With the effects of Congenital Zika syndrome manifesting in infants as more than microcephaly, rather a pattern of congenital anomalies, including intracranial and other brain or eye anomalies, the Centers for Disease Control (CDC) recently updated guidelines for physicians monitoring the development of infants born to mothers with a possible Zika virus infection during pregnancy.
Included within this document are instructions for laboratory testing and follow-up evaluation and care based on each patient’s lab results and observed conditions. The guidelines can be found in their entirety here on the CDC site.
Children’s National Congenital Zika Virus Program is poised to assist physicians with care for infants and children affected by Congenital Zika syndrome during infancy and throughout their childhood. The multidisciplinary team includes representatives from the Children’s National Complex Care Program available to provide comprehensive care coordination and help families with children affected by the syndrome—who may be medically complex, see multiple specialists, or are technology-dependent—navigate through the healthcare system.
In addition to complex care specialists, Children’s National has over 40 subspecialties under the same roof with top physicians available to work with healthcare professionals through the Congenital Zika Virus Program to provide their patients the best care for their specific conditions, including: ENT, Infectious Disease, Neonatology, Neurology (including Developmental Pediatrics), Ophthalmology, Orthopedics, Physical Medicine and Rehabilitation and Radiology.
Childrens National Health Systemhttps://tinyurl.com/y7vkv6y7

Ultrasonography findings seem to correlate well with the disease activity of idiopathic inflammatory myopathies (IIMs), and may be a useful tool for patient evaluation, according to a study.
Joana Sousa Neves, M.D., from the Hospital Conde de Bertiandos in Ponte de Lima, Portugal, and colleagues evaluated 15 IIM patients (from 2005 to 2015). Patients had a mean age of 52.2 ± 22.09 years and mean disease duration of 4.6 ± 3.20 years. Assessments included a physical examination, muscle strength tests, laboratory analysis, and a selective muscle ultrasonography assessment.
The researchers found that nine of the 15 patients were in clinical remission, and ultrasonography revealed a preserved muscle pattern. In one patient with longstanding polymyositis with proximal weakness, symmetrical proximal muscle atrophy was found. In the remaining five patients, inflammation and focal or generalized muscle edema were present with muscular weakness, suggesting active disease. One of these patients in acute flare presented with atrophy changes plus edema. An additional patient had early untreated myositis with moderate power Doppler signal.
“As far as muscle ultrasonography assessment is concerned, a single specific pattern was not observed in our study. A mixture of muscle edema and atrophy was detected depending on disease activity and duration,” the authors write. “Ultrasonography findings seem to correlate well with disease activity, suggested by clinical data, and may be a useful tool to complement patient evaluation.”

Physician’s Weekly http://tinyurl.com/yaoy7u9u

Although the problem of whether foetuses are able to feel pain or not is still controversial, experts at the University Hospital Virgen del Rocío in Seville have recently published a study in which they confirm that from the second trimester of pregnancy, the future baby already shows signs of pain when given a harmful stimulus or as a response to stress. In response to this confirmation, the researchers indicate the need to anaesthetise the foetus during open foetal surgery, OFS.
There is a school of thought that believes that in the case of foetal interventions, it is sufficient to administer anaesthesia to the mother as this passes through the foetus through the umbilical cord. Now, the experts have shown that this might not be sufficient and that from 21 weeks, the foetus can feel pain, so it also needs to be anaesthetised.
"At the Hospital Virgen del Rocío, we have spent a decade doing open foetal surgery. In 2007, we did the first intrauterine spina bifida operation in Europe, and in only one case was the foetus unable to receive intravenously administered anaesthesia from the start of the operation. It was at that moment that our monitoring teams detected anomalies in the behaviour of the foetus, which led us to believe that this was effectively a reaction to the stress caused by the pain. We quickly put in place the anaesthesia protocol and the spinal reconstruction was possible and the post-op period passed without any problems", explains Doctor Javier Márquez Rivas, Heat of the Infant Neurosurgery Unit and the Neurosurgery Service at the hospital.
For her part, Doctor María J. Mayorga Buiza, paediatric anaesthetist and first signatory of the article, adds that one of the key aspects of anaesthesia in open foetal surgery is to help uterine relaxation, to keep foetal circulation stable and, once surgery is complete, to offer adequate management of the patient to avoid contractions among other complications, which helps to reduce the incidence of premature birth in these cases.
Open foetal surgery (OFS) is still a serious procedure for the mother and the foetus. In such cases, anaesthesia given directly to the foetus can be provided by different means, but in the opinion of these experts, direct administration is "obligatory" for reduce foetal stress and also release the incidence of foetal mortality.
Even though current models do not prove the perception of foetal pain before the third trimester and there is little evidence of the effectiveness of direct foetal analgesic and anaesthetic techniques, it is a confirmed fact that foetal mortality is higher than 20% in the case of non-anaesthetised foetuses. This rate drops to 0% in operations carried out until now at the University Hospital Virgen del Rocío in Seville.
"The response of foetal stress to harmful stimulation that our monitoring teams observed in this case, does not completely prove that the foetus can feel pain. However, it is very improbable that there can be a perception of pain without a response to stress, and so these signals are often used as a substitute pain indicator", explains the University of Seville researcher and co-author of this study, The Applied Physics professor Emilio Gómez González.
University of Seville (in Spanish)comunicacion.us.es/centro-de-prensa/personal-docente-e-investigador/la-anestesia-disminuye-el-indice-de-mortalidad 

