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Coronavirus disease has many systemic disease symptoms and has severe consequences for the cardiovascular system. Objective. To assess the role of clinical and laboratory indicators in determining the risk of chronic heart failure (CHF) in COV-ID-19 survivors. Material and methods. In total, 151 patients treated in a monoinfectious hospital from 03.11.20 to 10.02.21 with a confirmed diagnosis of COVID-19 were retrospectively selected. Medical history and laboratory data were collected by reviewing electronic medical records. The data included age, gender, body mass index, smoking status, and comorbidities. The laboratory data included the results of hematology and blood chemistry, coagulation, and the levels of acute-phase proteins. The CHF occurrence was used as the study endpoint. Results and discussion. The study patients were divided into two groups depending on the presence of CHF: group 1 included 46 patients with CHF, and group 2 included 105 patients without CHF. The median age was 66.2 (50-92) years;91 (60.3%) were females. Laboratory tests, such as levels of the hs-C-reactive protein, lactate dehydrogenase, procalcitonin, creatinine, and bilirubin, were statistically significantly different in patients of the study groups, and the median values were higher in patients with CHF. Neutrophil-lymphocyte ratio (NLR) showed statistically significant differences between groups: in patients with CHF, the median was 4.97% compared to 3.62% (p=0.011) in those without CHF. The most significant predictors of an increased risk of CHF were age >=66 years (OR=8.038, p<0.001), procalcitonin level >=0.09 ng/mL (increased the CHF risk by 3.8 times, p<0.001), thrombocy-topenia <=220x109/L (p=0.010), an NLR ratio >=4.11% (p=0.010), and a history of chronic kidney disease (p=0.018). Conclusion. A model has been developed to determine the factors closely associated with the risk of chronic heart failure in CO-VID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Coronavirus disease has many systemic disease symptoms and has severe consequences for the cardiovascular system. Objective. To assess the role of clinical and laboratory indicators in determining the risk of chronic heart failure (CHF) in COV-ID-19 survivors. Material and methods. In total, 151 patients treated in a monoinfectious hospital from 03.11.20 to 10.02.21 with a confirmed diagnosis of COVID-19 were retrospectively selected. Medical history and laboratory data were collected by reviewing electronic medical records. The data included age, gender, body mass index, smoking status, and comorbidities. The laboratory data included the results of hematology and blood chemistry, coagulation, and the levels of acute-phase proteins. The CHF occurrence was used as the study endpoint. Results and discussion. The study patients were divided into two groups depending on the presence of CHF: group 1 included 46 patients with CHF, and group 2 included 105 patients without CHF. The median age was 66.2 (50-92) years;91 (60.3%) were females. Laboratory tests, such as levels of the hs-C-reactive protein, lactate dehydrogenase, procalcitonin, creatinine, and bilirubin, were statistically significantly different in patients of the study groups, and the median values were higher in patients with CHF. Neutrophil-lymphocyte ratio (NLR) showed statistically significant differences between groups: in patients with CHF, the median was 4.97% compared to 3.62% (p=0.011) in those without CHF. The most significant predictors of an increased risk of CHF were age >=66 years (OR=8.038, p<0.001), procalcitonin level >=0.09 ng/mL (increased the CHF risk by 3.8 times, p<0.001), thrombocy-topenia <=220x109/L (p=0.010), an NLR ratio >=4.11% (p=0.010), and a history of chronic kidney disease (p=0.018). Conclusion. A model has been developed to determine the factors closely associated with the risk of chronic heart failure in CO-VID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Background: A major consequence of COVID-19 is long-term metabolic complications (metabolic PASC or Long COVID) following acute disease resolution leading to hyperglycemia, increased risk of diabetes or defects in glucose metabolism. However, the mechanisms underlying the links between COVID-19 and glycometabolic disruptions remain unclear. Method(s): 15 African green monkeys (AGM;Chlorocebus aethiops) were infected with SARS-CoV-2 (Wuhan stain) and divided into two groups: unvaccinated (n=10) and vaccinated (BNT162b2 (Pfizer) 4-days post infection;n=5). Subgenomic SARS-CoV-2 mRNA (sgRNA) reflecting active replication was quantified in nasal and pharyngeal swabs, and blood chemistry analysis was performed longitudinally up to 18 weeks post-infection. We quantified liver glycogen at necropsy using Periodic acid-Schiff staining. Finally, we longitudinally analyzed 96 plasma proteins using a proximity extension