Vasculitis reumatoidea: una manifestación poco habitual. Presentación de tres casos clínicos y revisión de la literatura

La vasculitis reumatoidea es una complicación sistémica y poco frecuente de la Artritis Reumatoidea. Si bien su incidencia ha descendido en los últimos años con el advenimiento de las nuevas terapias inmunosupresoras y biológicas, continua teniendo una alta morbimortalidad. Predomina en el sexo masculino, en pacientes seropositivos y con un largo período de la enfermedad establecida. Requiere de alta presunción diagnostica, siendo el compromiso cutáneo y nervioso periférico el más frecuente. La biopsia de nervio o piel es requerida habitualmente para su diagnóstico. El tratamiento se basa en corticoides e inmunosupresores. Presentamos tres casos clínicos y realizamos una revisión de la literatura.

Rheumatoid vasculitis is a rare systemic complication of rheumatoid arthritis. Although its incidence has decreased in recent years with the advent of new immunosuppressive and biological therapies, it continues to have a high morbidity and mortality. It predominates in males, in seropositive patients and with a long period of established disease. It requires high diagnostic presumption, with skin and peripheral nervous involvement being the most affected. Nerve or skin biopsy is usually required for diagnosis. Treatment is based on corticosteroids and immunosuppressants. We present three clinical cases and carry out a review of the literature.

A vasculite reumatóide é uma complicação sistêmica rara da artrite reumatóide. Embora sua incidência tenha diminuído nos últimos anos com o advento de novas terapias imunossupressoras e biológicas, continua apresentando elevada morbidade e mortalidade. Predomina no sexo masculino, em pacientes soropositivos e com longo período de doença estabelecida. Exige alta presunção diagnóstica, sendo o envolvimento cutâneo e nervoso periférico os mais afetados. A biópsia de nervo ou pele geralmente é necessária para o diagnóstico. O tratamento é baseado em corticosteroides e imunossupressores. Apresentamos três casos clínicos e realizamos uma revisão da literatura.

New horizons in sickle cell crisis treatment

Even if life expectancy has increased, sickle cell disease (SCD) still presents difficulties, especially because of the painful episodes that occur frequently and without warning, known as Vaso-occlusive crises (VOCs). These crises are brought on by different cells adhering to one another and obstructing tiny blood veins, which can cause excruciating agony and eventually harm organs and tissues. While the majority of current treatments concentrate on symptom management and pain relief with the use of medications, hydration, and other general approaches, new discoveries about the fundamental mechanisms of VOCs provide intriguing new therapeutic options. With the goal of precisely addressing the pathways causing inflammation and cell adhesion, these cutting-edge treatments may lessen the frequency of VOCs and shield vital organs from harm. Though these treatments provide hope for improved SCD management, careful assessment and analysis of their efficacy and accessibility are necessary to guarantee their general benefit.

Leptospirosis-induced transverse myelitis and multiorgan failure: an uncommon manifestation in non-epidemic setting

Leptospirosis is a disease that can be transmitted from animals to humans. It is caused by a bacterium called Leptospira interrogans and is more common in tropical and subtropical regions. Despite being the most neglected tropical disease, it is a significant emerging and re-emerging disease, according to recent reports and reviews by the World Health Organization (WHO). Leptospirosis is widespread among humans and animals globally, and it is estimated that there are 1.03 million cases and 58,900 deaths annually, with a case fatality rate of 6.85%. Acute transverse myelitis (TM) is a rare neurological disease that affects the spinal cord. It is caused by various autoimmune reactions and is usually limited to several spinal cord segments. It has a poor prognosis. Our case report presents a unique situation where a patient developed multiorgan failure due to leptospirosis and also had a rare co-presentation of transverse myelitis.

