Patient with Jaundice, Dyspnea and Hyperferritinemia after COVID-19

The aim: to highlight the importance of considering hemophagocytic lymphohistiocytosis in patients with jaundice of unclear origin and systemic inflammatory manifestations after coronavirus infection. Key points. A 64-y.o. patient was admitted to the hospital with jaundice, pruritus, fatigue, weight loss. The complaints occurred 2 weeks after discharge from the hospital for treatment of patients with coronavirus infection. Laboratory tests revealed signs of hepatic insufficiency, markers of cholestasis and inflammation persisted in time. Upon instrumental examination no signs of hepatosplenomegaly, biliary tree changes, intra- and extrahepatic obstruction were found. S. aureus was identified in blood cultures, CT scan of the facial skull bones showcased the focus of infection in the area of the roots of teeth 2.4 and 2.5. Therefore, antibiotics were prescribed. Subsequently, the patient's condition was complicated by the development of two episodes of acute respiratory distress syndrome, which occurred during the withdrawal of glucocorticosteroid therapy. Liver biopsy was performed, morphological study revealed signs of "vanishing bile duct” syndrome, excessive activation of macrophages and hemosiderosis of sinusoidal cells. Identified lesions can be found in hemophagocytic lymphohistiocytosis (HLH), a life-threatening complication of coronavirus infection. Glucocorticosteroids therapy, transfusions of human immunoglobulin, albumin, and parenteral nutrition have led to patient's condition improvement. Conclusion. COVID-19 provokes the development of secondary HLH 10 times more often than other respiratory viral infections. The possibility of hemophagocytic syndrome development should be considered, including cases of overlap syndrome with sepsis, in patients with unresolved jaundice, hyperferritinemia after coronavirus infection. Routinely used scales and criteria for diagnosis of HLH (H-score, HLH 2004) in such cases lacks sensitivity, therefore, careful analysis of clinical picture and exclusion of other causes of jaundice are required. © 2022 Russian Journal of Gastroenterology, Hepatology, Coloproctology

COVID-19 AS A CAUSE OF COMA IN ADULT ONSET VANISHING WHITE MATTER DISEASE

A 34 year old female presented with fever, diarrhoea, confusion, and a decline in mobility, having recently tested positive for COVID-19. Her medical history included patent foramen ovale, primary ovarian failure and leukoencephalopathy which had been investigated in her 20s leading to a clinical diagnosis of Vanishing White Matter disease (VWM). On admission she deteriorated rapidly with decreased GCS requiring frequent critical care review. MRI demonstrated mild progression of the cerebral atrophy and slight increase in the 'cystic' changes in the white matter. Lumbar puncture was unremarkable. EEG demonstrated widespread cerebral dysfunction with frontotemporal emphasis but without seizure activity. She was managed with supportive care recovering to her baseline function within days. VWM is a leukodystrophy caused by recessive mutations in eukaryotic initiation factor 2B (eIF2b) complex. Adult onset presentations have been described which have a slowly progressive course. Patients with VWM are known to rapidly decline with fever, and mild head injury occasionally resulting in coma. Our case high-lights the potentially devastating effects of a neurotropic virus such as COVID-19 in VWM, and the need to consider rare genetic disorders in adult patients presenting with extensive white matter abnormalities on MRI and premature ovarian failure.

ResidualCovid-Net: An Interpretable Deep Network to Screen COVID-19 Utilizing Chest CT Images

Coronavirus illness, commonly abbreviated as COVID-19, has been designated a global pandemic. To prevent the spread of this deadly virus, those who are infected must be quarantined or evacuated. In this situation, a quick and systematic testing toolkit is required. Recent research has discovered that radiography chest CT has significant patterns and attributes that may be utilized to precisely identify COVID-19. A deep learning-based network called ResidualCovid-Net was suggested in this study to identify COVID-19 infestations using CT scans. The proposed ResidualCovid-Net is inspired by the original Resnet architecture. Another barrier in this aspect is clinically distinguishing among COVID-19, pneumonia and normal instances. ResidualCovid-Net was designed to identify anomalies in CT scans that may successfully delineate COVID-19, common pneumonia and normal cases. Gradients weighted class activation maps showed how well the network located anomalies in CT images and demonstrated the network's generalization ability. © 2021 IEEE.

Imaging in disappearing colorectal liver metastases and their accuracy: a systematic review.

BACKGROUND: Approximately 30% of patients with colorectal cancer develop colorectal liver metastases (CRLM). CRLM that become undetectable by imaging after chemotherapy are called disappearing liver metastases (DLM). But a DLM is not necessarily equal to cure. An increasing incidence of patients with DLM provides surgeons with a difficult dilemma: to resect or to not resect the original sites of DLM? The aim of this review was to investigate to what extent a DLM equates a complete response (CR) and to compare outcomes. METHODS: This review was conducted in accordance with the PRISMA guidelines and registered in Prospero (registration number CRD42017070441). Literature search was made in the PubMed and Embase databases. During the process of writing, PubMed was repeatedly searched and reference lists of included studies were screened for additional studies of interest for this review. Results were independently screened by two authors with the Covidence platform. Studies eligible for inclusion were those reporting outcomes of DLM in adult patients undergoing surgery following chemotherapy. RESULTS: Fifteen studies were included with a total of 2955 patients with CRLM. They had 4742 CRLM altogether. Post-chemotherapy, patients presented with 1561 DLM. Patients with one or more DLM ranged from 7 to 48% (median 19%). Median DLM per patient was 3.4 (range 0.4-5.6). Patients were predominantly evaluated by contrast-enhanced computed tomography (CE-CT) before and after chemotherapy, with some exceptions and with addition of magnetic resonance imaging (MRI) in some studies. Intraoperative ultrasound (IOUS) was universally performed in all but two studies. If a DLM remained undetectable by IOUS, this DLM represented a CR in 24-96% (median 77.5%). Further, if a DLM on preoperative CE-CT remained undetectable by additional workup with MRI and CE-IOUS, this DLM was equal to a CR in 75-94% (median 89%). Patients with resected DLM had a longer disease-free survival compared to patients with DLM left in situ but statistically significant differences in overall survival could not be found. CONCLUSION: Combination of CE-CT, MRI, and IOUS showed promising results in accurately identifying DLM with CR. This suggests that leaving DLM in situ could be an alternative to surgical resection when a DLM remains undetectable by MRI and IOUS.

Vanishing mediators in public health during COVID-19.

Public health interventions during the coronavirus disease 2019 pandemic aim to ensure that the lessons learned of the crises can prevent historical recurrences. Such interventions can mean vanishing mediators that must cater to a post-pandemic structure. Learning from large-scale political and scientific histories or advances-emancipatory projects, pandemic histories and vaccine developments-as well as individual agencies-physical activity and exercise-at the moment become crucial in rethinking and enacting utopian possibilities.

Metonymies, metaphors and/or language reconsiderations for sustainability during COVID-19.

Pandemic discussions employ language metaphors and metonymies to make sense of the coronavirus disease 2019 crisis. From commenting and proposing to revise terms such as social distancing, the war against the virus, to viewing mother nature as a killer, there are language reconsiderations to be made to avoid some disturbing mental imageries to picture a sustainable future. The Anthropocene geologic time and the improved environmental quality situate this backdrop. Language interventions make up as a vanishing mediation that will prompt a deeper understanding of the environment and nature as a whole.