorganisms have the ability to directly or indirectly result in spinal cord dysfunction. These agents may have the ability to infect the spinal cord itself, but frequently cause indirect damage by parainfectious or postinfectious immune-mediated destruction or external compression of the spinal cord. SUMMARY Infectious myelopathies can pose diagnostic difficulty but are potentially reversible causes of spinal cord dysfunction. The often complex relationship among the infectious agent, the immune system, and the neuraxis can create a difficult management conundrum whereby immune modulation may be the preferred approach.
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Bank AM, Batra A, Colorado RA, Lyons JL. Myeloradiculopathy associated with chikungunya virus infection. J Neurovirol 2015; 22:125-8. [PMID: 26306687 DOI: 10.1007/s13365-015-0372-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/25/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that is endemic to parts of Africa, South and Southeast Asia, and more recently the Caribbean. Patients typically present with fever, rash, and arthralgias, though neurologic symptoms, primarily encephalitis, have been described. We report the case of a 47-year-old woman who was clinically diagnosed with CHIKV while traveling in the Dominican Republic and presented 10 days later with left lower extremity weakness, a corresponding enhancing thoracic spinal cord lesion, and positive CHIKV serologies. She initially responded to corticosteroids, followed by relapsing symptoms and gradual clinical improvement. The time lapse between acute CHIKV infection and the onset of myelopathic sequelae suggests an immune-mediated phenomenon rather than direct activity of the virus itself. Chikungunya virus should be considered in the differential diagnosis of myelopathy in endemic areas. The progression of symptoms despite corticosteroid administration suggests more aggressive immunomodulatory therapies may be warranted at disease onset.
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Affiliation(s)
- Anna M Bank
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. .,Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. .,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Ayush Batra
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Rene A Colorado
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jennifer L Lyons
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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15
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Thakur KT, Lyons JL, Smith BR, Shinohara RT, Mateen FJ. Stroke in HIV-infected African Americans: a retrospective cohort study. J Neurovirol 2015; 22:50-5. [PMID: 26155903 DOI: 10.1007/s13365-015-0363-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 12/31/2022]
Abstract
The risk of having a first stroke is nearly twice as high among African Americans compared to Caucasians. HIV/AIDS is an independent risk factor for stroke. Our study aimed to report the risk factors and short-term clinical outcomes of African Americans with HIV infection and new-onset stroke admitted at the Johns Hopkins Hospitals (2000-2012). Multivariate linear regression was used to examine the association between potential predictors and odds of an unfavorable outcome, defined as a higher modified Rankin Scale (mRS) score on hospital discharge. African Americans comprised 105/125 (84%) of HIV-infected new-onset stroke inpatients (median age 50 years; 69% men; median CD4 140/mL; ischemic 77%; 39% taking highly active antiretroviral therapy). Vascular risk factors were common: hypertension (67%), cigarette smoking (66%), dyslipidemia (42%), hepatitis C (48%), intravenous drug abuse (32%), and prior myocardial infarction (29%). Prior aspirin and statin use were uncommon (18%, 9%). Unfavorable outcome (mRS score 4-6, n = 22 of 90 available records) was noted in 24% of patients, including seven in-hospital deaths. On multivariate analyses, higher CD4 count on hospital admission was associated with a lower mRS (-0.2 mRS points per 1 unit increase in CD4, 95% CI (-0.3, 0), p = 0.03). Intracerebral hemorrhage was also associated with a lower mRS (1.0 points lower, 95% CI (0.2, 1.8) compared to ischemic stroke, p = 0.01) after adjustment for other potential predictors. This underscores the importance of HIV infection on functional stroke outcomes beyond its recognized influence on stroke risk.
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Affiliation(s)
- Kiran T Thakur
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, USA.
| | - Jennifer L Lyons
- Harvard Medical School, Boston, MA, USA.,Division of Neuroinfectious Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Bryan R Smith
- Section of Infections of the Nervous System, National Institute for Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Farrah J Mateen
- Harvard Medical School, Boston, MA, USA. .,Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, Boston, MA, 02114, USA.