Psychiatric evaluation and support for the elderly undergoing elective surgery

Providing evaluation and support for individuals who choose to undergo surgery is an essential aspect of comprehensive healthcare. With the global population aging, it's becoming more common for elderly individuals to opt for surgeries. This requires understanding how health impacts surgical outcomes in this vulnerable group. This study delves into the presentation and management of factors throughout the entire surgical process, including before, during, and after surgery. The clinical presentation covers existing health conditions, cognitive issues, emotional responses, and ethical considerations related to decision-making abilities. Recognizing these factors is crucial in order to provide tailored interventions that promote the well-being of patients and improve overall outcomes. Clinical management involves measures before surgery, collaborative care models during the period and strategies to prevent or address psychiatric complications after surgery. Ethical considerations are consistently important throughout this process, especially concerning decision-making abilities. This comprehensive approach involves psychiatrists, geriatricians, anesthetists and other healthcare professionals who work together to enhance the well-being of surgical patients. As our population continues to age, further research and attention on aspects of care within this demographic are vital for providing comprehensive and patient-centered healthcare.

A comparative study on the clinical manifestations of children infected with erythromycin-resistant Bordetella pertussis of ptxP1 and ptxP3 genotypes / 中华实用儿科临床杂志

Objective:To determine the erythromycin resistance of Bordetella pertussis isolates and their ptxP1 and ptxP3 phenotypic composition and compare clinical manifestations of children with pertussis caused by the two types of strains. Methods:This was a cross-sectional study, the pertussis cases diagnosed using bacterial culture from January 2019 to December 2022 in Beijing Children′s Hospital and the First People′s Hospital of Wuhu were collected.Any suspected Bordetella pertussis colonies were identified by the slide agglutination test.The susceptibility of isolates to erythromycin was detected by the E-test and K-B test.The ptxP gene was amplified by polymerase chain reaction and sequenced to determine its genotype. t-test, Mann-Whitney U-test, Chi-square test and Fisher′s exact test were use to statistical analysis. Results:A total of 192 strains of Bordetella pertussis were identified, including 188 (97.9%) erythromycin-resistant strains.Among the 188 strains, 30.3%(57/188) belonged to the ptxP1 genotype and 69.7%(131/188) belonged to the ptxP3 genotype.In children aged below 1 year old, the incidence of paroxysmal cough caused by infection with the ptxP3 strain was higher than that with the ptxP1 strain (57.1% vs.29.4%, P<0.05), and children infected with the ptxP3 strain were more likely to develop apnea or asphyxia (23.8% vs.17.6%), post-tussive vomiting (44.4% vs.32.4%), whooping cough (72.0% vs.50.0%) and pneumonia or bronchitis (85.7% vs.73.5%) compared to those infected with the ptxP1 strain, but the differences were not statistically significant(all P>0.05). In children aged 1 year old and above, the white blood cell count of children infected with the ptxP1 strain was higher than that of infections with the ptxP3 strain [13.5(9.9, 24.5)×10 9/L, 10.3 (7.0, 16.4)×10 9/L, P<0.05], and children infected with the ptxP1 strain were more likely to contract other pathogen infections than those infected with the ptxP3 strain (17.4% vs.4.4%, P>0.05). Conclusions:ptxP3 erythromycin-resistant Bordetella pertussis has become the main pathogen of pertussis.Infants with pertussis caused by the ptxP3 erythromycin-resistant strain show more significant manifestations and a higher possibility of severe symptoms than those infected with the ptxP1 erythromycin-resistant strain.

Clinical characteristics and prognostic analysis of neonatal chylothorax / 中国新生儿科杂志

