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Background Specific antiviral treatment is only available for a small subset of viral encephalitis (VE). Adjunctive steroids are used, but there is scant evidence evaluating its utility. We present a systematic review and meta-analysis on the outcome of steroid use in VE. Methods We conducted a systematic literature review and reported it according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Two observational studies from unpublished or partially published data were added. For the meta-analysis, we employed the metaphor package of the statistical software R-4.3.1. Results We screened 378 studies and included 50. 155 patients were added from the Houston and Linz cohorts. Individual data were available for 281 persons, 120 (43%) of whom received steroids. The most common pathogens were herpes simplex virus 1, West Nile virus, and measles. Study designs and patient outcomes were heterogeneous. Only three of the trials report an advantage of steroid therapy. Steroid-induced side effects were scarce. Ten cohorts were included into the meta-analysis. For the pooled data, the null hypothesis could not be rejected (p = 0.245) using a random effects model, i.e., a benefit of steroid treatment on survival in VE could not be shown. Conclusions Steroids as potent anti-inflammatory agents may act through a reduction of secondary inflammation-mediated damage. Our data do not support the use of steroids in VE. However, multiple shortcomings apply. Standardized controlled trials are needed to investigate optimal dosing and timing of steroid administration and to explore potential subgroups that could benefit. Version of record

Herpes simplex virus (HSV) is a rare cause of hepatitis in pregnancy and the chronically immunosuppressed, with a high propensity to progress to acute liver failure (ALF) and death. Patients typically present with a nonspecific clinical picture that often delays diagnosis and treatment, contributing to the high mortality rate. We present a case of a young female on chronic prednisone and hydroxychloroquine for systemic lupus erythematosus (SLE) who was diagnosed with HSV-2 hepatitis after presenting with right-sided chest and abdominal discomfort. Despite early clinical deterioration, prompt initiation of therapy with intravenous acyclovir and methylprednisolone led to rapid improvement.

"El estudio presenta la estructura de la comunidad de peces demersales así como sus variaciones diurnas, estacionales e interanuales en relación con factores ambientales durante dos ciclos anuales (1998-1999). El trabajo se realizó en la laguna costera Las Guásimas, Sonora. Se recolectaron peces mensualmente durante el día y la noche en 6 estaciones de muestreo utilizando una red de arrastre, y se registró temperatura, salinidad y oxígeno disuelto in situ. Se aplicó un análisis de varianza no paramétrico (P< 0.05), y un Análisis de Correspondencia Canónica (ACC) para caracterizar las comunidad biótica y abiótica. El elenco sistemático estuvo representado por 29 Familias, 53 Géneros y 74 Especies, de las cuales 51 especies ocurrieron de día y 65 de noche. La composición de la comunidad de peces ocurrida en 1998 fue distinta a la de 1999 en un 60%, de acuerdo a las 10 especies más importantes según el Índice del Valor Biológico. La diversidad nocturna fue mayor a la diurna. El efecto de la temperatura del agua derivado de la presencia de dos eventos ambientales ocurridos en el periodo 1998-1999 (El Niño y La Niña) impactaron la riqueza y la abundancia de las especies. El ACC definió dos grupos comunitarios, uno que mostró especies con afinidad al día y otro hacia la noche, y este patrón se reflejó en todas las estaciones del año. El presente estudio aporta la primera evidencia de la variación diurna-nocturna de comunidades de peces demersales en una laguna costera del litoral sonorense del Golfo de California, y se destaca la importancia de promover dichos estudios, ya que la información aportada es elemental para mejorar el conocimiento de la estructura de las comunidades." "The study presents the structure of the demersal fish community and their variation diurnal, seasonal and yearly, related to environmental factors during two annual cycles (1998-1999).The work was conducted in the coastal lagoon Las Guásimas, Sonora. Fish were collected monthly during the day and night at 6 sampling stations using a trawl net and recorded temperature, salinity and dissolved oxygen in situ. We used a nonparametric analysis of variance (P