RESUMEN
A variety of complications came to light after the SARS-CoV-2 pandemic of 2020. One such post-covid complication that manifests itself in the form of a hyperinflammatory syndrome in the pediatric population is multisystem inflammatory syndrome in children (MIS-C). It results in severe inflammation of a variety of organ systems, including the heart, lungs, brain, kidneys, gastrointestinal system, skin, and eyes. Surprisingly, clinicians can easily mistake this type of presentation for many other diseases due to overlapping features, especially Kawasaki disease (KD). An interesting case report on a patient admitted to the Grodno regional infectious diseases clinical hospital, Grodno, Belarus. The patient was initially diagnosed with enteroviral infection (EVI) at the time of admission. The clinicians in charge observed the underlying cause to be masked by Kawasaki-like presentation, how they diagnosed MIS-C, Kawasaki-like phenotype: exanthema, cheilitis, scleritis, infectious cardiopathy, gastrointestinal syndrome, coagulopathy and managed this patient is described in this scientific paper. Although the presenting signs and symptoms of MIS-C overlap with other diseases, certain additional features can be helpful in differentiation. Mainly MIS-C is present in a relatively older subgroup along with gastrointestinal symptoms that are uncommon for KD. The patient was treated with IVIG and steroids after which he attained full recovery. MIS-C associated with COVID-19 is serious, rare, and potentially fatal. Clinicians, primary care physicians, and emergency department pediatricians must be quick to recognize it and treat it at the earliest by deploying immunomodulatory strategies to subdue systemic injury caused by hyper-inflammation.
RESUMEN
Skin is a frequently involved and damaged organ in cutaneous necrotizing vasculitis (CNV), mainly characterized histologically by a segmental angiocentric inflammatory condition with fibrinoid necrosis of the vessel wall. Various etiological factors have been described as probable causes that trigger CNV, ranging from infectious causes to autoimmune conditions. We have described a case of a middle-aged man with chronic kidney disease (CKD) that presented to the Grodno university clinic with Staphylococcal pneumonia and high level of the IgE antibodies that probably triggered CNV. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Based on the provisional diagnosis of hemorrhagic necrotizing vasculitis (cutaneous form), the patient was started on a low dose of glucocorticosteroid therapy. After carrying out a skin flap biopsy, a confirmed diagnosis of ANCA-negative CNV-leukocytoclastic vasculitis (LcV) form was made. The patient was started on steroid pulse therapy followed by plasmapheresis for elevated IgE count, leading to rapid resolution of symptoms. Literature has stated that CNV-LcV form commonly involves immune complexes composed of IgG or IgM. Based on our observation, we have proposed a novel hypothesis that elevated IgE and IgE immune complexes can be an additional triggering factor for CNV-LcV form as well.
RESUMEN
Background: A skeleton is a metabolically active organ that constantly undergoes remodelling throughout life. Various factors influence the process of bone formation and resorption. Menopause is a crucial stage in a woman’s life and a female’s body undergoes many significant changes during this stage. Hormone-related changes occur not only due to menopause but also due to aging; the two crucial hormones we emphasized in our study are- estrogen and melatonin; and their manifestation in the skeletal system of a postmenopausal population. Methods: Our study consisted of 48 post-menopausal females, 24 subjects in the case group, and 24 in the control groups, to study the differences in certain parameters existing between the two. Serum estrogen and melatonin were calculated using the ELISA test; bone mineral density (BMD) was evaluated using a portable ultrasound bone densitometer testing machine. Results: The factors (estrogen and melatonin) have a direct strong linear relation with BMD. Pearson correlation coefficient was found to be positive (r) 0.92, indicating a strong correlation. The ‘goodness of fit’ (r2) of multiple linear regression was found to be 0.8485 (roundabout 85%), indicating strong positive results. Conclusions: The results of our study exhibited strong interdependence of BMD on serum estrogen and melatonin. Osteopenic subjects who had a lower BMD were also found to have relatively lesser levels of serum estrogen and melatonin. Aligning with the results, similarly, the control group with normal BMD was found to have relatively higher serum levels of both hormones.
RESUMEN
Skin is a frequently involved and damaged organ in cutaneous necrotizing vasculitis (CNV), mainly characterized histologically by a segmental angiocentric inflammatory condition with fibrinoid necrosis of the vessel wall. Various etiological factors have been described as probable causes that trigger CNV, ranging from infectious causes to autoimmune conditions. We have described a case of a middle-aged man with chronic kidney disease (CKD) that presented to the Grodno university clinic with Staphylococcal pneumonia and high level of the IgE antibodies that probably triggered CNV. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Based on the provisional diagnosis of hemorrhagic necrotizing vasculitis (cutaneous form), the patient was started on a low dose of glucocorticosteroid therapy. After carrying out a skin flap biopsy, a confirmed diagnosis of ANCA-negative CNV-leukocytoclastic vasculitis (LcV) form was made. The patient was started on steroid pulse therapy followed by plasmapheresis for elevated IgE count, leading to rapid resolution of symptoms. Literature has stated that CNV-LcV form commonly involves immune complexes composed of IgG or IgM. Based on our observation, we have proposed a novel hypothesis that elevated IgE and IgE immune complexes can be an additional triggering factor for CNV-LcV form as well.
RESUMEN
Background: A skeleton is a metabolically active organ that constantly undergoes remodelling throughout life. Various factors influence the process of bone formation and resorption. Menopause is a crucial stage in a woman’s life and a female’s body undergoes many significant changes during this stage. Hormone-related changes occur not only due to menopause but also due to aging; the two crucial hormones we emphasized in our study are- estrogen and melatonin; and their manifestation in the skeletal system of a postmenopausal population. Methods: Our study consisted of 48 post-menopausal females, 24 subjects in the case group, and 24 in the control groups, to study the differences in certain parameters existing between the two. Serum estrogen and melatonin were calculated using the ELISA test; bone mineral density (BMD) was evaluated using a portable ultrasound bone densitometer testing machine. Results: The factors (estrogen and melatonin) have a direct strong linear relation with BMD. Pearson correlation coefficient was found to be positive (r) 0.92, indicating a strong correlation. The ‘goodness of fit’ (r2) of multiple linear regression was found to be 0.8485 (roundabout 85%), indicating strong positive results. Conclusions: The results of our study exhibited strong interdependence of BMD on serum estrogen and melatonin. Osteopenic subjects who had a lower BMD were also found to have relatively lesser levels of serum estrogen and melatonin. Aligning with the results, similarly, the control group with normal BMD was found to have relatively higher serum levels of both hormones.
RESUMEN
Plastic bronchitis (PB) is a rare condition of obstructive bronchial casts. The most common demographic that is affected by PB is children but adults with acute onset have also been reported. At present, there are no established guidelines for the management of PB which has led to the proposition of a variety of treatment regimens. Inhaled streptokinase (SK) can be one such treatment modality for this rare condition. An adult female patient presented to the Grodno university clinic with complaints of dyspnea, shortness of breath, and expectoration of firm, long, and branching bronchial casts. We used inhaled SK to treat this patient based on the cast composition on microscopic evaluation. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. SK, a potent fibrinolytic agent, can be useful in lysing fibrin-rich bronchial casts. With Inhaled SK therapy, there was a gradual improvement in the overall condition of the patient. In the subsequent clinical follow-up, the patient was asymptomatic and without recurrent casts. The course of treatment and positive recovery of the patient signifies the fact that inhaled SK can be a suitable therapeutic approach in PB. Therefore, based on our novel therapeutic approach, SK inhalation may be a possible treatment for bronchial casts in PB.