Objective:To investigate the clinical characteristics and prognosis of neonatal chylothorax.Methods:The clinical data of newborns diagnosed with chylothorax from June 2016 to June 2023 in Neonatal Center of Beijing Children's Hospital were retrospectively analyzed, and divided into congenital group and acquired group according to the pathogenesis of chylothorax. The clinical characteristics, treatment methods and prognosis of the two groups were compared.Results:A total of 23 cases were included, including 17 cases (73.9%) in the congenital group and 6 cases (26.1%) in the acquired group. There was no significant difference in gender, gestational age and birth weight between the two groups ( P>0.05). Compared with the acquired group, the proportion of lymphocytes (97.0% vs. 85.0%), the use of erythromycin (7/17 vs. 1/6) and octreotide (9/17 vs. 1/6) and special formula milk feeding (13/17 vs. 2/6) were higher in the congenital group; the proportion of right hydrothorax (1/17 vs. 3/6), invasive mechanical ventilation (6/17 vs. 6/6) and breastfeeding (0/17 vs. 3/6) were lower in the congenital group ( P<0.05). There were no significant differences in terms of the white blood cell count in pleural fluid and plasma protein content, incidence of bilateral and left pleural fluid, proportion of closed thoracic drainage, maximum daily drainage volume, drainage duration, total drainage volume, albumin utilization rate, length of stay and survival rate between the two groups ( P>0.05). 18 cases of pleural effusion absorption without recurrence after conservative treatment; 5 cases died, of which 4 cases died after their parents abandoned treatment, and 1 case died of neonatal necrotizing enterocolitis after thoracic duct ligation surgery. Conclusions:Congenital chylothorax and acquired chylothorax were similar in severity, course of disease and overall prognosis. The utilization rate of erythromycin and octreotide in congenital chylothorax was higher than that in acquired chylothorax. The neonatal chylothorax is usually with an overall good prognosis.

Hypercalcaemia crisis: A retrospective series of 143 cases / 中华内分泌代谢杂志

Objective:The study retrospectively analyzed the etiology, clinical manifestations, emergency treatment and etiological treatment of a large sample of cases with hypercalcemic crisis.Methods:The clincial data of patients with hypercalcaemia cirisis who were administered in First Medical Center of Chinese PLA General Hospital from January 2009 to July 2022 were analyzed, inculding the general data, clinical manifestations, etiology, photographic examination, emergency treatment, etiological treatment, serological examination before and after treatment, pathological immunohistochemical findings and prognosis.Results:A total of 143 hypercalcaemia crisis patients(84 males and 59 females) with a mean age of 53.51±16.60 were enrolled. The most common disease was hyperparathyroidism(62/143), followed by solid malignancy(57/143) and multiple myeloma(12/143). Patients presented with digestive system symptoms at 76.91%, followed by neurological symptoms at 63.60%, urinary system symptoms at 58.76%, musculoskeletal symptoms at 55.23%, and cardiovascular system symptoms at 32.91%. After emergency calcium-lowering treatment, the remission rate of hypercalcemic crisis in 143 patients was 100%(143/143), and after etiological treatment, the remission rate of hypercalcemia was 85.31%(122/143).Conclusion:Early identification, emergency treatment and etiology treatment of hypercalcaemia crisis are essential. Effective treament with comprehensive calcium reduction can quickly relieve clinical symptoms and create opportunities for treatment for the cause. Targeted etiological interventions can lead to the correction or long-term remission of hypercalcemia.

Research progress on autonomic dysfunction in dementia with Lewy bodies / 中华全科医师杂志

Dementia with Lewy bodies (DLB) is the second most common type of neurodegenerative dementia. Autonomic dysfunction is a relatively common clinical manifestation in DLB patients, affecting various systems such as the cardiovascular, urinary, reproductive, and sweating systems. Autonomic symptoms can have profound impact on the patients′ quality of life and can lead to complications affecting their life expectancy. This review summarizes the pathology, symptoms, examination and treatment of autonomic dysfunction in DLB to provide reference for clinicians.