assay (Olink). STRING was used to identify enriched protein networks. Comparisons between the two groups over time were performed using PERMANOVA. Result(s): All animals had detectable sgRNA ( >3.64x106) at day 3, and only two were undetectable at week 5. Post-infection BNT162b2 vaccination partially inhibited the SARS-CoV-2 mediated disruption of glucose levels (P=0.001, Fig. 1A). Liver glycogen levels following necropsy correlated positively with blood glucose levels at week 12 (r=0.74, P =0.003). Histopathological analysis revealed no marked evidence of long-term inflammation or fibrosis of pancreatic islets. Using the plasma proteomic data, we identified a signature of 15 SARS-CoV-2-modulated plasma proteins coinciding with early onset hyperglycemia during acute infection (P=0.001, Fig. 1B). These proteins are enriched for biological processes linked to chemotaxis (FDR=1.38E-06), and viral protein interaction with cytokines (FDR=1.01E-12) (Fig. 1C). Of these, CCL25 and glial cell derived neurotrophic factor (GDNF) remained persistently elevated post-acute infection and correlated with blood glucose levels (r=0.57, P=0.0003;and r=0.64, P<0.0001, respectively, Fig. 1D). Conclusion(s): Our AGM model validates phenotypes of metabolic PASC and offers an opportunity to mechanistically study the manifestations of PASC. Our preliminary data suggest that vaccine-preventable early insults by metabolicregulating immune factors may contribute to long-term dysregulated liver and systemic glucose homeostasis during PASC. These immune factors warrant further investigation for their mechanistic links to PASC. (Figure Presented).
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Feline Infectious Peritonitis (FIP) is highly mortality disease in cats. The reliable and fast diagnosis is crucial to the best prognosis. The aim of this study to evaluate the hemogram profile in cats infected with effusive FIP. Twenty cats had been diagnosed effusive FIP at Animal Clinic Department of Internal Medicine, Faculty Veterinary Medicine, Universitas Gadjah Mada were used in the study. The diagnosis were based on clinical examination, ultrasound, x-ray, rivalta test, and rapid test. The hemogram profile were analyzed include routine hematology and serum biochemistry. Hemogram profile in effusive FIP showed the decreased hematocrit, hyperproteinemia, and leukocytosis with an average 22.9+or-7.4%;9.0+or-2.2 g/dL;22425+or-4116 cells/mm3 respectively. Erythrocyte, hemoglobin and fibrinogen levels were still in the normal range. The results of differential leukocytes revealed that 90% cats had neutrophilia and 75% lymphopenia with an average 20066+or-3337 cells/mm3 and 1861+or-1818 cells/mm3 respectively. The blood chemistry profile showed 60% of cats experienced increase in SGPT and SGOT with an average 138.4+or-72.3 IU/L and 101+or-60.5 IU/L respectively. Hyperglobulinemia was found in 90% samples with an average 6.7+or-0.8 g/dL. All cats have a low albumin:globulin ratio with an average 0.3+or-0.1. The hemogram profile of effusive FIP were: leukocytosis, neutrophilia, lymphopenia, hyperglobulinemia, and decreased albumin-globulin ratio..
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The aim of our study is analysis of the androgenic status including testosterone (T) and dihydrotestosterone (DHT) in men hospitalized with coronavirus disease 2019 (COVID-19) and them relationship with the course of the disease. This is a monocentric prospective study performed on 125 male patients hospitalized for COVID-19. We conducted hematological examination, blood biochemical profile, hemostasis analysis and hormonal examination (T and DHT levels) lung and chest computed tomography and also assessed outcomes of hospitalization. Low DHT serum level was found only in 18 patients (14.4%). Subjects with low DHT were significantly older compare to subjects with normal DHT. At the same time in patients with normal DHT white blood cells (WBC) count, neutrophils at admission were higher than in patients with low DHT. No correlation was observed between T and DHT serum blood levels. C-reactive protein (CRP) has a weak positive correlation of DHT serum blood concentration (r = 0.22;p = 0.016). The inverse pattern was obtained for T serum blood concentration (r = -0.285;p = 0.001). After divided all males according to T concentrations we conducted next correlation analysis for DHT and CRP in two different groups: with normal T levels and with low T levels. We found that in males with normal T DHT levels are not correlated with CRP (r = 0.095;p = 0.462). However, in males with low T DHT and CRP had weak positive correlation with r = 0.317 (p = 0.012). Higher DHT concentrations are associated with higher CRP levels, however correlation is weak and in patients with normal T is absent, that may indicate anti-inflammatory effect of T and possible proinflammatory effect of DHT.Copyright © 2023 The Author(s).
