A Case Report of Acute Lymphoblastic Leukaemia (ALL)/Lymphoblastic Lymphoma (LBL) Following the Second Dose of Comirnaty®: An Analysis of the Potential Pathogenic Mechanism Based on of the Existing Literature (preprint)

In this report we describe the case of a healthy, young, athletic woman who developed acute lymphoblastic leukaemia (ALL)/lymphoblastic lymphoma (LBL) after receiving the second dose of the Pfizer/BioNTech modified mRNA (modRNA) COVID-19 genetic vaccine (marketed as Comirnaty®). The first dose of the genetic vaccine did not appear to illicit any noticeable side effects, but within 24 hours of the second dose the patient suffered widespread and intensifying bone pain, fever, vomiting, and general malaise. Due to the persistence of the symptoms, the patient underwent a series of tests and examinations including a full laboratory workup, a consult with a clinical immunologist and rheumatologist, a Positron Emission Tomography (PET) imaging, as well as an osteomedullary biopsy. These together led to a definitive diagnosis of ALL. A time interval of 16 weeks from the second vaccination to the diagnosis of cancer was noted. Several similar cases with identical pathology which developed after the modRNA COVID-19 vaccination, are described in case reports in the scientific literature. The massive and indiscriminate use of genetic vaccines to fight COVID-19 is raising serious concerns about their safety and about the technology platform as a whole for this purpose. Growing evidence is accumulating regarding the biodistribution and persistence of the modRNA which can reach, thanks to the lipid nanoparticles, a multitude of tissues and organs of the body, including the bone marrow and other blood-forming organs and tissues. Moreover, there is evidence that the modRNA vaccines display a particular tropism for the bone marrow, influencing the immune system at multiple levels and being able to trigger not only autoimmune-based pathologies, but also neoplastic mechanisms. The aim of this article is to assess, on the basis of the available scientific literature, the risk of developing haematopoietic cancers after modRNA vaccination, and to investigate the potential genetic mechanisms involved in the pathogenesis of disease.

Evaluating Nirmatrelvir-Ritonavir (Paxlovid®) in Outpatient COVID-19 Treatment: Safety, Tolerability, and Adherence Insights from Primary Healthcare Clinics (preprint)

Objective: This study aims to fill this gap by evaluating the safety, tolerability, and adherence of patients prescribed Paxlovid® in outpatient settings, focusing on its use in managing category 2 COVID-19 patients across three primary healthcare clinics in Selangor, Malaysia. Design: Retrospective cross-sectional study Setting: Data were collected from the Paxlovid® pharmacy registry and medical records at Klinik Kesihatan Seksyen 7, Klinik Kesihatan Seksyen 19, and Klinik Kesihatan Kelana Jaya between April 1, 2022, and November 30, 2022. Participants: This study analysed data from 415 category 2 COVID-19 patients aged ≥18 years old. Primary and secondary outcomes: Parameters assessed included patient demographics, dosing, current medication, changes in drug regimen, adherence, and ADR. Pharmacists follow-ups were conducted on days 3 and 5 post-medication initiation. Results: The majority (79.5%) of the cohort experienced ADR, predominantly dysgeusia, diarrhoea, body ache, vomiting, and nausea. Despite these, the ADR were generally well-tolerated, with no severe impacts reported. High adherence was observed, with 96.9% of patients completing the 5-day regimen. The primary reasons for non-adherence included adverse effect intolerability, dosing ambiguity, forgetfulness, concerns about ADR, and perceived health improvement. Notable medications interacting with Paxlovid® were simvastatin, amlodipine, and atorvastatin, and 21.7% of 23 concurrent medications were found not complying to the recommended interventions by the University of Liverpool COVID-19 Drug Interaction database. Conclusion: Nirmatrelvir-ritonavir (Paxlovid®) demonstrates a high level of safety and tolerability in outpatient COVID-19 patients, with optimal adherence observed. This study underscores the vital role of healthcare professionals in managing Paxlovid® within primary healthcare and highlights the need for broader research and direct patient involvement to enhance treatment strategies against COVID-19.