Differences in pulse manifestations at Cunkou based on simplified modeling of tactile sensing / 数字中医药（英文）

Objective @#In the theories of pulse disgnosis in traditional Chinese medicine (TCM), it is emphasized that pulse manifestations at the radial artery within the wrist (called Cunkou) signify the physiological and pathological conditions of different internal organs in the human body. However, different opinions exist among researchers about the objectiveness of the pulse diagnosis technique. Some researchers mentioned that no significant differences were observed in pulse manifestations at various Cunkou areas, hence there might be some difficulty in evaluating the status of different organs through checking pulse manifestations at Cunkou. This research aims to analyze the pulse response at Cunkou from the aspect of the characteristics of tactile sensing, thus to give a preliminary explanation to the above question.@*Methods@#This research utilized the Weber-Fechner law to model the tactile sensing as a dynamic low-pass signal filter with varying bandwidths under different compression levels during pulse diagnosis. The model was applied to analyzing the clinical data collected previously by our group. The arterial pressures measured invasively with equipment from 14 patients with aorta coarctation were processed to simulate different pulse manifestations at Cun, Guan, and Chi positions of Cunkou when different compression levels were applied.@*Result@#Due to the characteristics of tactile sensing, significant variations were observed in pulse manifestations at different pulse-depths under the application of changing compression levels; while no such changes in pulse manifestations were observed from the employment of transducer only, without tactile sensing involved. The results explained why different understandings on pulse manifestations were formed between direct pulse-taking technique in TCM and modern sphygmography using transducers. The features of pulse manifestations at Cunkou, using direct pulse-taking technique but at different depths, superficial, middle, and deep positions, respectively, predicted by the developed tactile sensing model were in line with those described in TCM pulse theories.@*Conclusion@#Based on the developed tactile sensing model, this study preliminarily explains the phenomenon that pulse manifestation at Cunkou changes in response to the compression force applied during TCM pulse-taking. Integrating the tactile sensing model with the study of TCM pulse diagnosis opens a new chapter for visualizing and quantitatively interpreting pulse manifestations. This not only expands the scope of pulse diagnosis study effectively, but also provide a scientific basis for further technical upgrading and optimization of existing pulse diagnosis equipment.

Research on Objective Characteristics of Tongue Manifestation in 315 Patients with Coronary Heart Disease / 中医杂志

ObjectiveTo investigate the objective characteristics of tongue manifestations in patients with coronary heart disease （CHD）. MethodsA total of 315 participants with CHD were recruited in the CHD group， and 211 healthy participants who underwent physical examination were recruited as the healthy control group. In addition， according to the common comorbidities （primary hypertension， carotid atherosclerosis， type 2 diabetes mellitus， fatty liver， hyperlipidaemia， heart failure， and cerebral infarction） in 315 participants with CHD， each comorbidity was classified into a group of comorbidities with that disease and a group of non-comorbidities. Tongue images were captured using a TFDA-1 tongue diagnostic instrument to characterise the tongue body （TB） and tongue coating （TC）， comparing the RGB， HIS， and Lab colour spaces in the chromaticity index （R， red； G， green； B， blue； H， hue； I， intensity； S， saturation； L， lightness； a， red-green axis； b， yellow-blue axis）， the tongue coating thickness index （per-All）， contrast （CON）， angular second moment （ASM）， entropy （ENT）， and mean （MEAN） in texture metrics. ResultsCompared with the healthy control group， the characteristic indexes of tongue body in CHD group showed lower TB-R， TB-G， TB-B， TB-I， TB-L and higher TB-H， TB-b； and the characteristic indexes of tongue coating in CHD group showed lower TC-R， TC-B and higher TC-CON， TC-MEAN， TC-H， TC-b （P＜0.05 or P＜0.01）. Compared with non-combined primary hypertension group， CHD combined primary hypertension group showed higher per-All， TB-G， TB-L， and lower TB-a， TC-a （P＜0.05）； compared with the non-combined carotid atherosclerosis group， CHD combined carotid atherosclerosis group showed higher TB-CON， TB-ENT， TB-MEAN， and lower TB-ASM （P＜0.05 or P＜0.01）； compared with the non-combined type 2 diabetes mellitus group， CHD combined type 2 diabetes mellitus group showed lower per-All and higher TB-H （P＜0.05 or P＜0.01）； compared with the non-combined fatty liver group， CHD combined fatty liver group showed higher TB-CON， TB-MEAN， TB-ENT， and lower TB-ASM and TC-S （P＜0.05 or P＜0.01）； compared with the non-combined hyperlipidaemia group， CHD combined hyperlipidaemia group showed lower TB-S and TB-a （P＜0.05）； compared with non-combined heart failure group， CHD combined heart failure group showed lower TB-R， TB-G， TB-I， TB-L， and higher TB-a （P＜0.05 or P＜0.01）； compared with non-combined cerebral infarction group， CHD combined cerebral infarction group showed higher TC-CON， TC-ENT， TC-MEAN， and lower TC-ASM （P＜0.05 or P＜0.01）. ConclusionCompared to healthy individuals， patients with CHD tend to have darker tongue colours and rougher TC textures. Compared with non-comorbidity participants， those with primary hypertension tended to be lighter tongue colour and thicker tongue coating， those with carotid atherosclerosis had paler tongue body， those with type 2 diabetes mellitus had thinner tongue coating， those with fatty liver disease had paler tongue body and whiter tongue colour， those with hyperlipidaemia and heart failure had paler tongue colour， and those with cerebral infarction had rougher tongue texture.