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The purpose of this experiment was to increase poultry meat production by increasing the number of chickens reared in the same area and managing it by using medicinal herbs Salvia officinalis L and Lavandula angustifolia L. in the broiler chicken diet. 705 one-day-old chicks were randomly distributed into to7 treatments with three replicates for an area of two m2 floor system in each replicate for each treatment, during 35 days of the study. T0 negative control 75 chicks, 25 chicks for each replicate 12-13 chicks per m2 fed standard diet. T1 positive control (stocking density without supplementation)105 chicks, 35 each replicate chicks 17-18 per m2 fed standard diet. The same stocking density for T2, T3, T4, T5, and T6 have been given standard feed with supplemented herbals, salvia 0.7%, 0.9%, lavender0.7%, 0.9%, and mixed 0.7% respectively. Depending on the results, chickens reared in stress stocking density with supplementations led to higher improvement of body weight, meat production, body weight gain (BWG), feed conversion ratio(FCR g feed/g weight), production index PI, carcass weight (g) and dressing percentage, RBCs 106cells/mm3, lymphocyte%, of increasing activity of thyroid hormones T3, T4 (nmol/L) boost antibody titers of ND and IBV when compared with positive control. However, heterophil%, stress indicator H/L ratio, glucose mg/ dL and cholesterol mg/ dL significantly reduced. The results showed that adding sage and lavender plants to broiler feed is effective in improving productivity, immunity, and resistance characteristics in reducing the adverse effects of stress caused by increasing the intensity of broiler rearing in the same area.
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Background: An intermediate respiratory care unit (IRCU) may be a valuable tool for optimizing patient care, allowing to implement standardized algorithm management to decrease clinical failure and mortality. We aimed to describe the practice of noninvasive respiratory strategies (NRS) in a novel facility fully dedicated to COVID-19 and to establish outcomes of these patients Methods: Prospective, observational study performed at one hospital in Spain. We included consecutive patients admitted to IRCU due to COVID-19 requiring NRS between December 2020 and September 2021. Data collected included mode and usage of NRS, endotracheal intubation and mortality to day 30. A multivariable Cox proportional hazards method was used to assess risk factors associated with clinical failure and mortality Findings: 1306 patients with COVID-19 were included. Of them, 64.6% were men and mean age was 54.7 years. During IRCU stay, 345 patients presented a clinical failure, (89.6% intubated;14.5% died). Cox model showed a higher clinical failure in IRCU when time between symptoms onset and hospitalization < 10 days (HR 1.59;95% CI 1.24-2.03;p<0.001) and PaO2/FiO2 <100 (HR 1.59;95% CI 1.27-1.98;p<0.001). Conversely, these variables were not associated with an increased mortality to day 30 Interpretation: IRCU may be a useful option for the multidisciplinary management of COVID-19 patients requiring NRS;thus, reducing ICU overcharge. Men gender, gas-exchange and blood chemistry at admission are associated with worse clinical outcomes, while older age, gas-exchange and blood chemistry are associated with 30-day mortality.
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Background: In India, the first case of COVID-19 was reported on January 30, 2020. The case reporting is based on the testing of individuals by Real-time Reverse Transcription- Polymerase Chain Reaction (RT-qPCR). The present study was conducted to evaluatedifferent parameters, Haematological and Biomarker variations in patients with SARS-CoV2 Infection to assess the prognostic significance. Material & Methods: The present prospective study was conducted among 70 patients who were diagnosed with COVID-19 infection. Relavant physical examination and clinical data of the patient and routine blood investigations including, CBC, serum biochemistry, coagulation function and measurement of inflammatory markers were performed. The results were analyzed by using a SPSS Statistics software version 25.0. Results: In the present study total patients were 70 out of which 58.6% were males and 41.4% were females. Maximum subjects belong to age group 61-80 yrs (47.1%). Mean haemoglobin was 12.89g/l, mean platelet was 9.96x103/l. Mean neutrophil were 88.21%, mean lymphocyte were 8.84%, mean eosinophil were 1.47%, mean monocyte was 1.59%, mean TLC was 12007.14/l. Mean random blood sugar was 148.09 mg/dl. Mean D-dimer was 0.56. Mean CRP levels were 65.5 mg/l. Mean LDH was 516.03 IU/L, mean IL-6 was 282.6pg/ml, and mean procalcitonin was 0.8 ng/ml. Mean SGOT was 62.36u/l, mean ALP was 171.87IU/L, mean urea levels were 57.10 mg/dl and mean INR was 1.22. Outcome mortality was present in total 14 subjects (5 were male and 9 were female) out of all 70 subjects. Conclusion: The present study concluded that Mean values of neutrophil, eosinophil, TLC, random blood sugar, IL6, SGOT, ALP, urea levels and INR were increased in patients with SARS-CoV2 Infection.
