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In gynecology, uterine myoma and adenomyosis are among the most common diseases. We can observe a significant increase in the detection of uterine myoma and adenomyosis and their complications after the coronavirus pandemic. The study was conducted in the department of gynecology III multidisciplinary clinic TMA for the period 2018 - 2022, the case histories of patients admitted for inpatient treatment for uterine myoma and adenomyosis were studied. A retrospective analysis of pre-covid and post-covid periods was performed. Thus, the results of the study showed that the rate of operative treatment for uterine myoma was 48.4% of all the operations performed during the study period. Over the last 2 years (the pandemic period) there was a 1.3-fold increase in the frequency of radical organ-assisted operations. Frequent complicated forms of myoma and adenomyosis after covid is a cause of bleeding and an indication for the operative treatment. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Aim: In the present study, our purpose was to evaluate the efficacy of the pulse-steroid treatment used in COVID-19 associated severe ARDS patients, and also to identify its effects on mortality in different doses. Study design: Retrospective Study Method: Patients with severe COVID-19 associated ARDS who had not previously received steroids, but were administered 1 g methylprednisolone (group 1) or 250 mg methylprednisolone (group 2) for 3 days, then 1 mg/kg/day during their hospitalization were retrospectively analyzed. The primary end-point was the discharge rate from the ICU or death. The secondary end-point was the 15th day survival rate. Result(s): A total of 48 patients with a mean age of 70.96+/-11.04 years were included. Twenty-six (54.2%) of them were male, 22 (45.8%) were female. Group 1 included 21 patients, group 2 included 27 patients. There was no difference in terms of demographic characteristics, comorbidities present, and medical findings between the groups on admission, except for the ferritin value which was lower in group 2 (p=0.027). There was no significant difference between groups groups in the 15-day mortality (p=0.134) and length of ICU stay (p=0.329). There was no difference between the groups in terms of discharge rates (p=0.55), need for mechanical ventilation (p=0.381), and complications (p=0.784). The odds ratio regarding the mortality of the patients in the 1 g pulse-steroid group was 3.17 times more likely than the 250 mg pulse-steroid group. Conclusion(s): Our results support that pulse-steroid therapy with 250 mg methylprednisolone may be more effective in patients admitted to intensive care units with ARDS due to COVID-19. Copyright © 2022 by Society of Turkish Intensivist.
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Objective: To explore the potential molecular mechanism of Compound Yizhihao Granules in treatment of coronavirus disease 2019 (COVID-19) through network pharmacology and molecular docking technology.
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Introduction: Malnutrition is associated with an increased risk of infection, longer hospital stays, and increased mortality [1]. COVID-19 infection is known to require several days or even weeks in hospital care, leading patients to nutritional risk [2]. Catheter-related infection (CRI) is associated with mortality, prolonged stays, and higher hospital costs [3]. Objetive: To assess the relationship between nutritional status (mNUTRIC) and central venous catheter (CVC) infection. Method(s): In this study we included patients admitted to the COVID-19 Intensive Care Unit (UCI) in 2020. Two groups were formed: mNUTRIC <5 (low risk) and mNUTRIC >=5 (high risk). The mNUTRIC score (0-9 points) is based on the NUTRIC score without the inclusion of the IL-6 value. It consists of 5 variables: age, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), number of comorbidities and days in the hospital before ICU admission [4]. Two groups were formed: positive blood and catheter tip cultures and the group with negative blood cultures. Pearson's chi-squared test was used to assess the relationship between nutritional status (mNUTRIC) and CVC infection. Result(s): Were admitted 51 patients to the ICU with COVID-19, and seven patients were removed from the final dataset due to lack of data. Of a total of 44, 77.3% were male, with ages ranging between 34 and 90 years, with an average of 70.3 years and a mean ICU stay was 15.05 days. With positive blood and catheter tip cultures, CRI was diagnosed in 8 patients (18.2%). There is a significant relationship between the mNUTRIC Score and CRI with chi2 = 5.5, p < .05. Discussion & conclusion: Nutritional status of COVID- 19 patients is undoubtedly related to complications and increased risk of death [5]. The relationship between high nutritional risk, present in 50% of the patients, and the presence of CRI has been statistically proven. The main recommendation after this study is that, through the mNUTRIC score, patients at risk are identified and nutritional intervention and CRI prevention strategies can be implemented early.
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INTRODUCTION: Autoimmune hematological complications related to COVID-19 are rare. There are only 5 pediatric case reports of autoimmune hemolytic anemia (AIHA) among 14 million pediatric COVID-19 cases in USA. Four were older (13-17 years), two had underlying autoimmune/hematologic conditions. Immunologic analysis varied, with cold, warm & mixed hemolytic anemias described. We present a previously healthy child with COVID-19 associated severe AIHA with peripheral reticulocytopenia. DESCRIPTION: A 3-year-old male presented with lethargy, fever, tachycardia and jaundice 10 days after COVID-19 diagnosis. Pertinent labs include hemoglobin (Hgb) 3.8 g/dL, Hct 9.9%, bilirubin 3.6 mg/dL, platelets 321,000/muL, RBC count 1.2 M/muL, WBC 35,600/muL, MCV 82.5fL. Reticulocyte count (RC) was only 2.8%. Peripheral blood smear showed anisocytosis, poikilocytosis, nucleated RBCs and left shifted granulocytosis. Bone marrow biopsy revealed erythroid hyperplasia without underlying malignancy;myeloid:erythroid ratio of 0.3:1. The outside hospital reported cold C3 agglutination following 4degreeC incubation, while our laboratory identified spontaneous agglutination at room temperature (warm agglutination). IV fluids, O2, and methylprednisolone (4 mg/kg/day) were started and two packed RBC transfusions (total 30 ml/kg) given for symptomatic anemia with Hgb < 4 g/dL. LDH peaked at 2255 U/L on Day 3. Reticulocyte count was low (2.8%-3.8%) Days 1-3, increased to 6.5% on Day 4 and peaked at >30.0% on Day 7. He was changed to oral prednisone 2 mg/kg/day on Day 12 and discharged on Day 13 with Hgb 7.0 g/dL and RC 29.9%. Most recent Hgb is 13.0 g/dL and RC 2.6%. DISCUSSION: COVID-19 associated AIHA is rare, and previously reported mostly in older children. Our patient was previously healthy, and demonstrated a strong bone marrow response with erythroid hyperplasia. Peripheral reticulocytosis was delayed, and correlated with initiation of systemic steroid therapy. Our patient had both cold and warm agglutination supporting extensive autoimmune destruction of early red cell lineage. These findings support immune activation during acute COVID-19 infection and COVID-19 as a trigger for AIHA. Patients developing AIHA may need to be tested for COVID-19 and carefully monitored for complications.