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16
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Abstract
Syphilis has reemerged as an important cause of neurological disease, affecting any part of the neuraxis at any stage of infection. What was once a dwindling diagnosis is now redoubling, particularly in the HIV-positive and in men who have sex with men populations. In the era of antibiotics and HIV coinfection, neurosyphilis presentations are protean, making diagnosis notoriously challenging. Advanced disease may be irreversible, and so early detection and treatment are ideal. Herein, we review recent advances in understanding neurosyphilis.
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17
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Morris NA, Matiello M, Lyons JL, Samuels MA. Neurologic complications in infective endocarditis: identification, management, and impact on cardiac surgery. Neurohospitalist 2014; 4:213-22. [PMID: 25360207 DOI: 10.1177/1941874414537077] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neurologic complications of infective endocarditis (IE) are common and frequently life threatening. Neurologic events are not always obvious. The prediction and management of neurologic complications of IE are not easily approached algorithmically, and the impact they have on timing and ability to surgically repair or replace the affected valve often requires a painstaking evaluation and joint effort across multiple medical disciplines in order to achieve the best possible outcome. Although specific recommendations are always tailored to the individual patient, there are some guiding principles that can be used to help direct the decision-making process. Herein, we review the pathophysiology, epidemiology, manifestations, and diagnosis of neurological complications of IE and further consider the impact they have on clinical decision making.
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Affiliation(s)
- Nicholas A Morris
- Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marcelo Matiello
- Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer L Lyons
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin A Samuels
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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18
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Raibagkar P, Neagu MR, Lyons JL, Klein JP. Imaging in neurologic infections I: bacterial and parasitic diseases. Curr Infect Dis Rep 2014; 16:443. [PMID: 25348741 DOI: 10.1007/s11908-014-0443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Often presenting as medical emergencies, nervous system infections can be diagnostically challenging. Knowledgeable utilization of neuroimaging modalities and the understanding of characteristic imaging findings facilitate early diagnosis and treatment. In the first part of this two-part review, we address common and unique diagnostic imaging features of bacterial and parasitic nervous system infections.
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Affiliation(s)
- Pooja Raibagkar
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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19
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Abstract
Infectious causes of peripheral nervous system (PNS) disease are underrecognized but potentially treatable. Heightened awareness educed by advanced understanding of the presentations and management of these infections can aid diagnosis and facilitate treatment. In this review, we discuss the clinical manifestations, diagnosis, and treatment of common bacterial, viral, and parasitic infections that affect the PNS. We additionally detail PNS side effects of some frequently used antimicrobial agents.
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Affiliation(s)
- Kate T. Brizzi
- Massachusetts General Hospital, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jennifer L. Lyons
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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20
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Affiliation(s)
- Jennifer L Lyons
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael G Erkkinen
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts Massachusetts General Hospital, Boston
| | - Ivana Vodopivec
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts Massachusetts General Hospital, Boston
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21
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Sweeney EM, Thakur KT, Lyons JL, Smith BR, Willey JZ, Cervantes-Arslanian AM, Hickey MK, Uchino K, Haussen DC, Koch S, Schwamm LH, Elkind MSV, Shinohara RT, Mateen FJ. Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults. Eur J Neurol 2014; 21:1394-9. [PMID: 25040336 DOI: 10.1111/ene.12506] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To our knowledge there are no studies reporting the use and short-term outcomes of intravenous tissue plasminogen activator (IV-TPA) for the treatment of acute ischaemic stroke (AIS) in people living with HIV. METHODS The US Nationwide Inpatient Sample (NIS) (2006-2010) was searched for HIV-infected AIS patients treated with IV-TPA. RESULTS In the NIS, 2.2% (62/2877) of HIV-infected AIS cases were thrombolyzed with IV-TPA (median age 52 years, range 27-78, 32% female, 22% Caucasian) vs. 2.1% (19 335/937 896) of HIV-uninfected cases (median age 72 years, range 17-102 years, 50% female, 74% Caucasian; P = 0.77). There were more deaths in HIV-infected versus uninfected patients with stroke (220/2877, 7.6% vs. 49 089/937 547, 5.2%, P < 0.001) but no difference in the proportion of deaths amongst IV-TPA-treated patients. The age- and sex-adjusted odds ratio for death following IV-TPA administration in HIV-infected versus uninfected patients was 2.26 (95% CI 1.12, 4.58), but the interaction on mortality between HIV and IV-TPA use was not statistically significant, indicating no difference in risk of in-hospital death by HIV serostatus with IV-TPA use. A higher number of HIV-infected patients remained in hospital versus died or were discharged at both 10 and 30 days (P < 0.01 at 10 and 30 days). No difference in the proportion of intracerebral hemorrhage in the two groups was found (P = 0.362). CONCLUSIONS The in-hospital mortality is higher amongst HIV-infected AIS patients than HIV-uninfected patients. However, the risk of death amongst HIV-infected patients treated with IV-TPA is similar to HIV-uninfected groups.