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Background: Acute kidney injury (AKI) occurs in about 10-15 % of hospitalized patients and represents a significant cause of death. This percentage, during the Covid-19 pandemic, seems to have increased. A meta-analysis reports an overall incidence of AKI, in patients with SARS-CoV2 infection, of 20.4%. The determining cause is not yet clear: direct and indirect damage (from cytokines cascade, iatrogenic damage, organ cross-talk, sepsis, mechanical ventilation, endothelial dysfunction and hypercoagulation) participate in the determination of the loss of renal function. Material(s) and Method(s): We have selected all patients, including SARS-CoV2 infection, admitted to the AOU Polyclinic 'G.Martino' from February 2022 to April 2022, who needed renal replacement therapy (RRT). Result(s): Twelve patients (50%) had SARS-CoV2 infection. Table 1 reports the characteristics of the patients divided according to SARS-CoV2 infection at admission;no significant difference is present. In accordance to the know negative prognostic value of AKI stage 3, 18 patients (75%) died during hospitalization. We then divided the patients into two groups according to death (tab.2). In death patients median creatinine was higher than in survival patients, but, on the other hand, in death patients hemodialytic therapy was done later. Conclusion(s): Our data show the importance of timing in the start of renal replacement therapy and the impossibility of reducing the choice to laboratory indications. Patients with increased renal impairment may be clinically more stable so starting dialysis treatment may not be an emergency. Conversely, patients who do not have a major alteration of the laboratory parameters, but with a more complex clinical picture, may have a better prognosis if, after an overall evaluation, the renal replacement treatment is started early. Moreover, our data show that blood chemical analysis data at admission in Covid-19 patients are not different from patients without Covid-19. Additionally, patients with SARS-CoV2 infection, may have clinical features (related for example to organ cross-talk or the need for mechanical ventilation) that could benefit from an early start of hemodialytic treatment with better outcomes.
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A 33yo man, ex-convict, with a history of IV substance abuse, without previous cardiological history, was admitted at our emergency department in the clinical context of an acute pericarditis, intermittent fever in the last 10 days and non-itchy maculo-papular erythema of palms and thorax. EKG documented a diffuse ST-segment elevation, chest X-rays revealed a bilateral pleural effusion and echocardiography documented a normal biventricular morphology and function, normal valvular function, and a circumferential pericardial effusion (14mm). The patient was admitted at our Cardiology Unit after a negative PCR SARS-CoV-2 test. Blood chemistry showed elevated WBC count with an important neutrophilia (24.000/mm3;90% neutrophils), elevated TnI-HS (236 ng/L;n.v. <18 ng/L), elevated C-reactive protein (340 mg/L;n.v. < 5mg/L). A classic anti-inflammatory therapy was set up with indomethacin + colchicine with little clinical benefit. Blood cultures, bacterial serology (i.e., Tubercolosis, T.gondii, Syphilis, Leptospirosis) and viral serology (i.e., HIV, HCV, HBV, EBV, HSV) resulted negative. However, an empirical antibiotic coverage was set up: sequentially with Piperacillin/Tazobactam, Vancomycin, Linezolid and Ceftriaxone. None of the antibiotics improved patient's clinical status. On the contrary, the patient developed an allergic reaction to Vancomycin and Linezolid. All autoantibodies tested resulted negative. After 10 days of hospitalization, the patient's clinical status continued to deteriorate. The intermittent fever (max 41degreeC) was not responsive to any treatment. The evanescent skin rash had spread to the whole body and was concomitant with the fever peaks. The indexes of inflammation were rising (C-reactive protein 400 mg/ L) and so were the WBC count (36.000/mm3). The patient lost weight (-8kg), developed hand and feet arthralgia, diffuse myalgia, painful retronucal lymph nodes, pharyngodynia and abdominal pain. An abdominal echography and CT were performed with evidence of mild abdominal effusion and splenomegaly. Hepatic cytolysis indices began to rise (AST 100 U/L;ALT 150 U/L;LDH 385 U/L). At that point, on the basis of Yamaguchi's Criteria, we suspected our patient could be affected