WHAT THE COVID-19 PANDEMIC TAUGHT US IN CHILDREN (preprint)

Objective: The COVID-19 pandemic is an important cause of morbidity and mortality, which has had a negative impact worldwide. We aimed to contribute to the medical literature by sharing the knowledge and experience of pediatric patients who were diagnosed as having COVID-19 in a one-year period. Method: Patients aged 1 month to 18 years who were diagnosed as having COVID-19 in our clinic, between March 2020 and April 2020, from when COVID-19 was declared as a pandemic, were included in the study. Results: Four hundred sixty-seven children were included in the study. There were 34 (7.3%) patients under one year of age, 111 (23.8%) between 1-5 years, 98 (30.4%) between 5-10 years, 142 (30.4%) between 11-15 years, and 82 (17.6%) age over 15 years. Fever (88.2%), vomiting (32.4%), and diarrhea (29.4%) in patients aged under 1 year, sore throat (36.6%) in patients aged 11-15 years, and dysgeusia (11%), anosmia (14.6%), headache (18.3%), malaise (40.8%), myalgia (28%), and dyspnea (17.1%) in those aged over 15 years of age were found significantly more common compared with the other age groups. Thirty-five (7.5%) patients were asymptomatic, 365 (78.1%) had mild disease, 35 (7.5%) were moderate, 27 (5.8%) were severe, and five (1.07%) were critical. Leukocyte count, erythrocyte sedimentation rate, ferritin, and C-reactive protein values were significantly higher in hospitalized patients. Four patients died during the study period (0.8%, 4/494). Conclusion: Although COVID-19 has an asymptomatic and mild course in children, it should be kept in mind that it may have a severe course.

Extended Duration and Intense Manifestations of COVID-19-Linked Cytotoxic Lesions of the Corpus Callosum: Case Reports and Literature Review (preprint)

While clinical instances of cytotoxic lesions of the corpus callosum (CLOCCs) are well-documented, international reports specific to COVID-19-related cases remain limited. This paper presents the case of a 40-year-old female patient admitted due to "sudden dizziness and poor limb coordination for 7 weeks following fever." She tested positive for COVID-19 and experienced symptoms like dizziness, temporary confusion, nausea, vomiting, cerebellar speech issues, and ataxia after fever onset. Later, she developed pyramidal tract symptoms and behavioral abnormalities. Head MRI revealed abnormal high signal in the splenium of the corpus callosum and abnormal signals in the left cerebellar peduncle on DWI. With no significant medical history and exclusion of other causes during treatment (including steroid therapy and two doses of intravenous immunoglobulin), a follow-up MRI after one month showed the lesions had disappeared. However, clinical recovery was slow, with residual symptoms persisting for almost a year, including involuntary tremors in the upper limbs and head. Phenytoin, gabapentin, and pregabalin showed limited effectiveness in treatment, but Arotinolol and donepezil led to slight improvement in involuntary tremors. This case suggests that COVID-19-associated CLOCCs might have a protracted course and severe symptoms, demanding differentiation from ischemic cerebrovascular diseases, particularly in early stages.

Clinical and Epidemiological Risk Factors Associated with Hospitalization and Mortality Rate of COVID-19 Patients in Banja Luka County: Retrospective Observational Cohort Study on 40,000 patients (preprint)

Background and Objectives: Since the beginning of COVID-19 pandemic, the infection primarily affected patients with following chronic conditions: cardiovascular disease, hypertension, chronic obstructive pulmonary disease, diabetes mellitus, obesity and cancer. The aim of this study was to explore clinical and epidemiological characteristics associated with COVID-19 outcomes in patients at the primary health care centre from March 2020 to September 2022. Materials and Methods: The study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed and registered as RT-PCR positive on COVID-19. Differences regarding the distributions of patients between groups were analysed using Pearson chi square test and Mantel-Haenszel chi square test for trends, while differences in mean values were compared using independent samples t test. Relationship between mortality and independent variables were examined using logistic regression. Results: Out of 40,692 COVID-19 positive patients, 7.76% were hospitalized. The average age of hospitalized patients was significantly higher than the age of non-hospitalized patients (64.2±16.1 vs. 45.4±18.7; p<0.001). The average age of patients with lethal outcome was nearly twice higher compared to patients with non-lethal outcome (74.6±11.5 vs. 45.7±18.6; p<0.001). Male patients had higher hospitalization and mortality rate, compared to females (9.8% vs. 5.9%, p<0.001; 4.8% vs. 3%, p<0.001, respectively). The highest hospitalization rate was in patients with chronic renal failure, diabetes and cardiovascular diseases, while the death rate was the highest among patients with CRF and hearth comorbidities. Fever, cough, fatigue, nausea and vomiting, chest pain, shortness of breath and appetite loss favoured hospitalization. Patients with fatigue and appetite loss had higher percentage of lethal outcome. Vaccinated patients had significantly lower rate of lethal outcome. Conclusions: Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in clinical outcomes of COVID-19.

