Silicone radial head prostheses; the clinical course and treatment of failure: A case series

The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact on COVID-19 patients remains unclear. Furthermore, severe COVID-19 has recently been associated with significant immune suppression, and this may in turn impact CMV reactivation, possibly contributing to clinical course. Nevertheless, multiple confounding factors in these patients will certainly challenge upcoming research. The authors present a case series of five patients admitted to the intensive care unit (ICU) in the context of respiratory failure due to severe COVID-19. All patients evolved with CMV reactivation during ICU stay.

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530. COVID-19 in kidney transplant recipients: Single-center experience and case-control study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.724 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S332-S332

Author(s):

Anna Hardesty ◽

Aakriti Pandita ◽

Yiyun Shi ◽

Kendra Vieira ◽

Ralph Rogers ◽

...

Keyword(s):

Kidney Transplant ◽

Case Control Study ◽

Clinical Course ◽

Case Series ◽

Case Fatality ◽

Case Control ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Transplant Patients ◽

Control Study

Abstract Background Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date. Methods We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died. Results 16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34–65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1–203) months. Two KTR, both transplanted >10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were >1,000 (normal: < 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2). Table 1 Table 2 Conclusion Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway. Disclosures All Authors: No reported disclosures

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Basal ganglia echogenicity in preterm infants: A case series

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-190390 ◽

2020 ◽

pp. 1-5

Author(s):

S. Harvey ◽

S. Ryan ◽

A. Tarrant ◽

M. King ◽

B. Hayes

Keyword(s):

Basal Ganglia ◽

Clinical Course ◽

Case Series ◽

Abnormal Development ◽

Cranial Ultrasound ◽

Perinatal Factors ◽

Mri Brain ◽

Developmental Progress ◽

Cognitive Delay ◽

History Of

BACKGROUND: Damage to the basal ganglia and thalamus (BGT) can be caused by multiple perinatal factors and may be associated with movement disorders, cognitive delay and visual difficulties. Changes in BGT structure, seen as echogenicity on ultrasound, are difficult to objectively quantify. The aetiology, clinical relevance and developmental outcomes of BGT echogenicity are poorly understood. We aimed to gain a better understanding of the natural history of BGT echogenicity in a preterm population. METHODS: Retrospective review of clinical course, neuroimaging and development in infants born <32weeks gestation over 5 years with evidence of BGT echogenicity. RESULTS: BGT echogenicity was reported in 18/650 infants (2.7%). Echogenicity appeared at a median of 8 days (2–45 days) and resolved on pre-discharge ultrasound in 50%. Thirteen infants had a term corrected MRI brain with abnormal BGT signal seen in 3 infants (23%). All 3 infants had persisting echogenicity on discharge ultrasound. No infant with echogenicity resolution on ultrasound had changes on term MRI. 14 infants had developmental progress available at 1 year corrected. Abnormal development was reported in four children of whom one had BGT changes on term MRI. Two children with persistent BGT changes but an otherwise normal MRI had reported normal neurodevelopment. CONCLUSION: BGT echogenicity is relatively common on routine ultrasound and resolves in the majority of infants by term corrected. This review suggests that at term corrected, normal cranial ultrasound may obviate the need for MRI where no other concerns exist. BGT echogenicity did not appear to independently influence neurodevelopment.

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Clinical Course of Venous Thromboembolism Following Abdominally-Based Microsurgical Breast Reconstruction: A Case Series

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2021.03.020 ◽

2021 ◽

Author(s):

Rakel M. Zarb ◽

Aishu Ramamurthi ◽

Erin L. Doren ◽

John A. LoGiudice ◽

John B. Hijjawi ◽

...

Keyword(s):

Venous Thromboembolism ◽

Breast Reconstruction ◽

Clinical Course ◽

Case Series

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Malignant thyroid teratoma: an integrated analysis of case series and case reports

Endocrine Related Cancer ◽

10.1530/erc-21-0142 ◽

2021 ◽

Author(s):

Huy Gia Vuong ◽

Truong P.x. Nguyen ◽

Hanh T.t. Ngo ◽

Lewis Hassell ◽

Kennichi Kakudo

Keyword(s):

Clinical Course ◽

Case Reports ◽

Case Series ◽

Seer Program ◽

Integrated Analysis ◽

Continuous Variables ◽

Chi Square ◽

Large Tumor ◽

Exact Test

Malignant thyroid teratoma (MTT) is a very rare thyroid malignancy. These neoplasms have been reported only in case reports and small-sized case series so far. In this study, we searched for MTTs in the Surveillance, Epidemiology, and End Result (SEER) program during 1975-2016. Subsequently, we incorporated the SEER data with published MTT cases in the literature to analyze the characteristics and prognostic factors of MTTs. Integrated data were analyzed using Chi-square or Fisher’s exact test for categorical covariates, and t-test or Mann-Whitney test for continuous variables. We included 28 studies with 36 MTT cases and found additional 8 cases from the SEER program for final analyses. Our results showed that MTT is typically seen in adult females. These neoplasms were associated with an aggressive clinical course with high rates of extrathyroidal extension (80%) and nodal involvement (62%). During follow-up, the development of recurrence and metastases were common (42% and 46%, respectively), and one-third of patients died at the last follow-up. Large tumor size (p = 0.022) and the presence of metastases during follow-up (p = 0.008) were associated with a higher mortality rate. In conclusion, our study demonstrated the characteristic features of MTT patients and outlined some parameters associated with a negative outcome which could help clinicians better predict the clinical course of these neoplasms.