Treatment of Paroxysmal Sympathetic Hyperactivity by the Method of “Returning Fire to Its Origin” / 中医杂志

This paper summarized the clinical experience of using the method of “returning fire to its origin” for treatment of paroxysmal sympathetic hyperactivity （PSH）. According to the causes and clinical characteristics of PSH， the author believes that the deficiency of kidney qi， and the loss of yin and yang are the basis of the pathogenesis of PSH. Fright causes qi to be chaotic as the triggering mechanism of PSH. The key mechanism of PSH is that the deficiency yang with upper manifestation， and the fire does not return to its origin. The treatment should be nourishing yin and astringing yang， by taking modified Yinhuo Decoction （引火汤） internally， and receiving warm moxibustion as the first choice externally with selected acupoints Guanyuan （CV 4）， Mingmen （GV 4）， and bilateral Yongquan （KI 1）； For prevention， attention should be paid to take care of stomach qi， support healthy qi， and cultivate original qi.

Research progress on the manifestations and prognosis of neonatal lupus erythematosus in various systems / 中国当代儿科杂志

Neonatal lupus erythematosus (NLE) is caused by the transmission of maternal anti-Ro/SSA antibodies, anti-La/SSB antibodies, and other autoantibodies to the fetus through the placenta. Usually, with the disappearance of autoantibodies in the children's body, abnormal changes in the mucocutaneous, blood system, and digestive system can spontaneously subside, but the damage to various systems caused by autoantibodies may persist for a long time. This article provides a comprehensive review of the manifestations and prognosis of NLE in various systems, including mucocutaneous, blood system, circulatory system, nervous system, digestive system, respiratory system, aiming to provide reference for clinical work.

Secondary oral syphilis presenting as a tumor-like lesion on the lower lip

ABSTRACT This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient's complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.

Acute pancreatitis caused by Systemic Lupus Erythematosus activity: a case report and literature review / Pancreatitis aguda por actividad del lupus eritematoso sistémico: reporte de caso y revisión de la literatura

A 32-year-old woman with systemic lupus erythematosus came to the rheumatology outpatient clinic reporting abdominal pain for a week, along with fever, arthralgias, myalgias, alopecia, asthenia and dyspnea on exertion over the last two months. She was hypotensive and tachycardic, requiring admission to the intensive care unit. She was diagnosed with lupus-related acute pancreatitis, an unusual complication occurring in less than 1% of cases. Most cases are mild and self-limited; however, severe and life-threatening events with multiple organ failure are possible. This article is a case report of lupus-related critical acute pancreatitis, and a literature review.