Lipase Elevation in Patients With COVID-19.

INTRODUCTION: Although coronavirus disease (COVID-19) has been associated with gastrointestinal manifestations, its effect on the pancreas remains unclear. We aimed to assess the frequency and characteristics of hyperlipasemia in patients with COVID-19. METHODS: A retrospective cohort study of hospitalized patients across 6 US centers with COVID-19. RESULTS: Of 71 patients, 9 (12.1%) developed hyperlipasemia, with 2 (2.8%) greater than 3 times upper limit of normal. No patient developed acute pancreatitis. Hyperlipasemia was not associated with poor outcomes or symptoms. DISCUSSION: Although a mild elevation in serum lipase was observed in some patients with COVID-19, clinical acute pancreatitis was not seen.

Gastrointestinal Symptoms of Monkeypox Infection: A systematic review and meta-analysis.

Since early May 2022, outbreaks of Monkeypox (Mpox) cases have emerged and become a global concern. Studies exploring the gastrointestinal symptoms and/or liver injury of Mpox are still very limited. This systematic review and meta-analysis is the first to summarize the gastrointestinal symptoms reported by Mpox patients. We searched for Mpox studies published until October 21, 2022, in MEDLINE, EMBASE, SCOPUS, and organization websites. Mpox studies were observational studies that reported at least one of either gastrointestinal symptoms and/or liver injury in Mpox patients. Meta-analysis was done to obtain the pooled prevalence of gastrointestinal symptoms in Mpox patients. Subgroup analyses were done based on the study location, age groups, and Mpox Clades. The quality of included studies was assessed using the NIH Quality Assessment Tool. Overall, 31 studies that reported gastrointestinal symptoms and/or liver injury in Mpox patients were included. The reported gastrointestinal symptoms were abdominal pain, anorexia, diarrhea, nausea, and vomiting. There is a lack of reporting for liver injury. The most prevalent gastrointestinal symptoms in Mpox patients were anorexia (47%; 95% confidence interval [CI] 41%-53%), followed by vomiting (12%; 95% CI 11%-13%), nausea (10%; 95% CI 9%-11%), abdominal pain (9%; 95% CI 8%-10%), and diarrhea (5%; 95% CI 4%-6%). Additionally, the prevalence of proctitis, rectal/anal pain, and rectal bleeding were 11% (95% CI 11%-12%), 25% (95% CI 24%-27%), and 12% (95% CI 11%-13%), respectively. Anorexia was the most frequently reported gastrointestinal symptom in Mpox patients, followed by vomiting, nausea, abdominal pain, and diarrhea. Proctitis is a novel presentation of Mpox in the 2022 outbreak.

A Deadly Case of Dehydration: Organic Acidemias in the Emergency Department.

BACKGROUND: Organic acidemias are rare genetic mutations, most commonly identified in the newborn period. Late-onset presentations present a diagnostic conundrum. Early identification and appropriate management can be lifesaving. CASE REPORT: We describe the case of a 3-year-old boy who presented to urgent care with 2 days of nausea, vomiting, and diarrhea followed by respiratory distress, shock, and encephalopathy. Brisk recognition of his shock state led to an urgent transfer to a tertiary care pediatric emergency department by air where his shock was treated and hyperammonemia was uncovered, leading to the diagnosis of late-onset propionic acidemia, which was subsequently managed with a good outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Late-onset presentations of inborn errors of metabolism, including organic acidemias, represent one of the most challenging pediatric cases an emergency physician can encounter. This case reviews the management and diagnosis of a late-onset inborn error of metabolism and emphasizes how prompt diagnosis and treatment can lead to a favorable outcome.