Losing an arm doesn’t have to mean losing all sense of touch, thanks to prosthetic arms that stimulate nerves with mild electrical feedback.
University of Illinois researchers have developed a control algorithm that regulates the current so a prosthetics user feels steady sensation, even when the electrodes begin to peel off or when sweat builds up.
“We’re giving sensation back to someone who’s lost their hand. The idea is that we no longer want the prosthetic hand to feel like a tool, we want it to feel like an extension of the body,” said Aadeel Akhtar, an M.D./Ph.D. student in the neuroscience program and the medical scholars program at the University of Illinois. Akhtar is the lead author of a paper describing the sensory control module, published in Science Robotics, and the founder and CEO of PSYONIC, a startup company that develops low-cost bionic arms.
“Commercial prosthetics don’t have good sensory feedback. This is a step toward getting reliable sensory feedback to users of prosthetics,” he said.
Prosthetic arms that offer nerve stimulation have sensors in the fingertips, so that when the user comes in contact with something, an electrical signal on the skin corresponds to the amount of pressure the arm exerts. For example, a light touch would generate a light sensation, but a hard push would have a stronger signal.
However, there have been many problems with giving users reliable feedback, said aerospace engineering professor Timothy Bretl, the principal investigator of the study. During ordinary wear over time, the electrodes connected to the skin can begin to peel off, causing a buildup of electrical current on the area that remains attached, which can give the user painful shocks. Alternately, sweat can impede the connection between the electrode and the skin, so that the user feels less or even no feedback at all.
“A steady, reliable sensory experience could significantly improve a prosthetic user’s quality of life,” Bretl said.
The controller monitors the feedback the patient is experiencing and automatically adjusts the current level so that the user feels steady feedback, even when sweating or when the electrodes are 75 percent peeled off.
The researchers tested the controller on two patient volunteers. They performed a test where the electrodes were progressively peeled back and found that the control module reduced the electrical current so that the users reported steady feedback without shocks. They also had the patients perform a series of everyday tasks that could cause loss of sensation due to sweat: climbing stairs, hammering a nail into a board and running on an elliptical machine.
“What we found is that when we didn’t use our controller, the users couldn’t feel the sensation anymore by the end of the activity. However, when we had the control algorithm on, after the activity they said they could still feel the sensation just fine,” Akhtar said.
Adding the controlled stimulation module would cost much less than the prosthetic itself, Akhtar said. "Although we don’t know yet the exact breakdown of costs, our goal is to have it be completely covered by insurance at no out-of-pocket costs to users."
The group is working on miniaturizing the module that provides the electrical feedback, so that it fits inside a prosthetic arm rather than attaching to the outside. They also plan to do more extensive patient testing with a larger group of participants.

University of Illinois Urbana-Champaignnews.illinois.edu/view/6367/643862

A drug already used to treat certain forms of cancer may also be an effective therapy for Huntington’s disease, according to a new study. The same study also increases our understanding of how this drug, and other medications like it, may offer hope for other neurodegenerative diseases like Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), and Parkinson’s disease.
Huntington’s disease is a devastating, inevitably fatal disease, with no medications that slow or stop disease progression. In this study, mice with the equivalent of Huntington’s disease became more mobile, recovered from neurodegeneration, and lived longer after being treated with bexarotene. The same research builds on a 2016 study where La Spada and his team showed that the drug KD3010 is an effective treatment for Huntington’s disease in mice and in human patient neurons made from stem cells.
Senior author Al La Spada, MD, PhD, said the study results are exciting not just because these drugs worked, but because of how they worked. “It’s not just the response from the drugs, but the mechanistic pathways these drugs are targeting,” said La Spada, director of the forthcoming Duke Center for Neurodegeneration and Neurotherapeutics. “These pathways are relevant to other neurodegenerative disorders and potentially the aging process, itself in addition to Huntington’s disease.”
Bexarotene and KD3010 function by activating PPARδ, a transcription factor that keeps neurons functional in two ways: by keeping mitochondria healthy and active, and by helping neurons remove dysfunctional proteins. Mice–and humans–with Huntington’s disease have problems activating PPARδ. When La Spada and colleagues treated Huntington’s mice with bexarotene or KD3010, they observed improved mitochondrial health in neurons, as well as increased removal of damaging misfolded proteins.
The same factors of impaired mitochondrial function and protein misfolding are recognized as increasingly important in diseases like Alzheimer’s disease, Parkinson’s disease, and ALS.
The study doesn’t mean that patients with Huntington’s disease or other conditions should rush to get bexarotene or KD3010. Further research needs to determine how to use these drugs in human patients. Bexarotene can have difficult side effects at high dosages, and optimal doses aren’t known, while KD3010 has only been tested in human subjects for type II diabetes.
Instead, future therapies for Huntington’s disease and other neurodegenerative conditions may take a cue from HIV treatments and involve a “cocktail” approach of combined medications. Lead author Audrey Dickey, PhD, found that, taken together, bexarotene and KD3010 produced better results in cells even when given at lower doses.
“With this approach, we could minimize side effects with lower doses of each compound, even when together the treatments provide a higher effect than either one alone,” said Dickey. “We are carrying out further research on the underlying mechanisms of neuroprotection and applying this research to other diseases with similar issues of mitochondrial dysfunction and protein quality control, such as Parkinson’s disease, Alzheimer’s disease, and ALS.”
Duke University School Of Medicinehttps://tinyurl.com/y73s5wfd