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- ArticleTitus J, Sarmiento B, Crouse R.Cureus. 2024 Jul;16(7):e64432.Guillain-Barre syndrome (GBS) is an acute post-infectious polyradiculoneuropathy characterized by autoantibodies targeting host antigens, resulting in nerve fiber demyelination and axonal degeneration. While symmetric ascending weakness is typical, neuropathic pain is a common yet variable manifestation. We present a case of a 52-year-old man with progressive bilateral leg weakness and severe neuropathic pain following a flu-like illness. Despite conventional analgesics, his pain persisted, necessitating a unique pain management approach. The patient's examination revealed hyporeflexia and sensory deficits consistent with GBS. Diagnostic workup, including lumbar puncture, showed albuminocytologic dissociation. Plasma exchange therapy was initiated, but severe nocturnal neuropathic pain persisted, exacerbating during treatment. Conventional pain medications were ineffective, prompting a multimodal approach. Combining hydromorphone and lorazepam provided significant pain relief, enabling completion of plasmapheresis sessions. This regimen, supplemented with gabapentin, proved effective in managing both GBS-associated and treatment-induced pain. This case underscores the debilitating nature of GBS-related pain and the importance of tailored pain management strategies. While conventional agents may fail, a multimodal approach, including opioids and adjunctive medications, can offer relief, facilitating essential treatments like plasmapheresis. Careful monitoring is imperative to mitigate risks associated with potent analgesics. Our experience contributes to the armamentarium for managing GBS-related pain, emphasizing individualized care to improve patient outcomes.
- ArticleJancek S, Bézier A, Gayral P, Paillusson C, Kaiser L, Dupas S, Le Ru BP, Barbe V, Periquet G, Drezen JM, Herniou EA.PLoS One. 2013;8(5):e64432.The geographic mosaic of coevolution predicts parasite virulence should be locally adapted to the host community. Cotesia parasitoid wasps adapt to local lepidopteran species possibly through their symbiotic bracovirus. The virus, essential for the parasitism success, is at the heart of the complex coevolutionary relationship linking the wasps and their hosts. The large segmented genome contained in the virus particles encodes virulence genes involved in host immune and developmental suppression. Coevolutionary arms race should result in the positive selection of particular beneficial alleles. To understand the global role of bracoviruses in the local adaptation or specialization of parasitoid wasps to their hosts, we studied the molecular evolution of four bracoviruses associated with wasps of the genus Cotesia, including C congregata, C vestalis and new data and annotation on two ecologically differentiated populations of C sesamie, Kitale and Mombasa. Paired orthologs analyses revealed more genes under positive selection when comparing the two C sesamiae bracoviruses belonging to the same species, and more genes under strong evolutionary constraint between species. Furthermore branch-site evolutionary models showed that 17 genes, out of the 54 currently available shared by the four bracoviruses, harboured sites under positive selection including: the histone H4-like, a C-type lectin, two ep1-like, ep2, a viral ankyrin, CrV1, a ben-domain, a Serine-rich, and eight unknown genes. Lastly the phylogenetic analyses of the histone, ep2 and CrV1 genes in different African C sesamiae populations showed that each gene described differently the individual relationships. In particular we found recombination had happened between the ep2 and CrV1 genes, which are localized 37.5 kb apart on the wasp chromosomes. Involved in multidirectional coevolutionary interactions, C sesamiae wasps rely on different bracovirus mediated molecular pathways to overcome local host resistance.
- BookSusan J. Noonan, MD, MPH.Summary: "An accessible, concise, and comprehensive guide to understanding and dealing with the impact and consequences of social isolation"-- Provided by publisher. "In Reconnecting after Isolation, Dr. Susan J. Noonan draws on our collective experience of the COVID-19 pandemic to help readers deal with the emotional impact of social isolation. Speaking as both a provider and recipient of mental health care services, Noonan combines her professional and personal experiences in an evidence- based and practical guide. Drawing on meticulous research and interviews with four psychologists, she outlines steps to overcome the emotional trauma of isolation. The book touches on how social isolation, loneliness, and stress affect each of us individually and can sometimes provoke depression, anxiety, post-traumatic stress disorder, suicidality, and substance use. Describing specific lifestyle interventions that may help, it offers tips for - developing effective coping skills - facing isolation-induced fears adapting effectively to the changes in our personal, family, work, academic, and social lives caused by imposed isolation - finding effective, culturally sensitive mental health care - improving sleep hygiene - building and maintaining resilience - adopting a healthy diet - overcoming the fatigue burnout - grieving a loss - engaging in regular physical exercise - keeping a daily routine or structure - maintaining contact with others Dr. Noonan also discusses re-entry anxiety, the challenging experience many have upon returning to their prior lifestyle, and the difficulty of establishing new school and work routines following social isolation"-- Publisher's description. How to keep calm, carry on, and reconnect during times of social isolation and emotional crisis. Although spending time alone for short periods may be restorative and helpful, unintentional or involuntary isolation can have profound detrimental effects on emotional and physical health. We all need social interaction and meaningful relationships in our lives to be well and thrive. Without them, we flounder. In Reconnecting after Isolation, Dr. Susan J. Noonan draws on our collective experience of the COVID-19 pandemic to help readers deal with the emotional impact of social isolation. Speaking as both a provider and recipient of mental health care services, Noonan combines her professional and personal experiences in an evidence-based and practical guide. Drawing on meticulous research and interviews with four psychologists, she outlines steps to overcome the emotional trauma of isolation. The book touches on how social isolation, loneliness, and stress affect each of us individually and can sometimes provoke depression, anxiety, post-traumatic stress disorder, suicidality, and substance use. Describing specific lifestyle interventions that may help, it offers tips for developing effective coping skills ; facing isolation-induced fears ; adapting effectively to the changes in our personal, family, work, academic, and social lives caused by imposed isolation ; finding effective, culturally sensitive mental health care ; improving sleep hygiene ; building and maintaining resilience ; adopting a healthy diet ; overcoming the fatigue burnout ; grieving a loss ; engaging in regular physical exercise ; keeping a daily routine or structure ; maintaining contact with others. Dr. Noonan also discusses re-entry anxiety, the challenging experience many have upon returning to their prior lifestyle, and the difficulty of establishing new school and work routines following social isolation. Accessible and compassionate, Reconnecting after Isolation empowers individuals to manage their own challenges, offering them a better chance of recovery and of staying well. -- Provided by publisher.
Contents:
Part One. How does social isolation affect me?
Chapter 1. What is Social Isolation?
Chapter 2. Stress and Coping Skills
Chapter 3. Facing Our Fears
Chapter 4. Fatigue and Burnout
Chapter 5. The Ability to Grieve
Chapter 6. Isolation and Mental Health
Chapter 7. Suicidal Thoughts or Impulses
Chapter 8. Substance Abuse and Addictions
Part Two. What can I do to help myself?
Chapter 9. Understanding the Basics of Mental Health
Chapter 10. Finding Effective Professional Mental Health
Chapter 11. Is Talk Therapy Right for Me?
Chapter 12. Building and Maintaining Resilience
Chapter 13. Looking Forward : Reentry Anxiety
Final ThoughtsDigital Access R2Library [2022], ©2022