Neurological Manifestations in COVID-19 Infection: A Systematic Review and Meta-Analysis.

BACKGROUND: Growing evidence showed that coronavirus disease 2019 (COVID-19) infection may present with neurological manifestations. This review aimed to determine the neurological manifestations and complications in COVID-19. METHODS: We conducted a systematic review and meta-analysis that included cohort and case series/reports involving a population of patients confirmed with COVID-19 infection and their neurologic manifestations. We searched the following electronic databases until April 18, 2020: PubMed, Embase, Scopus, and World Health Organization database (PROSPERO registration number: CRD42020180658). RESULTS: From 403 articles identified, 49 studies involving a total of 6,335 confirmed COVID-19 cases were included. The random-effects modeling analysis for each neurological symptom showed the following proportional point estimates with 95% confidence intervals: "headache" (0.12; 0.10-0.14; I2 = 77%), "dizziness" (0.08; 0.05-0.12; I2 = 82%), "headache and dizziness" (0.09; 0.06-0.13; I2 = 0%), "nausea" (0.07; 0.04-0.11; I2 = 79%), "vomiting" (0.05; 0.03-0.08; I2 = 74%), "nausea and vomiting" (0.06; 0.03-0.11; I2 = 83%), "confusion" (0.05; 0.02-0.14; I2 = 86%), and "myalgia" (0.21; 0.18-0.25; I2 = 85%). The most common neurological complication associated with COVID-19 infection was vascular disorders (n = 23); other associated conditions were encephalopathy (n = 3), encephalitis (n = 1), oculomotor nerve palsy (n = 1), isolated sudden-onset anosmia (n = 1), Guillain-Barré syndrome (n = 1), and Miller-Fisher syndrome (n = 2). Most patients with neurological complications survived (n = 14); a considerable number of patients died (n = 7); and the rest had unclear outcomes (n = 12). CONCLUSION: This review revealed that neurologic involvement may manifest in COVID-19 infection. What has initially been thought of as a primarily respiratory illness has evolved into a wide-ranging multi-organ disease.

The Effect of Acotiamide on Nausea as a Symptom of Chronic Nausea and Vomiting Syndrome after Coronavirus Disease 2019.

Chronic nausea and vomiting syndrome (CNVS), one of a functional gastroduodenal disorder, was identified in an 8-year-old girl and a 13-year-old boy who had complained of nausea for more than 4 months following coronavirus disease 2019 (COVID-19) due to normality of their head computed tomography and upper gastrointestinal tract images. The patients' symptoms responded quickly to acotiamide, a medication that is effective for treating functional dyspepsia (FD). Despite being a distinct illness from FD, CNVS is also a functional gastrointestinal disorder, and acotiamide may be just as effective for CNVS following COVID-19 as for FD.

Feeding intolerance during prolonged prone position in overweight and obese patients with severe COVID-19.

Introduction: Objective: the aim of this study was to compare the incidence rate of feeding intolerance (FI) during supine (SP) or prone positioning (PP) in critically ill COVID-19 patients. Methods: this was a retrospective cohort study of critically ill patients with overweight or obesity who received enteral nutrition (EN) in prone or supine positioning continuously during the first five days of mechanical ventilation. Nutritional risk, anthropometric measurements and body composition were assessed at the first 24 hours upon Intensive Care Unit (ICU) admission. Biochemical and clinical variables (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Kidney Injury [AKI] or comorbidities diagnosis) were collected. Pharmacotherapy (prokinetics, sedatives or neuromuscular blocking agents) and FI incidence (gastric residual volume [GRV] ≥ 200 ml or ≥ 500 ml, vomiting or diarrhea) were daily recorded. Constipation was defined as the absence of evacuation for five consecutive days. Results: eighty-two patients were included. Higher rate of prophylactic prokinetic prescription was observed in PP (42.8 vs 12.5 %, p = 0.002). GRV ≥ 200 in supine position was not different when compared to PP (p = 0.47). Vomiting episodes in supine compared to PP showed no difference between groups (15 % vs 24 %, p = 0.31). No differences in diarrhea events were detected (10 % vs 4.7 %, p = 0.36). Constipation was common in both groups (95 % vs 82 %, p = 0.06). Conclusion: FI during prone position was not different in comparison to supine position. Routinely use of prokinetics in continuous prone position may help to prevent FI incidence. Algorithm development is necessary for FI prevention and treatment so to avoid EN interruptions and adverse clinical outcomes.

