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We describe clinical and laboratory findings in 35 patients tested positive for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction on nasopharyngeal swab experiencing one or multiple syncope at disease onset. Clinical neurologic and cardiologic examination, and electrocardiographic findings were normal. Chest computed tomography showed findings consistent with interstitial pneumonia. Arterial blood gas analysis showed low pO2, pCO2, and ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) indicating hypocapnic hypoxemia. Patients who presented with syncope showed significantly lower heart rate as compared to 68 SARS-CoV-2 positive that did not. Such poorer than expected compensatory heart rate increase may have led to syncope based on individual susceptibility. We speculate that SARS-CoV-2 could have caused angiotensin-converting enzyme-2 (ACE2) receptor internalization in the nucleus of the solitary tract and other midbrain nuclei, impairing baroreflex and chemoreceptor response, and inhibiting the compensatory tachycardia during acute hypocapnic hypoxemia.

No systematic data on hospitalized SARS-COV-2 patients from Western countries are available. We report onset, course, correlations with comorbidities, and diagnostic accuracy of nasopharyngeal swab in 539 individuals suspected to carry SARS-COV-2 admitted to the hospital of Crema, Italy. All individuals underwent clinical and laboratory exams, SARS-COV-2 reverse transcriptase-polymerase chain reaction on nasopharyngeal swab, and chest X-ray and/or computed tomography (CT). Data on onset, course, comorbidities, number of drugs including angiotensin converting enzyme (ACE) inhibitors and angiotensin-II-receptor antagonists (sartans), follow-up swab, pharmacological treatments, non-invasive respiratory support, ICU admission, and deaths were recorded. Among 411 SARS-COV-2 patients (66.6% males) median age was 70.5 years (range 1-99). Chest CT was performed in 317 (77.2%) and showed interstitial pneumonia in 304 (96%). Fatality rate was 17.5% (74% males), with 6.6% in 60-69 years old, 21.1% in 70-79 years old, 38.8% in 80-89 years old, and 83.3% above 90 years. No death occurred below 60 years. Non-invasive respiratory support rate was 27.2% and ICU admission 6.8%. Older age, cough and dyspnea at onset, hypertension, cardiovascular diseases, diabetes, renal insufficiency, >7 drugs intake and positive X-ray, low lymphocyte count, high C-reactive protein, aspartate aminotransferase and lactate dehydrogenase values, and low PO2 partial pressure with high lactate at arterial blood gas analysis at admission were significantly associated with death. Use of ACE inhibitors or sartans was not associated with outcomes. Comorbidity network analysis revealed homogenous distribution of deceased and 60-80 aged SARS-COV-2 patients across diseases. Among 128 swab negative patients at admission (63.3% males) median age was 67.7 years (range 1-98). Chest CT was performed in 87 (68%) and showed interstitial pneumonia in 76 (87.3%). Follow-up swab turned positive in 13 of 32 patients. Using chest CT at admission as gold standard on the entire study population of 539 patients, nasopharyngeal swab had 80% sensitivity. SARS-CoV-2 caused high mortality among patients older than 60 years and correlated with pre- existing multiorgan impairment. ACE inhibitors and sartans did not influence patients’ outcome.

Objective To study the GI symptoms in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. Design We analysed epidemiological, demographic, clinical and laboratory data of 95 cases with SARS-CoV-2 caused coronavirus disease 2019. Real-time reverse transcriptase PCR was used to detect the presence of SARS-CoV-2 in faeces and GI tissues. Results Among the 95 patients, 58 cases exhibited GI symptoms of which 11 (11.6%) occurred on admission and 47 (49.5%) developed during hospitalisation. Diarrhoea (24.2%), anorexia (17.9%) and nausea (17.9%) were the main symptoms with five (5.3%), five (5.3%) and three (3.2%) cases occurred on the illness onset, respectively. A substantial proportion of patients developed diarrhoea during hospitalisation, potentially aggravated by various drugs including antibiotics. Faecal samples of 65 hospitalised patients were tested for the presence of SARS-CoV-2, including 42 with and 23 without GI symptoms, of which 22 (52.4%) and 9 (39.1%) were positive, respectively. Six patients with GI symptoms were subjected to endoscopy, revealing oesophageal bleeding with erosions and ulcers in one severe patient. SARS-CoV-2 RNA was detected in oesophagus, stomach, duodenum and rectum specimens for both two severe patients. In contrast, only duodenum was positive in one of the four non-severe patients. Conclusions GI tract may be a potential transmission route and target organ of SARS-CoV-2.

Summary Objective Although many studies have attempted to describe treatment outcomes in patients with drug‐resistant epilepsy, results are often limited by the adoption of nonhomogeneous criteria and different definitions of seizure freedom. We sought to evaluate treatment outcomes with a newly administered antiepileptic drug (AED) in a large population of adults with drug‐resistant focal epilepsy according to the International League Against Epilepsy (ILAE) outcome criteria. Methods This is a multicenter, observational, prospective study of 1053 patients with focal epilepsy diagnosed as drug‐resistant by the investigators. Patients were assessed at baseline and 6, 12, and 18 months, for up to a maximum of 34 months after introducing another AED into their treatment regimen. Drug resistance status and treatment outcomes were rated according to ILAE criteria by the investigators and by at least two independent members of an external expert panel (EP). Results A seizure‐free outcome after a newly administered AED according to ILAE criteria ranged from 11.8% after two failed drugs to 2.6% for more than six failures. Significantly fewer patients were rated by the EP as having a “treatment failure” as compared to the judgment of the investigator (46.7% vs 62.9%, P

