Case Series Study Research Articles

Relationship between proton pump inhibitor prescription and asthma exacerbation among adult patients: a self-controlled case series study.

Proton-pump inhibitors (PPI) are empirically used to treat asthma symptoms such as cough; however, the effectiveness of PPI on asthma exacerbation has not been well studied. We aimed to evaluate the relationship between PPI use and asthma exacerbation using a large administrative claims database in Japan. We conducted a self-controlled case series using the JMDC Claims Database (JMDC, Inc., Tokyo, Japan). The cases included adult patients with asthma who were prescribed PPI and experienced at least one outcome event between January 2015 and December 2019. The primary outcome was the composite outcome of hospital admissions and unscheduled outpatient clinic visits due to asthma exacerbation. We also conducted stratified analyses based on PPI generation, the presence of gastroesophageal reflux disease (GERD), asthma severity, and the number of allergic comorbidities. A total of 7379 eligible patients were included in the study. PPI prescription was associated with a decrease in the composite outcomes (incidence rate ratio, 0.90; 95% confidence interval, 0.87-0.93). However, PPI prescriptions did not affect the outcomes of hospital admissions (incidence rate ratio, 1.34; 95% confidence interval, 0.86-2.10). Stratified analyses based on PPI generation, the presence of GERD, asthma severity (except for severe asthma), and the number of allergic comorbidities yielded consistent results. PPI use was associated with a moderate decrease in asthma exacerbation, regardless of the patient profile. However, this effect was not as strong as the prevention of hospital admissions, and outcome events were not prevented in patients with severe asthma.

The outcomes of robotic-assisted enucleation for tumors located in uncinate process of pancreas in 16 cases

Objective: To summarize the experience of robot-assisted enucleation of tumors located in uncinate process of pancreas. Methods: This is a retrospective case series study. The clinical data of patients with robot-assisted enucleation of tumors located in the uncinate process of pancreas at the Department of Gastroenterology and Pancreatic Surgery,Zhejiang Provincial People's Hospital from June 2019 to December 2023 were retrospectively analyzed. A total of 16 cases were enrolled,including 10 males and 6 females,with an age(M(IQR)) of 56(21)years (range: 28 to 77 years),and body mass index of 22.4(2.3)kg/m2 (range:19.8 to 25.6 kg/m2). Follow-up was asked every 6 to 12 months after the first 3-month postoperative follow-up through out-patient service or via telephone. Results: In total 16 cases,there were 11 cases with pancreatic enucleation,and 5 cases with resection of the uninate process. The operation time was 70(60) minutes (range: 40 to 165 minutes),and the blood loss was 30(13)ml (range: 10 to 80 ml). The rate of pancreatic fistula was 5/16. The length of stay was 8(6)days (range: 5 to 33 days). The pathological finding included non-functional neuroendocrine tumor(n=3),insulinoma(n=2),introductal papillary mucinous neoplasm (n=5),solid pseudopapillary neoplasm (n=2),mucinous cystadenoma (n=1),serous cystadenoma (n=2),pseudocyst (n=1). Follow-up as of March 12, 2024, the follow-up time was 16(12)months (range: 3 to 41 months). All patients had no new onset diabetes and no dyspepsia. Conclusion: Robot-assisted surgical system can be used for local resection of uncinate process tumors of pancreas,and the quality of life of patients can be improved.

Transoral Laser Microlaryngeal Surgery with MLT Tubes: A Retrospective Case Series.

To evaluate effectiveness of using MLT tubes for transoral laser MLS in terms of surgical visualization, complete excision of vocal cord lesions, maintenance of adequate oxygenation and ventilation and the occurrence of any airway related complications. In a retrospective case series study, review of electronic medical records was conducted for 64 patients who underwent transoral laser MLS over an 18-month period. The collected data included vital parameters, mode of ventilation, ET tube details, surgical field of vision, perioperative adverse events and postoperative ventilation requirements. Among the 64 patients, 82.8% of the time, 5 size MLT tubes were used, fixed at meanlengths of21.6cm in females and 23.07cm in males respectively. A good surgical field of exposure was achieved in 92.2% of patients, with an average FiO2 of 0.29 during laser useand pressure control ventilation mode being the majority choice. 98.4% were extubated on table. The incidence of cuff rupture and bronchospasm was 4.7% and 1.6% respectively with no instances attributable to laser relatedevents. Even though Laser resistant tubes are considered gold standard, MLT tubes can be used by taking adequate precautions to reduce Laser related complications when there is limited availability of laser tubes. Level of evidence Case series.