Introducción: Objetivo: comparar la incidencia de intolerancia a la alimentación entre pacientes críticos en posición supino (PS) o prono (PP). Métodos: cohorte retrospectiva de pacientes bajo ventilación mecánica por distrés respiratorio por COVID-19 y sobrepeso y obesidad, quienes recibieron nutrición enteral (NE) en PP o PS. Se evaluaron riesgo nutricional, mediciones antropométricas y composición corporal en las primeras 24 horas de ingreso a la Unidad de Cuidados Intensivos (UCI). Se recolectaron variables bioquímicas y clínicas (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], lesión renal aguda y otras comorbilidades). Se registró el esquema de farmacoterapia prescrita durante los primeros cinco días (procinéticos, sedantes y bloqueadores neuromusculares). Se evaluó la incidencia de intolerancia a la alimentación, definida como la presencia de residuo gástrico (RG) ≥ 200 o ≥ 500 ml, vómito, diarrea o estreñimiento. Resultados: fueron incluidos 82 pacientes. Se observó una mayor prescripción de procinéticos como terapia profiláctica en PP (42,8 vs. 12,5 %, p = 0,002). No se observaron diferencias en RG ≥ 200 ml (p = 0,47) ni vómito (p = 0,31) entre ambos grupos. No se observaron diferencias en episodios de diarrea (10 % en PS vs. 4,7 % en PP, p = 0,36). El estreñimiento fue común en ambos grupos de estudio (95 vs. 82 %, p = 0,06). Conclusiones: la PP no se relaciona con una mayor incidencia de intolerancias a la alimentación. El uso rutinario de procinéticos durante la PP continua puede ayudar a prevenir la incidencia de dichas intolerancias. Es necesario el desarrollo de algoritmos para la prevención y tratamiento de las intolerancias a la alimentación para evitar interrupciones en la NE y desenlaces no deseables.

Benign Acute Children Myositis: Five Years’ Experience in a Tertiary Care Pediatric Hospital (preprint)

Purpose: Benign acute childhood myositis (BACM) is a self-limited childhood illness, and it is mainly caused by viral infections. Clinical and laboratory alterations usually normalize rapidly; generally, the only medical intervention required is supportive (hydration, analgesic medication). The low awareness about BACM often led to delayed diagnosis and unneeded ancillary investigations. This study aims to better characterize the clinical and laboratory features of BACM to improve the diagnostic process and inpatient and outpatient management.  Materials and methods: We conducted a retrospective study selecting all children admitted to Meyer's Children's Hospital-IRCCS (Florence, Italy) with a diagnosis of BACM over the last 5 years. Clinical, laboratory, and instrumental data were collected from electronic clinical records and analyzed.  Results: Sixteen patients were enrolled. The median age was 7.68 years (IQR 5.7-12.9). Male gender (62.5%) and Caucasian ethnicity (68.75%) were prevalent. Most of the patients were admitted during winter, and a second peak has been found in summer. All patients had bilateral calf pain at admission (87.5%), associated with asthenia, and refuse to walk (93.7%). Prodromal symptoms were fever (81.25%), cough (37.5%), coryza (43.5%), sore throat (50%), and vomiting (31.25%). The median value of CPK was 2,183.5 U/L (IQR 1,395.5-7,156.25) at peak. CPK median time to normalization was 7 days (IQR 7-8.5) from the nadir. Influenza B was the virus most frequently BACM associated, followed by influenza A; a novel association with Sars-CoV-2 has been detected. Two patients had pathogenic variants at the Next Generation Sequencing myopathies panel.  Conclusions: School-aged children admitted to the hospital with walking difficulty and myalgia generally after an upper respiratory tract infection with a moderate CPK elevation should remind at first of BACM. Rapid complaint resolution and biochemical markers normalization will prevent unnecessary tests and inappropriate therapies.

