Subcutaneous Emphysema Complicating Convalescent Stage of Measles in a Malnourished Indigent Child: A Case Report from North-western Nigeria.

Background: Measles is a highly infectious vaccine preventable viral disease that runs a devastating course in developing countries due to its association with malnutrition and poor immunization coverage. Among the complications of measles, pneumonia accounts for most measles-associated morbidity and mortality. However, subcutaneous emphysema is a rare complication of measles that can be challenging to manage and may portend poor outcome if untreated. Case presentation: We present a case of a 2yr old un-immunized rural dweller with massive subcutaneous emphysema comorbid with malnutrition complicating convalescent stage of measles. The child failed to improve with conservative management but responded to closed thoracostomy tube drainage (CTTD) through an underwater seal bottle with intermittent negative pressure wound therapy (NPWT). The child spent 47days on admission during which the treatment was supported by faith-based organization and social welfare unit of the hospital.ConclusionSubcutaneous emphysema is a rare complication of measles infection that can be challenging to manage especially when comorbid with malnutrition in an indigent child. Multi-disciplinary team approach and the use of CTTD with NPWT is an effective management measure which can shorten the duration of hospital stay.

Relative expression of pro-inflammatory molecules in COVID-19 patients manifested disease severities

Aggressive immune response, due to over-expressed pro-inflammatory molecules, had been characterized in COVID-19 patients. Some of those mediators have a dual and opposite role on immune-systems to play behind differential disease severities. We investigated the expression of some cytokines and chemokines in COVID-19 patients in Bangladesh. We diagnosed the patients by detecting SARS-CoV-2 RNA in nasal swab samples by the real-time RT-PCR method. Thirty adult patients were preselected based on their disease severities and grouped into mild, moderate, and severe cases. Nine healthy volunteers participated in this study as control. Relative expression of nine cytokines/chemokine in total leukocytes was semi-quantified in SYBRgreen-based qRT-PCR. We performed statistical tests on transformed log data using SPSS 24.0. At the onset of symptoms (day-1), ACE2 (P < 0.05) and IL-6 (P > 0.05) were up-regulated in all COVID-19 groups, although expression levels did not significantly correlate with disease severities. However, expression of IL-6, MCP-1, MIP-1α, TNF-α, RANTES, and ACE2, on day-14, were positively correlated with disease severities. Relative viral load at day-1 showed no significant correlation with cytokine expression but had a significant positive correlation with RANTES and ACE2 expression on day-14 (P < 0.05). Male patients had a higher level of IL-6 than female patients on day-1 (P < 0.05). All COVID-19 patients showed up-regulated cytokines and chemokines on the day-14 compared to day-1 except TNF-α. Female patients had higher expression of ACE2 and IL-12 on day-14. Up-regulated cytokines/chemokines at the convalescent stage, especially IL-6, may target anti-cytokine therapy in post-COVID-19 patients’ management.

Effect of ‘hand and foot acupuncture with twelve needles’ on hemiplegia patients with ‘qi deficiency and blood stasis’ syndrome in the convalescent stage of Ischaemic stroke: study protocol for a randomised controlled trial

Background Hemiplegia is a common sequela after stroke, and acupuncture is one of the most common physical therapies used to treat hemiplegia during the recovery stage after ischaemic stroke. ‘Hand and foot acupuncture with twelve needles’ is an acupuncture treatment performed after stroke. The principal objective of this study is to assess the efficacy and safety of ‘hand and foot acupuncture with twelve needles’ for hemiplegia in the convalescent stage of ischaemic stroke. Methods This is the protocol for a randomised, controlled clinical trial with two groups: a ‘hand and foot acupuncture with twelve needles’ group and a routine acupuncture group. A total of 208 participants will be randomly assigned to two different groups in a 1:1 ratio and will undergo conventional rehabilitation. Limb function will be evaluated by the simplified Fugl-Meyer assessment scale, Barthel Index, modified Ashworth scale and National Institute of Health stroke scale. The participants will be evaluated at baseline (on the day of enrolment) and followed up at 2 weeks, 1 month, 2 months and 3 months after enrolment. Discussion The results of this study will provide evidence on the effectiveness of ‘hand and foot acupuncture with twelve needles’ in the treatment of limb dysfunction that can be used for future evaluations. Trial registration Chictr.org.cnChiCTR1900021774. Registered on 8 March 2019