Evaluating Adherence to AAO Hydroxychloroquine Screening Guidelines

PurposeHydroxychloroquine (HCQ) is commonly prescribed for autoimmune disorders but carries a risk of retinal damage, which increases over time. The American Academy of Ophthalmology (AAO) issued updated guidelines in 2016 to optimize screening for HCQ retinopathy, recommending dosing based on real body weight and specific visual field (VF) testing patterns. This study aimed to assess adherence to the AAO guidelines for HCQ retinopathy screening in a clinical setting and to identify deviations in the implementation of these guidelines. DesignWe employed a large, single-center retrospective case series study design. MethodsWe conducted a retrospective analysis of 391 patients treated with HCQ at a single academic center from 2017 to 2019. The study focused on the appropriateness of screening tests, specifically optical coherence tomography (OCT) and VF testing, based on the duration of HCQ therapy. ResultsOur analysis showed that over-testing with OCT and VF was prevalent among patients on HCQ for five years or less, occurring in 56% and 48% of encounters, respectively. Conversely, there were missed screenings in patients on HCQ for more than five years, with 12% and 16% of encounters lacking OCT and VF testing, respectively. Notably, adherence to VF testing guidelines for Asian patients was poorly implemented, with the recommended wide pattern VF testing conducted in only two of nine cases. Additionally, there were significant instances where HCQ dosages exceeded recommended levels without subsequent adjustments, despite ophthalmologists' recommendations. ConclusionsThe study highlights a critical need for improved guideline adherence to prevent unnecessary testing costs and undetected retinopathy in long-term HCQ users. It underscores the importance of using real body weight for dosing decisions and enhancing collaboration between ophthalmologists and rheumatologists to manage the delicate balance between disease control and the risk of retinopathy. Further multi-center studies are warranted to evaluate adherence variations and develop strategies for guideline implementation.

Different clinical phenotypes in common variable immunodeficiency.

Background. We aimed to describe the clinical heterogeneity (infectious and noninfectious manifestations) and the impact of immunoglobulin replacement therapy on the reduction of infections in patients given a diagnosis of common variable immunodeficiency. Methods. This was a descriptive case series study. Medical charts were retrospectively reviewed based on demographics, clinical presentation, immunoglobulin replacement therapy and laboratory findings at diagnosis. Results. Thirty six common variable immunodeficiency patients were enrolled. Nineteen of them were male (53%). The median age at onset of symptoms was 8 years and at common variable immunodeficiency diagnosis was 19 years. Family history for immunodeficiency was observed in 2 patients (5%). Recurrent infections were present in 35 patients (97%) and they were the first clinical manifestations in 31 patients (86%). Respiratory infections were the most frequent, followed by gastrointestinal infections. Noninfectious manifestations were present in 32 patients (89%), including bronchopulmonary disease, allergy, autoimmunity, lymphoproliferation, gastrointestinal disorders and malignancy. Chronic pulmonary disease and lymphoproliferation were the most common. There was an important reduction of infections 1 year after begining immunoglobulin replacement therapy, mainly pneumonia and sinusitis. Conclusions. Although the diagnosis of common variable immunodeficiency has improved over the last decade, many patients are still being referred and diagnosed late. Physicians must recognize that both infectious and noninfectious manifestations can be the initial signs of common variable immunodeficiency and are very common in these patients. Immunoglobulin replacement therapy significantly reduces respiratory infections.

Human papillomavirus nonavalent (HPV9) vaccination and risk of immune mediated diseases, myocarditis, pericarditis, and thromboembolic outcomes in Denmark: self-controlled case series study

ObjectiveTo assess the associations between vaccination with the nonavalent human papillomavirus (HPV9) vaccine and immune mediated diseases, myocarditis, pericarditis, arterial thromboembolism, and venous thromboembolism with or without thrombocytopenia, in adolescent...