Vomiting of nurses while working in isolation wards: a cross-sectional study in China during COVID-19 (preprint)

Background: The early phases of COVID-19 infection are highly transmissible and can be life-threatening, with infected individuals requiring isolation for proper treatment. Healthcare workers, particularly nurses, who provide care in such areas must take precautionary measures by donning personal protective equipment. Unfortunately, these nurses are also at elevated risk for developing adverse psychological outcomes, such as fear, anxiety, burnout, and post-traumatic stress disorder. Objective: This study aimed to examine the characteristics and identify the risk factors associated with vomiting syndrome among nurses working in a COVID-19 isolation ward. The objective of the investigation is to provide valuable information to support the development of effective management strategies to minimize the occurrence of this syndrome. Design: This study employed a descriptive cross-sectional design and utilized a questionnaire as the data collection instrument. Methods: Data was collected from 354 nurses working in a COVID-19 isolation ward between January 2020 and March 2021. Three questionnaires were administered to gather data: the Gastroesophageal Reflux Questionnaire, the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), and the Symptom Checklist-90 (SCL-90). Binary regression analysis was conducted to determine the independent risk factors for vomiting syndrome among nurses working in COVID-19 isolation. Result: Of the 354 participants, 82 (23.16%) reported experiencing vomiting syndrome. The incidence of vomiting syndrome was higher among female participants (25.57%) compared to male participants (6.67%). Results of the study revealed that the scores for sleep quality, as assessed by the seven factors of the PSQI, were significantly higher in the vomiting syndrome group compared to the non-vomiting syndrome group (p < 0.05). The findings also indicated positive correlations between vomiting syndrome and several sleep-related factors, including sleep quality, sleep latency, sleep time, sleep disturbance, and sleep dysfunction (p < 0.05). In terms of self-symptom assessment, scores were found to be higher among participants in the vomiting syndrome group compared to the non-vomiting syndrome group (p < 0.05). Furthermore, positive correlations were observed between vomiting syndrome and somatization, obsessive-compulsive symptoms, phobic anxiety, and fear (p < 0.05), while a negative correlation was found between vomiting syndrome and paranoid ideation (p = 0.045). Binary regression analysis revealed that several independent risk factors for vomiting syndrome were identified, including gender (OR = 0.023, p = 0.001), personal protective equipment impact (OR = 3.647, p < 0.01), ICU work experience (OR = 0.003, p < 0.01), total SCL-90 score (OR = 1.148, p < 0.01), and total PSQI score (OR = 2.123, p < 0.01). Conclusions: The occurrence of vomiting syndrome among nurses working in COVID-19 isolation wards is substantial, yet has received limited attention in the literature. Further research is necessary to fully understand this phenomenon. The impact of the utilization of personal protective equipment on the incidence of vomiting syndrome warrants further investigation. Nurses with experience in intensive care units may be better equipped to handle the demands of working in isolation wards. Hospital administrators should be attentive to the issue of vomiting syndrome among nurses who are exposed to infectious diseases and wearing personal protective equipment, and should implement targeted measures in response to the specific characteristics of its occurrence as part of their health monitoring programs.

The challenges in diagnosis of multisystem inflammatory syndrome in children (MISC), comparison of MISC and drug eruption: A case report (preprint)

Unusual manifestations are possible for multi-system inflammatory syndrome brought on by SARS-Cov2 infection. Early diagnosis and effective treatment have a direct impact on the outcome. Every young patient who presents to the clinic with a fever, skin rash, stomach discomfort, or cardiovascular complications has to be evaluated for this potentially fatal disease. It is also of utmost importance to differentiate MIS-C from drug hypersensitivity (DHS). MIS-c highly resembles DHS but leads to more complications and a higher mortality rate. We report a 9-year-old female who initially presented with generalized abdominal pain, nausea, vomiting, and cough. She gradually developed an acute abdomen and was admitted for surgical management of a suspected perforated appendix. Her condition deteriorated despite surgery and medical treatment. Differentiating drug allergy from this new emerging syndrome can be difficult. Herein we discuss about it.

Bilious Emesis and Failure to Pass Meconium in the Nursery: A Case Study.