by Adult-onset Still's disease (AOSD) with an initial stage of hemophagocytic lymphohistiocytosis (HLH). Prednisone (IV 2 mg/kg/die) was administered for 72h with an incomplete clinical and biochemical response (C-reactive Protein 180 mg/L). Subsequently, Anakinra (SC 100 mg/die) was administered with a complete clinical response in less than 72h. AOSD is very uncommon. The annual incidence is 0.16/100.000 with an equal distribution between sexes. HLH have been observed in 15% of patients, meanwhile myopericarditis is a rare complication. Although rare, it is fair to know and consider AOSD in the complicated and tricky diagnostic process of myopericarditis. A noteworthy point of this case report is the extreme efficacy of Anakinra in contexts of systemic inflammation and myopericarditis. A point still to be clarified concerns the duration of the treatment and the down-titration of Anakinra in these complicated contexts..
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Background SARS-CoV-2, which appeared in December 2019 in Wuhan, China (1) in the first pandemic wave (from February 24 to June 11, 2020) infected more than 236,000 people, in the second wave (from September 14 to December 31, 2020) the number of infected was more than 1,822,000 (2). During the first wave, in our P.O., the number of deceased, as well as hospitalizations in intensive care were higher. Purpose of the work In our study we evaluated haematological alterations in hospitalized COVID 19 patients and, often in critical condition, for a hyperinflammatory state secondary to cytokine storm related to alterations of CD4/CD8 T lymphocytes. Materials and methods In the period between March and December 2020, 160 patients (97 males, 63 females average age 63.33 years + / -10.2) were enrolled in the COVID department of the P.O. S.Giuliano, because they were positive for the molecular swab in RT-PCR for SARS CoV-2. For each patient, blood count with smear, routine blood chemistry tests and in particular c-reactive protein, ferritin, ves, LDH, procalcitonin, troponin, fibrinogen, D-Dimer were performed. Results In COVID 19 patients with more severe symptoms, there was an increase in the value of white blood cells with an average of 20.0+/-5.0X103/microlitre (increase in neutrophils and monocytes, reduction in lymphocytes with NLR>5.92). Cytofluorimetric analysis has shown that CD3 T lymphocytes are significantly reduced. Patients with more severe syntoms showed a significant increase in C-Reactive Protein (10.6+/-7.5mg/dl), Troponin (433+/-400pg/ml), Myoglobin (3700+/-3000ng/ml),Fibrinogen(800+/-500mg/ dl),D-Dimer(800-5800ng/ml),Ferritin(950+/-450ng/ ml),LDH (850+/-250U/L)) Discussions and conclusions From our study it is evident that the hematological parameters associated with specific biomarkers of inflammation are useful to identify and differentiate covid positive patients with more severe and critical pathology even in the second pandemic wave. The severity of the pathology is positively correlated with the percentage values of neutrophils and NLR and negatively with the percentage of lymphocytes.
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Microbial secondary infections can contribute to an increase in the risk of mortality in COVID-19 patients, particularly in case of severe diseases. In this study, we collected and evaluated the clinical, laboratory and microbiological data of COVID-19 critical ill patients requiring intensive care (ICU) to evaluate the significance and the prognostic value of these parameters. One hundred seventy-eight ICU patients with severe COVID-19, hospitalized at the S. Francesco Hospital of Nuoro (Italy) in the period from March 2020 to May 2021, were enrolled in this study. Clinical data and microbiological results were collected. Blood chemistry parameters, relative to three different time points, were analyzed through multivariate and univariate statistical approaches. Seventy-four percent of the ICU COVID-19 patients had a negative outcome, while 26% had a favorable prognosis. A correlation between the laboratory parameters and days of hospitalization of the patients was observed with significant differences between the two groups. Moreover, Staphylococcus aureus, Enterococcus faecalis, Candida spp, Pseudomonas aeruginosa and Klebsiella pneumoniae were the most frequently isolated microorganisms from all clinical specimens. Secondary infections play an important role in the clinical outcome. The analysis of the blood chemistry tests was found useful in monitoring the progression of COVID-19.