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Affiliation(s)
- E M Sweeney
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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22
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Snider SB, Jacobs CS, Scripko PS, Klein JP, Lyons JL. Hemorrhagic and ischemic stroke secondary to herpes simplex virus type 2 meningitis and vasculopathy. J Neurovirol 2014; 20:419-22. [PMID: 24806272 DOI: 10.1007/s13365-014-0253-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/15/2014] [Indexed: 11/29/2022]
Abstract
Herpes simplex virus type 2 (HSV-2) meningitis dogmatically is benign and self-limited in the immune competent patient. However, we describe how left untreated HSV-2 meningitis can be complicated by vasculitis and both ischemic and hemorrhagic stroke. We report a 57-year-old woman with lymphocytic meningitis complicated by ischemic stroke and intracerebral hemorrhage in the setting of vasculopathy and HSV-2 DNA detected in CSF successfully treated with acyclovir and corticosteroids. Subsequent angiographic magnetic resonance imaging revealed improvement in the vasculopathy after treatment. This case demonstrates that HSV-2 meningitis may take a less benign course and further provides the first evidence of angiographic improvement in addition to clinical improvement after definitive treatment.
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Affiliation(s)
- Samuel B Snider
- Departments of Neurology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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23
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Litvintseva AP, Lindsley MD, Gade L, Smith R, Chiller T, Lyons JL, Thakur KT, Zhang SX, Grgurich DE, Kerkering TM, Brandt ME, Park BJ. Utility of (1-3)-β-D-glucan testing for diagnostics and monitoring response to treatment during the multistate outbreak of fungal meningitis and other infections. Clin Infect Dis 2013; 58:622-30. [PMID: 24336827 DOI: 10.1093/cid/cit808] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The 2012 outbreak of fungal meningitis associated with contaminated methylprednisolone produced by a compounding pharmacy has resulted in >750 infections. An important question facing patients and clinicians is the duration of antifungal therapy. We evaluated (1-3)-β-d-glucan (BDG) as a marker for monitoring response to treatment. METHODS We determined sensitivity and specificity of BDG testing using the Fungitell assay, by testing 41 cerebrospinal fluid (CSF) specimens from confirmed cases of fungal meningitis and 66 negative control CSF specimens. We also assessed whether BDG levels correlate with clinical status by using incident samples from 108 case patients with meningitis and 20 patients with serially collected CSF. RESULTS A cutoff value of 138 pg/mL provided 100% sensitivity and 98% specificity for diagnosis of fungal meningitis in this outbreak. Patients with serially collected CSF were divided into 2 groups: those in whom BDG levels declined with treatment and those in whom BDG remained elevated. Whereas most patients with a decline in CSF BDG had clinical improvement, all 3 patients with continually elevated BDG had poor clinical outcomes (stroke, meningitis relapse, or development of new disease). CONCLUSIONS Our data suggest that measuring BDG in CSF is a highly sensitive test for diagnosis of fungal meningitis in this outbreak. Analysis of BDG levels in serially collected CSF demonstrated that BDG may correlate with clinical response. Routine measurement of BDG in CSF may provide useful adjunctive data for the clinical management of patients with outbreak-associated meningitis.