The present magnetoencephalography (MEG) study tested the hypothesis of a phase synchronization (functional coupling) of cortical alpha rhythms (about 6–12 Hz) within a “speech” cortical neural network comprising bilateral primary auditory cortex and Wernicke's areas, during dichotic listening (DL) of consonant‐vowel (CV) syllables. Dichotic stimulation was done with the CV‐syllable pairs /da/‐/ba/ (true DL, yielded by stimuli having high spectral overlap) and /da/‐/ka/ (sham DL, obtained with stimuli having poor spectral overlap). Whole‐head MEG activity (165 sensors) was recorded from 10 healthy right‐handed non‐musicians showing right ear advantage in a speech DL task. Functional coupling of alpha rhythms was defined as the spectral coherence at the following bands: alpha 1 (about 6–8 Hz), alpha 2 (about 8–10 Hz), and alpha 3 (about 10–12) with respect to the peak of individual alpha frequency. Results showed an inverse pattern of functional coupling: during DL of speech sounds, spectral coherence of the high‐band alpha rhythms increased between left auditory and Wernicke's areas with respect to sham DL, whereas it decreased between left and right auditory areas. The increase of functional coupling within the left hemisphere would underlie the processing of the syllable presented to the right ear, which arrives to the left auditory cortex without the interference of the other syllable presented to the left ear. Conversely, the decrease of inter‐hemispherical coupling of the high‐band alpha might be due to the fact that the two auditory cortices do not receive the same information from the ears during DL. These results suggest that functional coupling of alpha rhythms can constitute a neural substrate for the lateralization of auditory stimuli during DL. Hum Brain Mapp 2008. © 2007 Wiley‐Liss, Inc.

Objective: To investigate quantitative EEG (qEEG) in anorexia nervosa (AN) and bulimia nervosa (BN) in comparison with healthy controls. Methods: Resting EEG was recorded in 30 healthy females (age: 27.1 ± 5.5), 16-AN females (age: 26.4 ± 9.5) and 12-BN females (age: 27.0 ± 6.3). Cortical EEG sources (delta, theta, alpha 1, alpha 2, beta 1, beta 2) were modeled by LORETA solutions. The statistical analysis was performed considering the factors Group, power Band, and region of interest (central, frontal, parietal, occipital, temporal, limbic). Results: Alpha 1 sources in central, parietal, occipital and limbic areas showed a greater amplitude in Controls versus AN and BN groups. Alpha 2 sources in parietal, occipital and limbic areas showed a greater amplitude in Controls than in both AN and BN groups. Alpha 1 sources in temporal area showed a greater amplitude in Controls compared to both the BN and AN groups as well as in the BN group compared to AN group. Central alpha 1 source correlated significantly with BMI in patients. Conclusions: These results support the hypothesis that eating disorders are related to altered mechanisms of cortical neural synchronization, especially in rolandic alpha rhythms. Significance: To our knowledge this is the first study by LORETA able to detect modifications of cortical EEG activity in eating disorders.

Dichotic listening (DL) is a neuropsychological technique for the study of functional laterality. Based on behavioral patient studies, the ‘‘structural theory’’ states that lateralization of the auditory input during DL is allowed by an inhibition of the ipsilateral pathways. We aimed here at extending this theory to provide a neurophysiological basis of verbal DL. We investigated the magnetic responses of the primary auditory cortices elicited by dichotic consonant--vowel syllables. Dichotic stimuli consisted of 2 syllables pairs, a ‘‘competing’’ one composed by syllables with high spectral overlap (/da/ and /ba/) and a ‘‘noncompeting’’ pair (/da/ and /ka/). One of the syllables in each pair was delivered at 2 intensities, whereas the other did not change. A reduced increase of source intensity in response to dichotic pairs at the 2 levels was assumed to indicate pathway inhibition effects. We obtained that the left ipsilateral pathway (i.e., the left ipsilateral signal) was strongly inhibited by the right contralateral one. Conversely, the right ipsilateral pathway did not show an inhibition larger than the left contralateral one. These results extend the notion of auditory functional asymmetries by showing that beyond hemispheric functional specialization there is an asymmetry within the ascending auditory system, which is based on a competition mechanism. The larger the competition between the left and right ear stimuli, the larger are the inhibition effects, which determine the pathway asymmetry. These findings represent as well a neurophysiological basis for the ‘‘structural theory’’ explaining the right ear preference usually found in verbal DL tasks.

Objective The aim of this preliminary study was to investigate the physiologic substrate of executive function in anorexia nervosa (AN) by assessing the relation between brain perfusion and Stroop interference task (SIT). Method The classical SIT test and brain single-photon emission tomography (SPET) were evaluated in 16 AN females (mean age = 23.69 ± 8.68 years; mean body mass index [BMI] = 16.19 ± 1.53 kg/m2). The relation between the two examinations was searched by statistical parametric mapping (SPM 99) with a height threshold of p = .001. Results An abnormally low or a borderline SIT value was found in 25% of patients. A significant correlation between the SIT score and brain perfusion was found in the superior frontal gyrus of both hemispheres (Brodmann's area [BA] 6 in both hemispheres and BA 8 in the right hemisphere). No correlation was found in the anterior cingulate gyrus. Conclusion BA 6 and BA 8 and the anterior cingulate are believed to be the basis of both error detection and immediate correction. Activity of BA 6 and BA 8 reflects this executive task in AN patients as well, whereas the lack of correlation in the anterior cingulate may suggest its blunted activity in AN patients, similarly to what is shown in other conditions characterized by impaired executive function, such as patients with depression, patients with schizophrenia, and abstinent drug abusers. However, these findings should still be quoted as preliminary, given some limitations of the study design, such as the lack of a control group, and the unfeasibility of controlling some relevant confounding variables, such as psychiatric comorbidity, medication, and the time interval between examinations, mainly deriving from the relatively few patients studied. © 2005 by Wiley Periodicals, Inc.