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A male Munchkin cat was brought to a small animal teaching hospital at Mahanakorn University of Technology. The patient presentation with vomiting, chronic diarrhea, and intermittent fever. From history-taking, the owner previously had a cat that was diagnosed with feline infectious peritonitis (FIP) living in the same house but had isolated in a separate area. Fecal examination revealed bacterial enteritis. Hematology and blood chemistry results shown lymphopenia, hypoalbuminemia, and low serum albumin/globulin ratio (0.3 A: G ratio). Abdominal ultrasound revealed mesenteric lymph node (MLN) enlargement and cholecystitis. Cell cytology from the liver and MLN revealed suppurative inflammation. Reverse transcription PCR (RT-PCR) was negative for the Feline coronavirus (FCoV) in the blood sample. On the 4th day of treatment, the cat developed pleural and peritoneal effusion. Thoracentesis and abdominocentesis were performed and submitted for analysis. The fluid's results were classified as modified transudate, low A: G ratio (0.3), Rivalta's test (positive), and positive for FCoV by using RT-PCR. On the 8th day of treatment, the cat died from systemic hypotension. Viscous straw yellow-colored fluid and pyogranulomatous lesions at the liver, lung, kidney, and MLN were observed from the necropsy. Histopathology's results shown severe suppurative inflammation in all the above organs. FIP was confirmed by detected FCoV antigen in the cytoplasm of macrophages in the kidney and lung tissue by immunohistochemistry staining.
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Background: Arthritis by Paracoccidioides brasiliensis is a remarkably unusual etiology of infectious joint disease. While osseous lesions can be present in systemic disease, intra-articular-restricted disease without typical lung or lymph node involvement is mostly anecdotal1,2. Objectives: We hereby describe a case of this fungal arthritis in a patient with rheumatoid arthritis (RA) without signifcant immunosuppression. Methods: Patient records review. Written informed consent was obtained. Results: A 65-year-old female Brazilian patient with a 35-year history of seropositive RA complained of a painful knee edema for the last three weeks. Skin surrounding the joint was erythematous, warm, and tender to the touch, which initially raised the suspicion of cellulitis. She had already received a 10-day course of amoxicillin-clavulanate, with no improvement. C-reactive protein was 17.8 mg/L, rest of blood chemistry panel was within reference range. Point-of-care ultrasound revealed joint effusion, and a diagnostic arthrocentesis was performed. Synovial fluid was slightly turbid, with 10,100 cells per mm3, of which 80% were lymphocytes. Cultures for bacteria and mycobacteria yielded negative results, but culture for fungi detected growth of P. brasiliensis. The patient had been solely on prednisone 5 mg once daily for the last year, given that, due to covid-19 pandemics, she lost regular follow-up and abandoned treatment with immunosuppressants. Aside from mild RA-related interstitial lung disease, she had no other comorbidity. She denied local trauma to the knee, which made hematogenous dissemination of the fungi the most probable source. Comprehensive work-up to search for organic involvement of paracoccid-ioidomycosis, including chest computed tomography and transthoracic echocardiogram, did not evidence any visceral compromise. Voricona-zole 200mg t.i.d. was started, with good response. Three months after the beginning of the azole, tofacitinib was started for moderate RA disease activity, which also responded satisfactorily. Repeat arthrocentesis and synovial biopsy were performed eight months after the start of antifun-gal treatment, the former being normal (770 cells per mm3, negative cultures), and the later only demonstrating non-specific chronic synovitis with fibrosis. Conclusion: We reported an exceedingly rare presentation of P. brasiliensis infection with exclusive joint involvement.