We present a case of an infant born to a mother with COVID-19, who at 24 hours of life was treated with a glycerin suppository for failure to pass meconium and went on to develop bilious emesis and abdominal distention as feeding continued over the next several hours. After a barium enema identified the distal obstruction, the pediatric surgical team used rectal irrigation to remove a large meconium plug, which mimicked the appearance of the descending colon on plain film, in a case of small left colon syndrome. Although intestinal obstruction in the newborn is rare, it is imperative that it is promptly diagnosed and treated appropriately to avoid negative outcomes; which, even in perhaps the mildest form of functional distal obstruction, meconium plug syndrome, can lead to an impressive clinical illness with risk of intestinal perforation and subsequent meconium peritonitis if the obstruction is not relieved.

Mechanism and potential treatments for gastrointestinal dysfunction in patients with COVID-19.

The global coronavirus disease 2019 (COVID-19) has become one of the biggest threats to the world since 2019. The respiratory and gastrointestinal tracts are the main targets for severe acute respiratory syndrome coronavirus 2 infection for they highly express angiotensin-converting enzyme-2 and transmembrane protease serine 2. In patients suffering from COVID-19, gastrointestinal symptoms have ranged from 12% to 61%. Anorexia, nausea and/or vomiting, diarrhea, and abdominal pain are considered to be the main gastrointestinal symptoms of COVID-19. It has been reported that the direct damage of intestinal mucosal epithelial cells, malnutrition, and intestinal flora disorders are involved in COVID-19. However, the underlying mechanisms remain unclear. Thus, in this study, we reviewed and discussed the correlated mechanisms that cause gastrointestinal symptoms in order to help to develop the treatment strategy and build an appropriate guideline for medical workers.

Neuromyelitis Optica Spectrum Disorder After BIBP COVID-19 Vaccine: A Case Report (preprint)

Background: With the availability of the COVID-19 vaccine, post-vaccination neurological complications have occasionally been reported. Case presentation: We present a case of neuromyelitis optica spectrum disorder (NMOSD) that developed 1 month after the second dose of BIBP COVID-19 vaccine (SARS-CoV-2-Vaccine [Vero Cell] Inactived). The patient presented itching, numbness of the hand and right side of the face, associated with nausea, vomiting and hiccups. Brain MRI showed lesions in the area postrema, medulla, and bilateral hypothalamus, typical of NMOSD. Serum antibodies to anti-AQP4 and anti-MOG were negative. Conclusions: The pathogenesis of NMOSD development and the vaccine is still unknown. The presentation of NMOSD is generally aggressive and disabling, it is important for the neurologist to be attentive to the highly variable clinical presentation after vaccination against COVID-9 for early diagnosis and effective treatment.

A Phase 2/3 observer-blind, randomized, controlled study to determine the safety and immunogenicity of SARS-CoV-2 recombinant spike protein vaccine in Indian children and adolescents aged 2 to 17 years (preprint)

Background: A recombinant, adjuvanted COVID-19 vaccine, SII-NVX-CoV2373 was manufactured in India and evaluated in Indian children and adolescents to assess safety and immunogenicity. Methods: This was a Phase 2/3 observer-blind, randomized, controlled study in children and adolescents aged 2 to 17 years. Participants were randomly assigned in 3:1 ratio to receive two doses of SII-NVX-CoV2373 or placebo on day 1 and day 22. Solicited adverse events (AEs) were collected for 7 days after each vaccination. Unsolicited AEs were collected for 35 days following first dose and serious AEs (SAEs) and adverse events of special interest (AESI) were collected throughout the study. Anti S IgG and neutralizing antibodies against the SARS-CoV-2 were measured at baseline, day 22, day 36 and day 180. Variant immune responses were assessed in a subset of participants at baseline, day 36 and day 180. Primary objectives were to demonstrate non-inferiority of SII-NVX-CoV2373 in each pediatric age group (12 to 17 years and 2 to 11 years, separately) to that in adults in terms of ratio of titers of both anti-S IgG and neutralizing antibodies 14 days after the second dose (day 36). Non-inferiority was to be concluded if the lower bound of 95% CI of the ratio was >0.67. Results: A total of 920 children and adolescents (460 in each age cohort; 12 to 17 years and 2 to 11 years) were randomized and vaccinated. The demographic and baseline characteristics between the two groups were comparable in both age groups. After the second dose, there were more than 100-fold rise in anti-S IgG GMEUs and more than 84-fold rise in neutralizing antibodies GMTs from baseline in the participants who received SII-NVX-CoV2373. The GMTs in both age groups were non-inferior to those observed in Indian adults. The seroconversion rate was [≥] 98% (anti-S IgG) and [≥] 97.9% (neutralizing antibodies) in both age groups, respectively. Similar findings were seen in the baseline seronegative participants. SII-NVX-CoV2373 also showed robust responses against various variants of concern. Injection site pain, tenderness, swelling, erythema and fever, headache, malaise, fatigue, myalgia, arthralgia, nausea and vomiting were the common solicited adverse events which were transient and resolved without any sequelae. Throughout the study, only two causally unrelated SAEs and no AESI were reported. Conclusion: SII-NVX-CoV2373 has been found safe and well tolerated in children and adolescents of 2 to 17 years. The vaccine was highly immunogenic and the immune response was non-inferior to that in adults.