Outcome and treatment of cesarean scar ectopic pregnancy under ultrasound-guided vacuum aspiration.

This study aimed to describe cases of cesarean scar pregnancies that were successfully treated with suction curettage under ultrasound guidance and their outcome. This retrospective, descriptive case-series study was performed on 17 patients diagnosed with cesarean scar ectopic pregnancy in Sulaimani Maternity Teaching Hospital from May 2022 to April 2023. The patients' sociodemographic and clinical data were collected. The patients were treated with suction curettage alone or in combination with local injection of methotrexate under ultrasound guidance. Patients with a viable fetus (n = 4) received local intrinsic methotrexate injection into the gestational sac and suction curettage, while those in whom the fetus had died (n = 13) underwent only suction curettage. Five patients required intrauterine balloon insertion to stop bleeding without further treatment, and only three required a blood transfusion owing to severe bleeding. Cesarean scar ectopic pregnancy is a dangerous and complex disorder with an increasing occurrence in recent years. Accurate early diagnosis and effective management are essential to reduce maternal mortality and mortality of this type of pregnancy.

Cervical Sympathetic Blockade Produces a Significant Reduction in Suicidal Ideation in a PTSD Cohort: A Case Series of 254 Patients

Background: Suicide is estimated to account for 1.4% of deaths worldwide, making it among one the leading causes of premature death. Stellate ganglion block (SGB) has been shown to reduce suicidal ideation in a single case report of a patient with comorbid post-traumatic stress disorder (PTSD) and suicidal ideation. Aims: To report a significant reduction of suicidal ideation using cervical sympathetic block (CSB), a more advanced version of SGB, in a cohort of patients with PTSD. Methods: 254 patients were evaluated for suicidal ideation via pre- and post-suicide risk assessments by using the Depressive Symptom Index - Suicidality Subscale (DSI-SS) as part of a pre- and post-treatment clinical interview. Further included were other psychiatric measures. Patients received CSB as per clinic protocol. Results: Overall, the patients had an average DSI-SS reduction of 43.8%, PCL-5 reduction of 31.7%, GAD-7 reduction of 22.5%, and PHQ-9 reduction of 35.5%, following CSB. Limitations: Lack of control, given this is an open-labeled, case series study. Conclusion: Cervical sympathetic block is a safe and minimally invasive procedure that may provide significant reduction in suicidal ideation as well as symptoms of PTSD.

Malignancy and tuberculosis coexistence: a case series study

Malignancy and tuberculosis coexistence: a case series study

Use of indocyanine green-human serum albumin complexes in fluorescence image-guided laparoscopic anatomical liver resection: a case series study (with video)

BackgroundThis study aimed to investigate the feasibility and efficacy of near-infrared fluorescence-guided laparoscopic anatomical hepatectomy (LAH) using a novel indocyanine green (ICG)-human serum albumin complex (HSA) in patients with hepatocellular carcinoma.MethodsClinical data of hepatocellular carcinoma patients who underwent ICG-HSA fluorescence-guided LAH at our center from January 2024 to April 2024 were prospectively collected and analyzed. Ultraviolet absorption spectroscopy was used to test the absorption and stability of ICG-HSA complex solutions under different conditions. After determining the optimal ratio, the complex was administered intravenously during surgery to perform negative staining via Glissonean pedicle isolation. LAH was performed along the fluorescence-demarcated boundaries.ResultsThirty-one patients were included (24 men; mean age, 54.61 ± 13.54 years). The median maximum tumor diameter was 2.80 (interquartile range [IQR], 2.00–4.00) cm. S8 segmentectomy (22.6%) and right posterior segmentectomy (19.4%) were the most common resections performed. Successful fluorescence negative staining was achieved in all patients using ICG and HSA at a 1:6 molar ratio at room temperature. Mean operation time was 297.58 ± 85.53 min, Median intraoperative blood loss was 100.0 mL (IQR, 50.0–200.0). The median surgical margin distance was 0.90 cm (IQR, 0.40–1.50). The postoperative complication rate was 45.2% (35.5% Clavien–Dindo grade I and 9.7% grade II). The median length of hospital stay was 5.0 days (IQR, 4.0–5.0).ConclusionICG-HSA-assisted LAH is safe and feasible. Compared with free ICG, the novel ICG-HSA complex exhibits better optical properties and in vivo stability, which can improve the accuracy of intraoperative liver segment localization and optimize the anatomical dissection plane. It has the potential to become an ideal fluorescent imaging agent for anatomical hepatectomy.Graphical abstractA In vitro binding experiments of indocyanine green (ICG) and human serum albumin (HSA) suggested that a 1:6 molar ratio and a configuration temperature of 37°C were optimal. B During surgery, after extrahepatic Glissonean isolation of the liver pedicle planned for resection, the ICG-HSA complex was administered through a peripheral vein using an infusion pump. C ICG-HSA metabolism comprises three stages: intravascular, liver, and systemic clearance. D The actual intraoperative fluorescence imaging and guidance effects of ICG-HSA in laparoscopic fluorescence negative-staining right hemihepatectomy.