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Affiliation(s)
- Anastasia P Litvintseva
- Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Abstract
OBJECTIVE To ascertain the current status of global health training and humanitarian relief opportunities in US and Canadian postgraduate neurology programs. BACKGROUND There is a growing interest among North American trainees to pursue medical electives in low- and middle-income countries. Such training opportunities provide many educational and humanitarian benefits but also pose several challenges related to organization, human resources, funding, and trainee and patient safety. The current support and engagement of neurology postgraduate training programs for trainees to pursue international rotations is unknown. METHODS A survey was distributed to all program directors in the United States and Canada (December 2012-February 2013) through the American Academy of Neurology to assess the training opportunities, institutional partnerships, and support available for international neurology electives. RESULTS Approximately half of responding programs (53%) allow residents to pursue global health-related electives, and 11% reported that at least 1 trainee participated in humanitarian relief during training (survey response rate 61%, 143/234 program directors). Canadian programs were more likely to allow residents to pursue international electives than US programs (10/11, 91% vs 65/129, 50%, p = 0.023). The number of trainees participating in international electives was low: 0%-9% of residents (55% of programs) and 10%-19% of residents (21% of programs). Lack of funding was the most commonly cited reason for residents not participating in global health electives. If funding was available, 93% of program directors stated there would be time for residents to participate. Most program directors (75%) were interested in further information on global health electives. CONCLUSIONS In spite of high perceived interest, only half of US neurology training programs include international electives, mostly due to a reported lack of funding. By contrast, the majority of Canadian programs that responded allow international electives, likely due to clearer guidelines from the Royal College of Physicians and Surgeons of Canada compared to the Accreditation Council of Graduate Medical Education. However, the number of both Canadian and US neurology trainees venturing abroad remains a minority. Most program directors are interested in learning more information related to global health electives for neurology residents.
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Affiliation(s)
- Jennifer L Lyons
- From the Department of Neurology (J.L.L.), Brigham and Women's Hospital, Boston, MA; the American Academy of Neurology (M.E.C.), Minneapolis, MN; the Department of Neurology (J.W.E.), University of California at San Francisco; the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; and the Department of International Health (F.J.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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25
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Berkowitz AL, Mittal MK, McLane HC, Shen GC, Muralidharan R, Lyons JL, Shinohara RT, Shuaib A, Mateen FJ. Worldwide Reported Use of IV Tissue Plasminogen Activator for Acute Ischemic Stroke. Int J Stroke 2013; 9:349-55. [DOI: 10.1111/ijs.12205] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
Abstract
Background and Purpose Intravenous tissue plasminogen activator is the most effective treatment for acute ischemic stroke, and its use may therefore serve as an indicator of the available level of acute stroke care. The greatest burden of stroke is in low- and middle-income countries, but the extent to which intravenous tissue plasminogen activator is used in these countries is unreported. Summary of Review A systematic review was performed searching each country name AND ‘stroke’ OR ‘tissue plasminogen activator’ OR ‘thrombolysis’ using PubMed, Embase, Global Health, African Index Medicus, and abstracts published in the International Journal of Stroke (Jan. 1, 1996–Oct. 1, 2012). The reported use of intravenous tissue plasminogen activator was then analyzed according to country-level income status, total expenditure on health per capita, and mortality and disability-adjusted life years due to stroke. There were 118 780 citations reviewed. Of 214 countries and independent territories, 64 (30%) reported use of intravenous tissue plasminogen activator for acute ischemic stroke in the medical literature: 3% (1/36) low-income, 19% (10/54) lower-middle-income, 33% (18/54) upper-middle-income, and 50% (35/70) high-income-countries (test for trend, P < 0·001). When considering country-level determinants of reported intravenous tissue plasminogen activator use for acute ischemic stroke, total healthcare expenditure per capita (odds ratio 3·3 per 1000 international dollar increase, 95% confidence interval 1·4–9·9, P = 0·02) and reported mortality rate from cerebrovascular disease (odds ratio 1·02, 95% confidence interval 0·99–1·06, P = 0·02) were significant, but reported disability-adjusted life years from cerebrovascular diseases and gross national income per capita were not ( P > 0·05). Of the 10 countries with the highest disability-adjusted life years due to stroke, only one reported intravenous tissue plasminogen activator use. Conclusions By reported use, intravenous tissue plasminogen activator for acute ischemic stroke is available to some patients in approximately one-third of countries. Access to advanced acute stroke care is most limited where the greatest burden of cerebrovascular disease is reported.