The SARS-CoV-2 induced targeted amino acid profiling in patients at hospitalized and convalescent stage

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces an ongoing global health crisis. Here we utilized a combination of targeted amino acids and clinical biochemical profiling to analyze the plasma of COVID-19 subjects at the hospitalization stage and one-month post-infection convalescent stage, respectively, to investigate the systematic injury during COVID-19 disease progress. We found the virus-induced inflammatory status and reduced liver synthesis capacity in hospitalized patients, which manifested with increased branched-chain amino acids, aromatic amino acids, one-carbon related metabolites, and decreased methionine. Most of these disturbances during infection get recovery except for the increased levels of medium-chain acylcarnitines in the convalescent subjects, implying the existence of incomplete fatty acids oxidation during recovery periods. Our results suggested that the imbalance of the amino acid profiling in COVID-19 patients. The majority of disturbed amino acids recovered in one-month. The incomplete fatty acid oxidation products suggested it might take longer time for convalescent patients to get complete recovery.

Myocardial Area at Risk and Salvage in reperfused acute MI Measured by Texture Analysis of Cardiac T2 Mapping and Its Prediction Value of Functional Recovery in the Convalescent Stage

To assess the ability of distinguishing the area at risk (AAR) and evaluating the prognostic abilities of T2-mapping texture analysis (TA) in reperfused acute MI, 106 patients who were diagnosed with AMI and treated with percutaneous coronary intervention (PCI) underwent acute (less than five days) enhanced cardiac magnetic resonance imaging. Of these patients, 45 of them had a subsequent CMR scan following recovery (after at least three months). Cine imaging, T2-Mapping, T2-weighted STIR imaging, and LGE imaging were performed. In the TA, regions of interest (infarcted, salvageable, and remote) were drawn by two blinded, independent readers based on LGE and T2-weighted imaging. Seven independent texture features on T2-Mapping were selected: Perc.50%, S(2,2)InvDfMom, S(2.-2)AngScMom, S(4,0)Entropy, 45dgrLngREmph, 45dgr_Fraction and 135dr_GLevNonU. Among them, 45dgr_LngREmph, 45dgr_Fraction and 135dr_GLevNonU showed more promise. The average value of 135dr_GLevNonU in the infarct zone, AAR zone, and the remote zone was: 61.96 ± 26.03, 31.811 ± 18.933 and 99.839 ± 26.231, respectively. Additionally, 135dr_GLevNonU provided the highest 0.855(± 0.083) area under the curve (AUC) from the receiver operating characteristic curve (ROC curve) for distinguishing AAR from the infarct zone. The AUC for differentiating AAR from the remote zone is 0.942 ± 0.041. Texture features are not associated with convalescent decreased strain or ejection fraction (EF) (p > 0.05) in the standard regression analysis; and cannot predict left ventricle remodeling (LVR) in the logistic regression analysis (p > 0.05). T2-mapping TA in reperfused AMI can distinguish AAR from both the infarct zone and the remote myocardial zone without LGE imaging. However, these features cannot predict patients’ functional recovery in the convalescent stage.

Melanin change of retinal pigment epithelium and choroid in the convalescent stage of Vogt-Koyanagi-Harada disease

AIM: To observe the melanin change of the retinal pigment epithelium (RPE) and choroid in the convalescent stage of Vogt-Koyanagi-Harada (VKH). METHODS: A retrospective study was performed on 40 eyes of 20 patients in the convalescent stage of VKH. Fundus photography (FP), multi-spectral imaging (MSI), and optical coherence tomography (OCT) were performed. RESULTS: In the VKH convalescent stage, focal RPE melanin accumulation (FRMA) was detected in 34 eyes (85%) on MSI and in 7 eyes (17.5%) on FP. FRMA was limited to the previous retinal detachment area in all 28 eyes (FRMA was detected in 34 eyes on MSI, which were enrolled, and 6 eyes lacked data in the acute stage). Sunset-glow fundus was detected in 20 eyes (50%) on FP. The mean density of FRMA in a 1-mm-diameter circular area of the fovea was 0.04±0.07 on MSI, which was significantly correlated with sunset-glow fundus (ρ=0.467, P=0.02). CONCLUSION: In the VKH convalescent stage, FRMA is derived from the RPE melanin change, and sunset-glow fundus is derived from the choroid melanin change. A higher density of FRMA in the fovea and sunset-glow fundus represents more serious depigmentation of melanin.