DRESS syndrome and tuberculosis: Implementation of a desensitization and re-desensitization protocol to recover antituberculosis drugs in a case series at a specialized TB Unit in Lima, Peru.

Antituberculosis drugs (ATDs) could cause severe and rare reactions, such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Recovering ATDs might guarantee a higher cure rate for tuberculosis patients. Our aim was to evaluate the results of desensitization and re-desensitization to recover ATDs in a case series of patients with DRESS syndrome. A retrospective case series study was conducted on patients with DRESS syndrome due to therapy with ATDs from 2021 to 2023. Desensitization and re-desensitization protocols, designed with an algorithm proposed by the Tuberculosis Specialized Unit of the Dos de Mayo National Hospital in Lima, Peru, were implemented. A total of 18 patients underwent desensitization or re-desensitization protocols, achieving an overall success rate of 72.2%. The average time for the development of DRESS syndrome due to ATDs was 19 days. Rifampicin (84.2%), isoniazid (68.4%), and pyrazinamide (26.3%) were identified as the main drugs responsible for this adverse reaction. All patients presented with fever and skin rash, with an average eosinophil percentage of 16.7% (interquartile range: 4.5-28.8). Organ involvement (liver, kidney, and heart) was observed in 8 patients, but only 2 patients experienced severe complications due to DRESS syndrome. A significant association was found between the number of ATDs used and eosinophil levels (P =.03). The study introduced a desensitization and re-desensitization algorithm for the treatment of DRESS syndrome, notable for its safety, adaptability, and high success rate. This advancement provided healthcare professionals with safer and more effective therapeutic approaches for managing this complex condition.

Arthroscopic subscapularis augmentation of the classic Bankart repair leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss.

The long-term failure rate of the arthroscopic Bankart repair may reach unacceptable values, raising the need to augment this classic procedure. Arthroscopic subscapularis augmentation is the tenodesis of the upper part of the subscapularis tendon to the anterior glenoid rim. The aim of the study was to evaluate the mid-term clinical and functional outcomes of patients operated with arthroscopic subscapularis augmentation of the classic Bankart repair due to recurrent anterior shoulder instability. This is a retrospective single-centre case series study with prospectively collected data. All patients suffered from recurrent anterior shoulder instability and had glenoid bone loss less than 13.5% of the inferior glenoid diameter (subcritical glenoid bone loss). Patients with greater anterior glenoid bone defect, engaging Hill-Sachs lesions, multidirectional instability or subscapularis insufficiency were excluded. Postoperatively, all patients were evaluated for recurrence and apprehension. The patient's shoulder range of motion and functional scores were recorded. The final study cohort included 34 patients with a mean age of 29.3 ± 10.2 years. The mean follow-up period was 42.4 ± 10.7 months (range, 24-62 months). Two out of 34 patients (5.8%) experienced a re-dislocation postoperatively, while one additional patient had a subjective feeling of apprehension. External rotation at the last follow-up was lower compared to preoperative values or the healthy side, but only one patient had restrictions in his sporting activities. The functional scores were significantly increased compared to the preoperative values. Twenty-two out of 26 patients (84.6%) returned to the same level of sporting activities, and 30/34 patients (88.2%) were highly satisfied with the results. Arthroscopic subscapularis augmentation of the classic Bankart repair reduces the dislocation recurrence rate and leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss. Level IV.