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Affiliation(s)
- Aaron L. Berkowitz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Manoj K. Mittal
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Gordon C. Shen
- Health Policy and Management Division, School of Public Health, University of California, Berkeley, CA, USA
| | - RajaNandini Muralidharan
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer L. Lyons
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russell T. Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashfaq Shuaib
- Division of Neurology, Department of Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
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26
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Abstract
Mold infections of the central nervous system (CNS) present as abscesses, infarcts, hemorrhages, and, less commonly, meningitis. These invasive infections are difficult both to identify and to eradicate given low-sensitivity diagnostics and high-toxicity, low-efficacy antifungal therapies, hence resulting in high rates of morbidity and mortality. Herein, the recent literature on CNS mold infections is reviewed, and updates in diagnosis and management are discussed.
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Affiliation(s)
- Jennifer L Lyons
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,
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27
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Abstract
Integrity of descending white matter tracts can be evaluated by diffusion tensor imaging. In rim-enhancing intraparenchymal lesions, this technique can assist in the differentiation of demyelinating disease from tumor or abscess. Diffusion tensor imaging characteristics of tuberculoma have not been previously reported to our knowledge. A patient with headaches, dizziness, and mild left-sided weakness underwent MRI with diffusion tensor imaging. A large, rim-enhancing lesion within the pons was discovered, which subsequently was diagnosed as tuberculoma. Tractography maps prepared from diffusion tensor imaging data revealed predominantly displaced descending fiber tracts in the region of the rim-enhancing lesion. A few tracts adjacent to the lesion appeared truncated, and this abnormal finding correlated to the patient's clinical deficit. The tractography characteristics of diffusion tensor imaging in this patient potentially are distinct from those seen with demyelinating lesions, which may show more extensive tract truncation. Together with the consonance of exam findings and tract truncation seen in this patient, tractography may prove useful in the diagnosis of suspected tuberculoma.
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Affiliation(s)
- Jennifer L Lyons
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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28
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Awosika OO, Lyons JL, Ciarlini P, Phillips RE, Alfson ED, Johnson EL, Koo S, Marty F, Drew C, Zaki S, Folkerth RD, Klein JP. Fatal adenovirus encephalomyeloradiculitis in an umbilical cord stem cell transplant recipient. Neurology 2013; 80:1715-7. [PMID: 23596062 DOI: 10.1212/wnl.0b013e3182904f96] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Oluwole O Awosika
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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29
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Bell WR, Dalton JB, McCall CM, Karram S, Pearce DT, Memon W, Lee R, Carroll KC, Lyons JL, Gireesh ED, Trivedi JB, Cettomai D, Smith BR, Chang T, Tochen L, Ratchford JN, Harrison DM, Ostrow LW, Stevens RD, Chen L, Zhang SX. Iatrogenic Exserohilum infection of the central nervous system: mycological identification and histopathological findings. Mod Pathol 2013; 26:166-70. [PMID: 23222492 DOI: 10.1038/modpathol.2012.208] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An outbreak of fungal infections has been identified in patients who received epidural injections of methylprednisolone acetate that was contaminated with environmental molds. In this report, we present the mycological and histopathological findings in an index case of Exserohilum meningitis and vasculitis in an immunocompetent patient, who received a cervical spine epidural steroid injection for chronic neck pain 1 week before the onset of fulminant meningitis with subsequent multiple brain and spinal cord infarcts. The fungus was recovered from two separate cerebrospinal fluid specimens collected before initiation of antifungal therapy and at autopsy on standard bacterial and fungal culture media. The mold was identified phenotypically as Exserohilum species. DNA sequencing targeting the internal transcribed spacer region and D1/D2 region of 28S ribosomal DNA enabled further speciation as E. rostratum. Gross examination at autopsy revealed moderate brain edema with bilateral uncal herniation and a ventriculostomy tract to the third ventricle. The brainstem, cerebellum, and right orbitofrontal cortex were soft and friable, along with hemorrhages in the cerebellar vermis and thalamus. Microscopic examination demonstrated numerous fungi with septate hyphae invading blood vessel walls and inducing acute necrotizing inflammation. The leptomeninges were diffusely infiltrated by mixed inflammatory cells along with scattered foci of fungal elements. This is the first report of iatrogenic E. rostratum meningitis in humans. This report describes the microbiological procedures and histopathological features for the identification of E. rostratum (a pigmented vascularly invasive fungi), the cause of a current nationwide outbreak of fatal fungal meningitis.