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The role of infectious agents derived antigens including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been recognized as a trigger for development of autoimmune mediated disorders following natural infection or immunization. However, there is a scarcity of reports of occurrence of autoimmune associated kidney disorders or flare ups following exposure to a SARS-CoV-2 vaccine. A 65-year-old female presented to a nephrology clinic for evaluation of worsening renal dysfunction. The patient is well known to have systemic sarcoidosis under complete remission on low dose prednisone and likely membranous nephropathy (no previous kidney biopsy) with mildly elevated phospholipase A2 receptor (PLA2R) antibodies. Her membranous nephropathy was in partial remission on angiotensin receptor blockage, with urine to protein creatinine ratio (UPCR) of 1.5 g/g . Five months after receiving the single dose SARS-CoV-2 vaccine (Johnson & Johnson®), she started having a flare up of her systemic sarcoidosis with worsening joint, skin and respiratory symptoms. Blood chemistry revealed worsening renal dysfunction with elevated creatinine up to 1.7 mg/dL from her baseline of 1.0 mg/dL. UPCR was also elevated at 3.4 g/g. Urine sediment revealed no red blood cells or casts, only several calcium oxalate dihydrate crystals. A kidney biopsy was performed and showed a combination of membranous nephropathy (PLA2R positive) along with granulomatous interstitial nephritis with well-formed epithelioid granulomas characteristic of sarcoidosis. She was started on high dose prednisone and her renal function improved to 1.2 mg/dL, UPCR decreased to 1.8 g/g and serum PLA2R antibodies became undetectable. She is still being monitored. After many years of renal sarcoidosis and membranous nephropathy remission, the relapse of renal disease after receiving the SARS-CoV-2 vaccine (Johnson & Johnson®) suggests the association between receiving the vaccine and the recurrence of renal sarcoidosis and membranous nephropathy.
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Minmin, a 1-year-old male local cat weighing 4.3 kg has decreased appetite and an enlarged abdominal cavity. Based on physical examination, there was abdominal distension. Routine hematology and blood biochemical examinations were performed which showed chronic inflammation and abnormal liver and kidney function. Radiographic examination and abdominocentesis showed fluid accumulation in the abdominal cavity (ascites) with pale yellow fluid and thickened liquid consistency. The results of the rivalta test showed a positive accumulation of exudate which was characterized by a jellyfish-like formation. The cat was diagnosed with effusive feline infectious peritonitis. The therapies given are diuretic furosemide 5 mg/kg BW (twice a day) intravenously, antibiotic cefotaxime sodium 30 mg/kg BW (twice a day) intravenously, anti-inflammatory dexamethasone 0,5 mg/kg BW (twice a day) subcutaneously, hepato-protector betaine 2.5 mg/kg BW (every two days) subcutaneously, and keto acid 11 mg/kg BW orally (every two days). The results of treatment for one week only provide temporary results in reducing the degree of abdominal distension. The cat died in the sixth month after therapy.
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Objective: To investigate the clinical features of the two cases presenting neurological syndrome after receiving COVID-19 vaccination, who were diagnosed with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Background: Neurological symptoms can occur after COVID-19 mRNA vaccination. However, its etiology hasn't been fully revealed. Design/Methods: A 23-year-old previously healthy man (Patient 1) and a 33-year-old woman with a history of depression (Patient 2) developed neurological symptoms approximately one week after receipt of the first standard dose (0.3 mL, intramuscular injection) of COVID-19 mRNA vaccination (Coronavirus Modified Uridine RNA Vaccine (SARS-CoV-2)) (Day 1) and deteriorated over the next week. Clinical course, laboratory and MRI findings were serially analyzed. Results: Patient 1 presented with headache, low-grade fever and memory disturbance (Day 3). Intravenous acyclovir and meropenem were administered under a possible diagnosis of aseptic meningitis but not effective. Patient 2 presented with visual disturbance, headache, dysarthria, a left forearm tremor, dysesthesia of the mouth and distal limbs, and visual agnosia (Day 10). In both patients, reverse transcription polymerase chain reaction test results for severe acute respiratory syndrome coronavirus 2 were negative. Complete blood cell count, blood-chemistry including electrolytes and antibody titers, and cerebrospinal fluid test findings were unremarkable initially. However, second cerebrospinal fluid test of Patient 1 (Day 8) showed pleocytosis (942 cells/μL, normal ≤ 5 cells/μL) and elevated protein levels (181 mg/dL, normal 10-40 mg/dL). Brain MRI on Day 17 in Patient 1 and Day 15 in Patient 2 after receiving the vaccination showed high signal intensity lesions at the midline of the splenium of the corpus callosum. Based on the typical imaging features, the patients were diagnosed with MERS. Intravenous methylprednisolone therapy (1,000 mg/day for 3 days) improved their symptoms and MRI lesion disappeared. Conclusions: MERS should be considered in patients with neurological manifestation after COVID-19 vaccination, even though symptoms were mild and nonspecific.