Mujer de 32 años con lupus eritematoso sistémico acude a consulta externa de reumatología por dolor abdominal de una semana de evolución, además de fiebre, artralgias, mialgias, alopecia, astenia y disnea de esfuerzo de 2 meses de evolución. También presentó hipotensión y taquicardia, por lo que requirió ingreso en la unidad de cuidados intensivos. Le diagnosticaron pancreatitis aguda relacionada con el lupus, que es una complicación inusual que ocurre en menos del 1% de los pacientes. La mayoría de los casos son leves y autolimitados, sin embargo, es posible que se presenten eventos graves y potencialmente mortales, con disfunción multiorgánica. Este artículo es un reporte de caso de una pancreatitis aguda crítica relacionada con lupus y una revisión de la literatura.

Cutaneous manifestations of COVID-19 patients in a Hospital in São Paulo, Brazil, and global literature review

Abstract Background: Since the beginning of the COVID-19 pandemic, a myriad of cutaneous manifestations have been described in association with this viral infection. However, in Latin America, this kind of data is still scarce. Objective: In this sense, the goal of this study was to describe the dermatological findings observed during SARS-CoV-2 infection, in a Brazilian Hospital. Methods: This is a cross-sectional, retrospective and descriptive study of 50 cases of new-onset dermatologic symptoms in patients with COVID-19, treated at Hospital Sírio-Libanês, from February to June 2020. Results: The patients (n = 50) were classified into 6 groups, according to the elementary lesions and the statistical analysis was performed. The most common cutaneous lesions were maculopapular eruptions (44%), necrosis, purpura, and livedo (32%), urticarial lesions (12%), pseudochilblains (4%) and papular-vesicular eruption (4%). In 46% of the patients the cutaneous lesions occurred in association with other symptoms, such as pruritus (38%), pain and burning sensation (8%). Lower limbs were affected in 44% of the cases, followed by the trunk (38%), upper limbs (24%) and face (14%). Cutaneous lesions were mostly found after other COVID-19 systemic symptoms, with a mean period between the viral syndrome and cutaneous signs of 5 days (SD = 6.1 days). Study limitations: It is a small sample, in a single-center study, with patients exclusively from a private Hospitals. Conclusions: Patients in Brazil have the same proportion of lesions as revealed in other studies in Europa. The compiled data is essential for a better understanding of cutaneous manifestations deemed secondary to COVID.

Defecation Syncope: A Rare Manifestation in Covid Patients

Introduction: Physical activity leads to raised oxygen demand. This causes desaturation in patients with moderate to severe ARDS. Case Report: A 65yr/M was admitted complaining of breathlessness, cough and fever. RT-PCR was positive, inflammatory markers raised and HRCT Thorax consistent with covid findings. The patient was a known hypertensive taking Tab. Telmisartan (40mg). He had received 1st dose of Covishield vaccine. Treatment was initiated according to covid protocol. Oxygen therapy via NRBM mask at 10-15 litres was started and saturation maintained at 90-95%. On 9th day of admission, pt’s. saturation fell to 77%, while defecating. Subsequently, similar episodes were noted. Saturation fell to 55% transiently prompting BiPAP intervention. On Day 12 a severe episode of desaturation was noted but patient improved, without needing intubation. Diagnosis of Defecation Syncope was made. Discussion: Defecation Syncope (DS) is a parasympathetic response to the exerted pressure on the rectum and diaphragm, and closure of the epiglottis during defecation. Initially there is rise in BP and bradycardia, then rapid fall in BP leading to decreased cerebral perfusion causing syncope. Secondly, raised intra-abdominal pressure causes the diaphragm to exert greater pressure on the thoracic cavity. A (V/Q) mismatch causes hypoxia and desaturation in such patients. Constipation predisposes to DS. Conclusion: While these patients perform voiding activity, adequate fluid therapy should be initiated. Oxygen flow should be increased. Laxatives should be used judiciously. Emergency trolley should be kept on standby. Occasionally, such patients may have fatal outcomes. Patients should be under vigilance of healthcare providers.