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Lotus Birth: A Case Series Report on Umbilical Nonseverance

Clinical Pediatrics ◽

10.1177/0009922818806843 ◽

2018 ◽

Vol 58 (1) ◽

pp. 88-94 ◽

Cited By ~ 5

Author(s):

Kimberly K. Monroe ◽

Alexandra Rubin ◽

Kerry P. Mychaliska ◽

Maria Skoczylas ◽

Heather L. Burrows

Keyword(s):

Hepatitis B ◽

Vitamin K ◽

Chart Review ◽

Clinical Course ◽

Group B Streptococcus ◽

Case Series ◽

Hepatitis B Vaccine ◽

Case Series Report ◽

Group B ◽

Series Report

Lotus birth is the practice of leaving the umbilical cord uncut until separation occurs naturally. Our case series report describes delivery characteristics, neonatal clinical course, cord and placenta management, maternal reasons for a lotus birth, and desire for future lotus births. Between April 2014 and January 2017, six lotus births occurred. Mothers (four of the six) were contacted by phone after giving birth. A chart review was completed on each patient to evaluate if erythromycin ointment, hepatitis B vaccine, and vitamin K (intramuscular or oral) were administered, treatment of the placenta, maternal group B streptococcus status, postnatal infant fevers, infant hemoglobin or hematocrit levels, jaundice requiring phototherapy, and infant readmissions. Three of the six families decided to cut the cord before hospital discharge. No infections were noted. All contacted mothers would elect for a lotus birth again (4/6). One hepatitis B vaccine was given; all others declined perinatal immunization.

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Acute bacterial nephritis. A descriptive study of an underdiagnosed entity

Revista Mexicana de Urología ◽

10.48193/rmu.v80i3.556 ◽

2020 ◽

Vol 80 (3) ◽

pp. 1-10

Author(s):

Pedro Antonio Madero-Morales ◽

Rigoberto Pallares-Méndez ◽

Rodrigo Romero-Mata ◽

Guillermo Vizcarra-Mata ◽

Andrés Guillén-Lozoya

Keyword(s):

Acute Pyelonephritis ◽

Clinical Characteristics ◽

Clinical Course ◽

Case Series ◽

Therapy Response ◽

Time Frame ◽

Clinical Findings ◽

Imaging Features ◽

Imaging Studies ◽

Retrospective Case

Background: Acute bacterial nephritis is an infectious process diagnosed through imaging studies. The clinical course of the disease has been shown to be more aggressive than acute pyelonephritis. It continues to be underdiagnosed, thus there are few studies on the entity in the literature. Objective: To describe the clinical characteristics and imaging features of acute bacterial nephritis, as well as its clinical course. Design: A descriptive, retrospective case series was conducted. Materials and methods: Thirty-two cases of acute bacterial nephritis in patients admitted to the hospital within the time frame of 2009 to 2016 were reviewed. The patients’ clinical characteristics upon admission were registered, as well as inpatient clinical progression, culture results, and antibiotic therapy response. The imaging studies were re-evaluated and the diagnostic consistency with either the focal or multifocal disease presentation was confirmed. Results: Cases predominated in women (n=29, 90.62%) and the most frequently associated comorbidities were diabetes (n=16, 50%) and obesity (n=9, 28.25%). The most important clinical findings upon admission were fever (n=15, 46.87%) and leukocytosis (n=27, 84.38%). Escherichia coli was the most commonly isolated bacterium (63.63%). Both acute focal bacterial nephritis and acute multifocal bacterial nephritis were observed in 46.87% (n=15) and 53.13% (n=17) of the patients, respectively. Imaging studies were required for all diagnoses. Conclusion: Fever and leukocytosis are the main findings in acute bacterial nephritis. Imaging studies are necessary for making the diagnosis, given that acute pyelonephritis and acute bacterial nephritis cannot be clinically differentiated.

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B.04 Distal and asymmetric myasthenia gravis: a case series of 54 patients

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.63 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S10-S10

Author(s):

AG Florendo-Cumbermack ◽

MW Nicolle

Keyword(s):

Myasthenia Gravis ◽

Clinical Course ◽

Case Reports ◽

Delayed Diagnosis ◽

Case Series ◽

Retrospective Chart Review ◽

Individual Case ◽

Response To Treatment ◽

Antibody Testing ◽

Repetitive Nerve Stimulation

Background: Distal/asymmetric presentations of myasthenia gravis (MG) are uncommon and occur in 3-7% of patients with MG. This pattern of weakness is often not recognized as a manifestation of MG, leading to inappropriate investigations, delayed diagnosis and potentially missed opportunities for treatment. Our knowledge about this atypical presentation is limited to small case series and individual case reports. This study therefore aims to expand our understanding by describing the clinical course, diagnosis and treatment of a larger series of patients with this presentation. Methods: We conducted a retrospective chart review of patients with definite MG (either acetylcholine receptor [AChR] or MuSK antibody positive or clear evidence of postsynaptic neuromuscular junction dysfunction on electrodiagnostic studies), who attended the MG Clinic in London. Details of the clinical course, electrodiagnostic studies, antibody testing and response to treatment are reported. Results: 5.9% (54/921) of patients with definite MG had distal/asymmetric limb involvement, 56% at onset and 4% developing more than 10 years later. Males predominated (2:1). Finger extensors were most affected. 83% were AChR antibody positive. 7% had thymomas. On repetitive nerve stimulation most patients showed the most significant decrement distally on the more affected side. Almost all patients improved with treatment. Conclusions: This study expands our understanding of distal/asymmetric presentations of MG.

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