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Affiliation(s)
- W Robert Bell
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287-7093, USA
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30
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Lyons JL, Gireesh ED, Trivedi JB, Bell WR, Cettomai D, Smith BR, Karram S, Chang T, Tochen L, Zhang SX, McCall CM, Pearce DT, Carroll KC, Chen L, Ratchford JN, Harrison DM, Ostrow LW, Stevens RD. Fatal exserohilum meningitis and central nervous system vasculitis after cervical epidural methylprednisolone injection. Ann Intern Med 2012; 157:835-6. [PMID: 23277893 DOI: 10.7326/0003-4819-158-1-201212040-00557] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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31
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Wood BR, Klein JP, Lyons JL, Milner DA, Phillips RE, Schutten M, Folkerth RD, Ciarlini P, Henrich TJ, Johnson JA. HIV-2 encephalitis: case report and literature review. AIDS Patient Care STDS 2012; 26:383-7. [PMID: 22694171 DOI: 10.1089/apc.2012.0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report the case of a 59-year-old man who moved from Cape Verde to Massachusetts at the age of 29. He had multiple sexual contacts with female partners in Cape Verde and with West African women in Massachusetts, as well as multiple past indeterminate HIV-1 antibody tests. He presented to our facility with 2-3 months of inappropriate behaviors, memory impairment, weight loss, and night sweats, at which time he was found to have an abnormal enhancing lesion of the corpus collosum on brain magnetic resonance imaging (MRI). Laboratory testing revealed a CD4 count of 63 cells/mm(3), positive HIV-2 Western blot, serum HIV-2 RNA polymerase chain reaction (PCR) of 1160 copies per milliliter and cerebrospinal fluid (CSF) HIV-2 RNA PCR of 2730 copies per milliliter. Brain biopsy demonstrated syncytial giant cells centered around small blood vessels and accompanied by microglia, which correlated with prior pathologic descriptions of HIV-2 encephalitis and with well-described findings of HIV-1 encephalitis. Based on genotype resistance assay results, treatment guidelines, and prior studies validating success with lopinavir-ritonavir, he was treated with tenofovir-emtricitabine and lopinavir-ritonavir, which has led to virologic suppression along with steady neurologic and radiologic improvement, although he continues to have deficits.