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Cardiovascular complications are a frequent occurrence in Sars-CoV-2 infection. Takotsubo cardiomyopathy is a possible cause of transient ST segment elevation (1- 3% of total cases) and is characterized by a reversible left ventricular dysfunction with coronary arteries free from critical stenosis. The predominant echocardiographic pattern is an akinesia of the mid-apical myocardial segments with preserved kinetics of the basal segments. The incidence of Takotsubo cardiomyopathy showed a marked increase during the COVID-19 pandemic. Three factors mainly contribute to the onset of cardiomyopathy in patients with COVID-19: cytokine storm, adrenergic hyperactivation and microvascular dysfunction. A 79-year-old woman was hospitalized in the Pneumology department of our hospital for bilateral interstitial pneumonia Sars-CoV-2 related. In remote medical history: in 2010 diagnosis of breast cancer with negative follow-up for disease recovery, arterial hypertension, hypercholesterolemia and syndrome of reduced mobility as a result of a previous ischemic stroke. Non-invasive mechanical ventilation with c-PAP was started and, for the detection of anterolateral electrocardiographic anomalies (diffuse symmetrical negative T waves) and an increase in myocardionecrosis markers, echocardiographic evaluation was performed, which revealed an akinesia of the mid-apical segments of the left ventricle with preserved kinetics of the basal segments and severely depressed global systolic function (ejection fraction: 30%). BNP (18.100 pg /mL), interleukin-6 (339 pg /mL) and CRP (136mg /L) were elevated on blood chemistry tests. In the suspicion of Takotsubo cardiomyopathy (InterTAK Score: 67, probability: 79.8%), cardioprotective therapy with ACE inhibitor, beta-blocker, diuretics, low molecular weight heparin, double antiaggregation and statin was started, deferring coronary angiography to improved clinical conditions. In the following days, due to the respiratory and haemodynamic worsening, the patient was transferred to an intensive setting, where she was intubated and treated with levosimendan and noradrenaline. Serial echocardiograms showed a progressive improvement of the global systolic function (ejection fraction at the last checkup: 55%), with complete regression of the kinetic anomalies, confirming of the diagnostic hypothesis of stress cardiomyopathy. For a pulmonary mycotic superinfection, complicated by iatrogenic pneumothorax, in the following days the patient died. (Figure Presented).
ABSTRACT
Since the onset of the COVID-19 pandemic and the associated lockdowns, many events occurred, such as supply chain disruption, shielding and working from home restrictions along with diminished incomes and people's extra time spent in their own homes;all these have led to broad changes in consumer attitudes and behaviour. Therefore, people spent more time at home in all countries, and there was a significant increase in the number of people who enjoyed experiencing cooking at home, having a regular schedule for their meals. Pasta represents one of the most consumed food products in the world, their consumption increasing from year to year, experiencing a boost demand during the pandemic, because it has many important advantages such as: low cost, easy to cook, high nutritional value and long shelf life. Properly cooked pasta has a low potential to increase blood sugar, it slows down digestion and give a feeling of satiety for a longer period. The purpose of this study was to obtain information on consumer perceptions towards pasta consumption in order to develop new products that are adapted to current consumer requirements and preferences.
ABSTRACT
Objective: To explore the early warning signs of deterioration of patients with COVID-19. Methods: The data of thirty-six patients who were admitted to Handan Infectious Disease Hospital was collected. The clinical features and laboratory testing were analyzed retrospectively. The initial laboratory testing included blood chemistries, blood routine, D-dimer, coagulation function, etc. The patients were divided into mild/common group and severe/critical group. Results: The lymphocyte count, monocyte count, hemoglobin, and albumin levels in severe/critical group were lower compared with those in mild/common group, while the fibrinogen was higher. The lymphocyte count and monocyte count were positively correlated with hemoglobin, pre-albumin respectively. Conclusion: In conclusion, patients with lower initial prealbumin and hemoglobin level were more likely to progress into severe conditions. Decreased prealbumin and hemoglobin, combined with lymphocyte count and monocyte count, could be the early warning signs of deterioration of patients with COVID-19.