Gastrointestinal symptoms and liver involvement in patients diagnosed with COVID-19 / Síntomas gastrointestinales y afectación hepática en pacientes diagnosticados con COVID-19

Se identificó la relación entre los síntomas gastrointestinales y la afectación hepática en pacientes diagnosticados con COVID-19. El daño hepático en estos pacientes puede ser causado por el virus que infecta directamente las células hepáticas, por ello se debe prestar más atención al estado de la función hepática de los pacientes con COVID-19. Se realizó un estudio observacional, descriptivo y transversal en pacientes diagnosticados con COVID-19, pertenecientes a dos hospitales del cantón Ambato, de enero a julio de 2021. Se seleccionó una muestra no probabilística, de 125 pacientes con los siguientes criterios: no presentar afectación hepática, no estar bajo tratamiento con fármacos hepatotóxicos. Para identificar posible diferencia de medias entre los niveles de las determinaciones de TGP, TGO, GGT y LDH en los pacientes con y sin síntomas se utilizó la prueba t de Student para muestras independientes. Posteriormente, se realizó la prueba estadística Regresión logística binaria con el método Intro. La prueba de bondad de ajuste Hosmer-Lemeshow permitió evaluar el ajuste del modelo. Para todas las pruebas de hipótesis se empleó un nivel de significación del 5%(AU)

The relationship between gastrointestinal symptoms and liver involvement in patients diagnosed with COVID-19 was identified. Liver damage in these patients may be caused by the virus directly infecting liver cells, so more attention should be paid to the liver function status of COVID-19 patients. An observational, descriptive and cross-sectional study was carried out in patients diagnosed with COVID-19, belonging to two hospitals in the Ambato canton, from January to July 2021. A non-probabilistic sample of 125 patients was selected with the following criteria: no liver involvement, no treatment with hepatotoxic drugs. To identify possible mean differences between the levels of TGP, TGO, GGT and LDH determinations in patients with and without symptoms, the Student's t-test was used for independent samples. Subsequently, the binary logistic regression statistical test was performed with the Intro method. The Hosmer-Lemeshow goodness-of-fit test allowed us to evaluate the fit of the model. For all hypothesis tests, a significance level of 5% was used(AU)

Chronic heart failure in a patient with SARS-CoV-2 infection: a case report and discussion (preprint)

The involvement of the heart in COVID-19 infection appears to have a major negative influence on patient prognosis and survival. Myocarditis is caused by COVID-19, which can lead to heart failure and arrhythmias. On October 11, 2022, a 60-year-old middle-aged black African female widow was admitted with history of muscular weakness for two days and lack of appetite, and occasional vomiting for one day. She arrived at the emergency room after complaining for two days of peeing less than usual, weakness, a fast heartbeat, swelling in the feet, pink blood-tinged mucus, fever, headache, dehydration, a non-productive cough, and shortness of breath. Her neurological assessment to determine her level of consciousness indicated a Glasgow coma rating of 10/15. Routine reverse transcription polymerase chain reaction (COVID-19) testing was performed in the emergency room; she tested positive. To treat her proven COVID-19 infection, she was received subcutaneous enoxaparin 80 mg every 12 hours as prophylaxis of deep venous thromboembolism. Because of a probable lung bacterial superinfection, 1 g of ceftriaxone and 500 mg of azithromycin were given orally once a day for five days to reduce her hospital-acquired infectious diseases.