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Affiliation(s)
- Brian R. Wood
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joshua P. Klein
- Departments of Neurology and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer L. Lyons
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Danny A. Milner
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard E. Phillips
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Martin Schutten
- Erasmus MC, Department of Virology, Rotterdam, The Netherlands
| | - Rebecca D. Folkerth
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pedro Ciarlini
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Timothy J. Henrich
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer A. Johnson
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts
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Lyons JL, Uno H, Ancuta P, Kamat A, Moore DJ, Singer EJ, Morgello S, Gabuzda D. Plasma sCD14 is a biomarker associated with impaired neurocognitive test performance in attention and learning domains in HIV infection. J Acquir Immune Defic Syndr 2011; 57:371-9. [PMID: 21646912 DOI: 10.1097/qai.0b013e3182237e54] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Mild forms of HIV-associated neurocognitive disorders (HAND) remain prevalent in the era of combination antiretroviral therapy (cART). Although elevated lipopolysaccharide (LPS) and immune activation are implicated in HAND pathogenesis, relationships of LPS and inflammatory markers to mild forms of HAND or impairment in specific cognitive domains are unknown. To examine these relationships, we compared plasma soluble CD14 (sCD14), CCL2, and LPS levels with neurocognitive test scores in a cART era cohort. METHODS We analyzed plasma from HIV+ subjects (n = 97) with nadir CD4 counts <300 and high frequency of hepatitis C virus coinfection and illicit drug use for relationships between sCD14, CCL2, and LPS levels and neurocognitive test scores. RESULTS Plasma sCD14 levels were higher in subjects with test scores indicating global impairment (P = 0.007), particularly in attention and learning domains (P = 0.015 and P = 0.03, respectively), regardless of HAND diagnosis. Plasma sCD14 levels correlated inversely with global, attention, and learning T scores (P = 0.036, 0.047, and 0.007, respectively) and yielded higher area under receiver operating characteristic values for predicting impaired scores than single-marker models based on plasma or cerebrospinal fluid viral load or CD4 count (area under receiver operating characteristic values = 0.71, 0.81, and 0.71, respectively) and in 4-marker models based on plasma sCD14 and 3 conventional markers compared with the 3-marker models. CONCLUSIONS Plasma sCD14 is a biomarker associated with impaired neurocognitive testing in attention and learning domains in HIV-infected individuals with advanced disease, suggesting involvement of cortical and limbic pathways by inflammatory processes in the cART era. Plasma sCD14 is a potential biomarker to monitor HAND progression and therapeutic responses.
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Affiliation(s)
- Jennifer L Lyons
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
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Abstract
BACKGROUND AND PURPOSE High core body temperatures have been shown to selectively damage the cerebellum and basal ganglia in malignant hyperthermia, but involvement of both areas in neuroleptic malignant syndrome (NMS) has not been described. METHODS Here, we report a case of acute cerebellar and basal ganglia injury by magnetic resonance imaging (MRI) in the setting of NMS. We discuss the pathophysiology, both of NMS and hyperthermic brain injury. RESULTS MRI showed new restricted diffusion in cerebellar hemispheres bilaterally and right basal ganglia when compared with brain MRI obtained 1 month prior. T2 FLAIR hyperintensities corresponding to diffusion restriction were also seen in the cerebellum. CONCLUSIONS Both the basal ganglia and cerebellum can be injured selectively in NMS.
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Liu C, Bonner TI, Nguyen T, Lyons JL, Christian SL, Gershon ES. DNannotator: Annotation software tool kit for regional genomic sequences. Nucleic Acids Res 2003; 31:3729-35. [PMID: 12824405 PMCID: PMC168949 DOI: 10.1093/nar/gkg542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sequence annotation is essential for genomics-based research. Investigators of a specific genomic region who have developed abundant local discoveries such as genes and genetic markers, or have collected annotations from multiple resources, can be overwhelmed by the difficulty in creating local annotation and the complexity of integrating all the annotations. Presenting such integrated data in a form suitable for data mining and high-throughput experimental design is even more daunting. DNannotator, a web application, was designed to perform batch annotation on a sizeable genomic region. It takes annotation source data, such as SNPs, genes, primers, and so on, prepared by the end-user and/or a specified target of genomic DNA, and performs de novo annotation. DNannotator can also robustly migrate existing annotations in GenBank format from one sequence to another. Annotation results are provided in GenBank format and in tab-delimited text, which can be imported and managed in a database or spreadsheet and combined with existing annotation as desired. Graphic viewers, such as Genome Browser or Artemis, can display the annotation results. Reference data (reports on the process) facilitating the user's evaluation of annotation quality are optionally provided. DNannotator can be accessed at http://sky.bsd.uchicago.edu/DNannotator.htm.
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Affiliation(s)
- Chunyu Liu
- Department of Psychiatry, University of Chicago, Chicago, IL, USA.
