Idiopathic systemic capillary leak syndrome: a case report.

BACKGROUND: Idiopathic systemic capillary leak syndrome (ISCLS) is a rare disease characterized by recurrent episodes of acute life-threatening attacks of shock, hemoconcentration, and hypoalbuminemia. Increase in capillary permeability results in reversible plasma movement into the interstitial spaces followed by appearance of related symptoms or complications, including renal failure. This condition can be potentially life-threatening; however, it is easily misdiagnosed. CASE PRESENTATION: A 47-year-old man with no previous medical history presented to the emergency department after experiencing general weakness and abdominal pain. He developed hypovolemic shock within 3 h of presentation and initial laboratory tests showed hemoconcentration, hypoalbuminemia and acute kidney injury. Following vigorous fluid therapy and supportive care, the patient recovered, but a similar episode recurred after 4 months without any specific trigger. Based on the combined clinical manifestations and laboratory findings of both the attacks, he was diagnosed with ISCLS. Symptomatic relief was achieved via oxygen supplementation and massive volume replacement using normal saline and the patient was prescribed bambuterol 10 mg and theophylline 400 mg once-a-day. He was discharged from the hospital on day 5 of hospitalization. Thereafter, the patient has been followed for 5 years without any symptoms or recurrence of ISCLS even in the situation of COVID-19 infection. CONCLUSIONS: ISCLS is an extremely infrequent and commonly misdiagnosed disease. However, early diagnosis, treatment and prophylaxis through accumulated clinical data can prevent ISCLS recurrence and the development of related fatal complications. Therefore, clinicians need to be well aware of the variety of clinical characteristics and treatment options of this disease.

Impact of COVID-19 infection on sports performance of elite university athletes.

BACKGROUND: Cardiopulmonary functions of athletes can be affected by the Coronavirus disease 2019 (COVID-19). This study aimed to investigate athletes' pattern of returning to sports after COVID-19, their experience of COVID-19-associated symptoms, and the disturbance in sports performance caused by the symptoms. METHODS: Elite university athletes who were infected with COVID-19 in 2022 were recruited for the survey and the data for 226 respondents were analyzed. Information about COVID-19 infection and the degree of disturbance in ordinary training and competition was collected. Their returning pattern to sports, the prevalence of COVID-19 symptoms, the degree of disturbance in sports by related symptoms, and factors associated with disturbance in sports and fatigue were analyzed. RESULTS: Results showed that 53.5% of the analyzed athletes returned to ordinary training immediately after quarantine, while 61.5% experienced disturbance in ordinary training, and 30.9% experienced that in competition. Most prevalent COVID-19 symptoms were lack of energy, easy fatiguability and cough. Disturbance in ordinary training and competition were mainly related to generalized, cardiologic, and respiratory symptoms. Women and those with severe and generalized symptoms had significantly higher odds of experiencing disturbance in training. Those with cognitive symptoms had higher odds of being "fatigue case." CONCLUSIONS: More than half of the athletes returned immediately to sports after the legal quarantine period of COVID-19 infection and experienced disturbance in ordinary training by related symptoms. Prevalent COVID-19 symptoms and the associated factors causing disturbance in sports and fatigue case were also revealed. This study will be helpful to establish the safe return guidelines essential for athletes after COVID-19.

Evaluation of nurse-led social media intervention for diabetes self-management: A mixed-method study.

AIMS: This study aimed to investigate the effectiveness and understand the process of a nurse-led social media intervention for health behavior and glucose control for diabetes self-management among patients with type 2 diabetes mellitus. DESIGN: This study had an explanatory sequential mixed methods design, with a randomized controlled trial and qualitative interviews. METHODS: A total of 89 patients diagnosed with type 2 diabetes mellitus were randomly assigned to an intervention or a control group. Patients in the intervention group were invited to join the closed nurse-led social media platform that included diabetes information, action planning, unmoderated chat, and questions and answers. The outcomes of diabetes self-care behavior, hemoglobin A1c (HbA1c) percentage, fasting blood sugar level (FBS), systolic and diastolic blood pressure, and triglyceride (TG) and total cholesterol levels were measured at baseline, 3 months, and 6 months. A linear mixed model was used to analyze the effectiveness of the intervention over time. Qualitative data were collected from interviews with seven patients engaged in the intervention and analyzed using qualitative content analysis. FINDINGS: After 6 months, insulin users who were provided with the social media intervention had significantly lower FBS and TG levels than those with usual care (135.80 ± 12.37 vs. 175.82 ± 15.34 mg/dL, p = 0.049; 206.85 ± 38.26 vs. 387.50 ± 56.19 mg/dL, p = 0.013; respectively). Although a similar rate of decrease in the HbA1c level over time was observed among insulin and noninsulin users after the social media intervention, this decrease was significantly greater among noninsulin users at 3 and 6 months compared with the control group (6.38 ± 0.34 vs. 7.25 ± 0.24, p = 0.040; 6.31 ± 0.37 vs. 7.28 ± 0.26, p = 0.036; respectively). Interview with seven patients who engaged in the intervention revealed that their engagement in the intervention was primarily determined by their acceptance of the role of managing their diabetes. Being engaged in the intervention, patients benefited from information sharing and interactive support to motivate their self-care, nurses' professional advice to modify their behaviors, and action planning to make progress toward behavioral change. CONCLUSIONS: The positive outcomes of the nurse-led social media intervention indicate that the social media platform is an effective strategy to implement diabetes self-management in clinical nursing practice. CLINICAL RELEVANCE: The social media intervention would be successfully implemented by nurses to facilitate patients accepting their role in diabetes management and employing key services for diabetes information, support, professional advice, and action planning.

Onset of various CNS inflammatory demyelination diseases following COVID-19 vaccinations.

BACKGROUND: Since the start of COVID-19 vaccination worldwide, there have been several reports of inflammatory demyelinating diseases of the central nervous system (CNS-IDDs) following vaccination. METHODS: We prospectively collected cases of new-onset CNS-IDDs with a temporal relationship between disease onset and COVID-19 vaccination and investigated their proportion among newly registered cases of CNS-IDD over the past year. RESULTS: Among 117 cases, 10 (8.5%) had their first disease manifestation within one month following COVID-19 vaccination: 2 multiple sclerosis, 2 neuromyelitis optica spectrum disorder, 3 MOG antibody-associated disease, and 3 unclassified CNS-IDDs. CONCLUSION: This observation suggests that COVID-19 vaccination may trigger the onset of various CNS-IDDs in susceptible individuals.

Pneumonia-targeted lopinavir/ritonavir-based treatment for patients with COVID-19: an early-period retrospective single center observational study.

BACKGROUND: Robust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential. METHODS: A lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group). RESULTS: In total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067-0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128-8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021-1.202; P = 0.014). CONCLUSIONS: Early, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.

Early Safety Monitoring of COVID-19 Vaccines in Healthcare Workers.

Hospital-based surveillance for adverse events was conducted on healthcare workers after they received the first dose of coronavirus disease 2019 (COVID-19) vaccine. Among the two new platform vaccines (messenger RNA- and adenoviral vector-based vaccines), the rates of systemic adverse events were significantly higher among adenovirus-vectored vaccine recipients. Fatigue (87.6% vs. 53.8%), myalgia (80.8% vs. 50.0%), headache (72.0% vs. 28.8%), and fever (≥ 38.0°C, 38.7% vs. 0%) were the most common adverse events among adenovirus-vectored vaccine recipients, but most symptoms resolved within 2 days. Both types of COVID-19 vaccines were generally safe, and serious adverse events rarely occurred.