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Case Diagnosis: A 78-year-old man with Parsonage- Turner Syndrome (PTS). Case Description or Program Description: The patient developed acute left-sided neck and shoulder pain upon awakening five days after receiving a Moderna COVID-19 vaccine booster shot. Clinical examination, electrodiagnostic studies, and magnetic resonance imaging were consistent with a diagnosis of PTS. Setting(s): Tertiary referral center. Assessment/Results: His physical exam revealed severe weakness in left shoulder abduction and external rotation without sensory deficits. An urgent MRI of his cervical spine demonstrated multilevel degenerative changes including severe bilateral C5-6 neural foraminal narrowing, and an MRI of the left shoulder showed mild degenerative changes. He was treated with a sixday course of an oral methylprednisolone dose pack and his pain and weakness significantly improved. He was referred for electrodiagnostic testing 24 days after the onset of his symptoms, and by the time of the study, his pain and weakness had improved by 50%. The test revealed no significant abnormalities in the sensory and motor nerve conduction studies. Needle electromyography showed abnormal spontaneous activity in both the left infraspinatus and left deltoid with decreased recruitment of polyphasic motor unit action potentials in the left deltoid. Notably, the left mid/low cervical paraspinals, and other left C5/C6 innervated muscles including the biceps, and brachioradialis were all normal, making a diagnosis of cervical radiculopathy unlikely. Discussion (relevance): There have been eight published reports of PTS related to COVID-19 vaccinations at the time of this publication, which are also reviewed. Reports have occurred in three separate vaccines with variable onset of symptoms and recovery patterns as detailed in the table provided. Conclusion(s): Our case report and review of the literature highlights the importance of recognizing PTS as a potential cause of severe shoulder/arm pain and weakness after administration of a COVID-19 vaccine.
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Introduction: SARS-COV-2, causing the COVID-19 pandemic, had a disease spectrum affecting multiple organs since its emergence in 2019. There is an association between COVID-19 and thyroid disease. Multiple vaccines had been approved for SARS-COV-2. Despite their safety profile, adverse effects have been reported. An association between thyrotoxicosis after the vaccine has been reported. But COVID-19 vaccine is very rare to precipitate a thyroid storm. Case Description: 29-year-old gentleman, presented to Emergency Department (ED) complaining of shortness of breath for 5 days, increasing in severity. He had a cough with whitish sputum, no fever or chest pain. He had palpitations and 10 kg weight loss, for 6 months. Five days prior to the presentation he received the second dose of the BNT162b2 vaccine (Pfizer-BioNTech COVID -19 vaccine) Physical examination: the vital signs showed tachycardia 175 beat/minute with an irregular pulse, otherwise unremarkable, he was conscious alert and oriented to time place and person, there was bilateral mild exophthalmos and diffuse soft goiter. Chest exam showed bilateral coarse basal crackles. He has bilateral pitting edema of the lower limbs. Blood investigation was remarkable for TSH < 0.01 (0.3-4.5 mIU/L), FT3 12.6 (3.6-7.4 pmol/L), FT4 48.5 (11-23.5 pmol/L) and TSH receptor antibodies (TRAB) 34, Positive > 1.75 IU/L. Electrocardiography showed atrial fibrillation with a rapid ventricular response. Echocardiography showed reduced ejection fraction (40%) with moderate global hypokinesia. The patient was admitted under MICU care as thyroid storm (Bursh-Wartosfsky score 50/140) secondary to Graves’s disease and precipitated by COVID 19 vaccine. He was started on Propylthiouracil 200 mg every 4 hours, hydrocortisone 100 mg every 8 hours, Lugol’s solution 10 drops every 8 hours, cholestyramine 4 gm every 6 hours, and metoprolol 12.5 mg every 12 hours, the dose of metoprolol increased gradually to avoid worsening of heart failure. The patient’s condition was improving, he was switched from propylthiouracil to carbimazole 20 mg twice daily, and after a few days, he was stable and discharged home on carbimazole and metoprolol. The patient didn’t attend the endocrine clinic for follow-up as he traveled back to his home country. Discussion: The association between thyrotoxicosis and the COVID-19 vaccine is reported in the literature. Very rarely COVID-19 vaccine can precipitate thyroid storm in a patient with Graves’s disease. The immune system activation after the vaccine possibly leads to a decompensated state in this patient with existing hyperthyroidism.