Pattern of adverse drug reactions with chemotherapeutic drugs in a tertiary care hospital of North India: a retrospective study

Background: Adverse drug reactions are important causes of mortality and morbidity in the patients. Early detection, evaluation and monitoring of ADRs is essential to improve public health. Methods: This was an observational, non-interventional and retrospective study conducted at the ADR monitoring centre of a tertiary care hospital of North India. Suspected ADR forms reported over a period of 4 years involving at least one chemotherapeutic drug with at least one dose were analyzed. Results: A total of 261 chemotherapeutic drugs associated ADRs were analyzed. Out of these, maximum numbers of ADRs were reported by males (54%). Maximum reporting was done by Skin and VD department (37.93%). Causality assessment was probable in maximum number of cases (54%). Most common ADRs were skin rashes (21.46%), followed by jaundice, urticaria and fixed drug eruptions. Maximum ADRs were suspected to be caused by Anti tubercular drugs (31.42%) followed by anticancer drugs (14.56%). Conclusions: ADRs due to antibiotics and anticancer drugs is a significant health problem.

Quality of life in COVID survivors and post COVID manifestations in a tertiary care hospital, Nalanda, Bihar

Background: COVID-19 pandemic had affected majority of the population across the world. Majority of the cases still complaining of post COVID symptoms. This study was undertaken to study the various pattern of post COVID-19 manifestations in this region in a group of patients attending hospital. Methods: An observational study was undertaken in a group of 120 patients attending a tertiary care hospital. The patients were subjected for a detailed history and thorough physical examination and the details were entered in to a proforma. The data thus obtained was compiled and analysed. Results: This study had shown than majority of cases were aged more than 50 years and most of them were females. The common post COVID-19 manifestations included joint pain, continued loss of taste and smell, dyspnoea, Anxiety/ depression and sleep disturbances in this study. Conclusions: This study had observed continued symptoms from the episode of disease varying from mild to severe manifestations. This study urges for a comprehensive rehabilitation program for all COVID-19 patients.

A rare presentation of Mycoplasma pneumoniae with splenic nodules

Mycoplasma pneumoniae is a common respiratory pathogen that can cause a wide spectrum of extrapulmonary manifestations with neurological manifestations being the most common. Here, we report a rare case of splenic nodules in a 7-year-old girl with M. pneumoniae infection which responded well to macrolides. M. pneumoniae infection should be considered in children with extrapulmonary manifestations including splenic lesions

Emergence Of Dengue Virus Type 4 During COVID-19 Pandemic In Patients Admitted to a Teaching Hospital In Malaysia (Peningkatan virus denggi serotip keempat semasa pandemik COVID-19 pada pesakit yang dimasukkan ke hospital pengajar di Malaysia) / Jurnal Sains Kesihatan Malaysia

@#Prior to COVID-19, dengue was an important public health problem in Malaysia. Due to the movement control order imposed by the Malaysian government to curb the COVID-19 transmission, a study predicted that mosquito-borne diseases would increase during lockdown and partial lockdown seasons. Thus, this study aims to determine the current situation of dengue incidence during the pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020 and 2021). We compared the number of laboratory-confirmed cases in the pre-COVID19 year (2019) and during the COVID-19 pandemic (2020 and 2021). In addition to that, we characterized the clinical manifestation, dengue serotype and viremia levels of dengue patients that were admitted to the Hospital Cancelor Tuanku Muhriz. We found a significant decrease in the number of laboratory-confirmed cases between COVID-19 pandemic and the pre-covid period (p2020=0.064; p2021<0.001). In this study, we found DENV 4 serotype was the most common serotype in dengue patients admitted to our hospital. There was no significant correlation between DENV serotype/viremia level with clinical manifestation of dengue fever and dengue with warning signs. However, patients infected with DENV4 had the highest viral load compared to patients infected with other serotypes. We also found high viremia levels were significantly associated with the febrile phase.