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Baggia S, Lyons JL, Angell E, Barkhuizen A, Han YB, Planck SR, Taurog JD, Rosenbaum JT. A novel model of bacterially-induced acute anterior uveitis in rats and the lack of effect from HLA-B27 expression. J Investig Med 1997; 45:295-301. [PMID: 9250003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Humans with the major histocompatibility antigen B27 (HLA-B27) are especially at risk for developing rheumatic disorders such as ankylosing spondylitis and Reiter's syndrome. Acute anterior uveitis (AAU) often occurs in association with these diseases or in HLA B27 positive individuals without joint disease. METHODS We induced acute anterior uveitis in Lewis rats by a standard model, the intraperitoneal injection of 200 micrograms of Escherichia coli endotoxin. We also developed a novel model of uveitis secondary to gram-negative infection. RESULTS Transgenic rats that expressed a low copy number of the B27 gene did not differ statistically from litter mate controls in the intensity of anterior uveitis as judged by histology, enumeration of cells in aqueous humor, protein in aqueous humor, or slit lamp examination. The majority of rats exposed to live Salmonella enteritidis or Yersinia enterocolitica 0:3 using either an oral or intravenous route of infection developed anterior uveitis. In contrast to the disease induced by endotoxin that is most intense 24 hours after the endotoxin challenge, uveitis induced by live bacteria usually began 7 to 9 days after exposure to bacterial products, was more often unilateral, persisted for as long as 3 weeks, and was sometimes recurrent. The expression of HLA-B27 did not appear to influence the incidence or severity of uveitis in B27+ low copy heterozygous animals. CONCLUSION This rat model of AAU should facilitate evaluation of bacterial antigenic component(s) involved in the pathogenesis of live gram-negative bacteria induced AAU.
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Affiliation(s)
- S Baggia
- Department of Ophthalmology, Oregon Health Sciences University, Portland, USA
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Abstract
BACKGROUND Inflammatory bowel disease (IBD) and spondyloarthropathy (SA) such as Reiter syndrome may be characterized by diarrhea, arthritis, stomatitis, and uveitis. OBJECTIVE To determine if the characteristics of the eye disease could help distinguish these 2 diagnoses. DESIGN Seventeen patients with uveitis and IBD referred to a university clinic were compared retrospectively with 89 patients with uveitis and SA referred to the same clinic. RESULTS Twelve (80%) of the 15 patients with evaluable IBD had Crohn disease. In marked contrast to patients with SA, patients with IBD were usually female (82%). Whereas uveitis with SA was predominantly anterior, unilateral, sudden in onset, and limited in duration, patients with IBD frequently had uveitis that was bilateral, posterior, insidious in onset, and/or chronic in duration. Results for 89% of the patients with SA who underwent HLA-B27 typing were positive, compared with only 46% of such patients with IBD. Episcleritis, scleritis, and glaucoma were more common among patients with IBD. Arthritis did not easily distinguish the 2 groups, as 13 (76%) of the patients with IBD had a history of joint disease. In 10 (59%) of the patients with IBD, the diagnosis of uveitis preceded that of IBD. CONCLUSION The hallmarks of uveitis can often distinguish SA and IBD.
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Affiliation(s)
- J L Lyons
- Casey Eye Institute, Oregon Health Sciences University, Portland, USA
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Abstract
The Therapeutic Work Program operates in an ambulatory care setting and aids in assessing and developing prevocational skills in adults with head injuries. The program has eight phases, including initial evaluation, individual and group treatment, and prevocational assessment and treatment. We conducted a phone survey to evaluate the program's effectiveness and found that 79% of the 29 respondents participated in occupational activities (i.e., they were competitive or volunteer employees, homemakers, or students), a greater percentage than reported by other prevocational programs for patients with head injuries.
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Affiliation(s)
- J L Lyons
- New England Rehabilitation Hospital, Portland, Maine
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Salsbury DL, Lyons JL. A simple procedure for removing interdigital cysts of cattle. Vet Med Small Anim Clin 1969; 64:1067-70. [PMID: 5196065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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