Pseudochamber-Protected Keratoplasty (PPK) with a New Inter-Corneal Surgical Device Implant Technique in High-Risk Cases.

Background/Objectives: To describe the pseudochamber-protected keratoplasty (PPK) procedure with the new Endo-K Pro® implant technique and report the clinical outcomes in patients at high risk for penetrating keratoplasty (PKP). Methods: This case series study included patients who required a PKP and had a high risk for corneal transplant failure. All cases underwent the PPK procedure with simultaneous Endo-K Pro® implantation and had a minimum follow-up of 12 months. Graft survival was the primary outcome (defined as a clear graft with an endothelial cell density >500 cells/mm2). Central corneal thickness (CCT), corrected distance visual acuity (CDVA), intraocular pressure (IOP), and complication rate were the secondary outcomes. Results: Twenty-five eyes (twenty-five patients) were included. The mean follow-up was 23.64 ± 8.2 months (range: 12-36 months). Graft survival was achieved in 23 of the 25 cases (92%). One eye had to be re-transplanted due to persistent oedema secondary to uncontrolled IOP. In two cases (8%), the graft failed three months after surgery when an anterior pseudochamber collapsed due to direct contact of donor endothelium and host tissue. Six eyes experienced host tissue protrusion that was successfully managed using an Nd: YAG laser (two eyes) or injecting a cohesive viscoelastic into the pseudochamber (four eyes). CDVA increased significantly during the follow-up period. No significant changes were found in IOP. No intra- or postoperative complications were reported. Conclusions: PPK with the Endo-K Pro® implant seems to be an effective and safe surgical approach as an alternative in high-risk patients for PKP, allowing full-thickness corneal transplantation without performing an open-sky procedure.

Perceptions and Effectiveness of a Fully-Automated Brief Behavioral Insomnia Therapy, Delivered by a Virtual Companion, in Older and Young Adults

Abstract Background and Objectives One of the most common sleep disturbances in older people is insomnia. Cognitive-behavioral therapy is the first-line treatment for this condition in older adults, but in-person treatment is costly and often unavailable. In this study, in a group of older and young subjects, we aimed to compare: (1) their initial perceptions of a fully-automated mobile health intervention to manage insomnia, (2) how these perceptions related to treatment completion, and (3) the effects of the intervention on insomnia severity and related outcomes. Research Design and Methods A case series study was conducted with a self-selected sample of older (> 65 years) and young (18-35 years) adults (n=5,660) who downloaded a free app, available in France, that delivers a brief behavioral intervention for insomnia aided by a virtual companion. The 17-day intervention included sleep hygiene and stimulus control recommendations. Primary outcome was treatment completion (yes/no). At the beginning of the intervention, treatment acceptability and trust in the virtual companion were assessed with two short questionnaires (completion rate: 1,597 users). Insomnia was evaluated with the Insomnia Severity Index. Results Logistic regression analyses showed that higher credibility and trust in the app’s virtual companion were associated with higher odds of treatment completion, but only in older adults (Trust scores x Age group: OR=1.12, [95%CI=1.01-1.25], p < .05, and Credibility scores x Age group: OR=1.25, [95%CI=1.06-1.47], p < .01). Within the subset of users who completed the intervention (n=289), insomnia remission (χ2=2.72, NS) and insomnia response rates (χ2=2.34, NS) were comparable across both groups. Discussion and Implications This brief behavioral intervention appears to be efficacious for the self-management of insomnia symptoms in older adults. The integration of persuasive interaction elements, such as avatars and virtual coaches, in fully-automated interventions could be particularly useful to stimulate older adults’ engagement.

Sterile water and regional citrate anticoagulation: A simple CRRT strategy for safe correction of severe hyponatraemia.

Hyponatraemia is a prevalent electrolyte disturbance observed in critically ill patients. The rapid correction of low plasma sodium levels by continuous renal replacement therapy (CRRT) carries the risk of developing osmotic demyelination syndrome (ODS), which can be prevented by implementing an individualized CRRT method. This study aims to introduce a CRRT protocol for the safe and gradual correction of severe hyponatraemia. This retrospective case series study was conducted in an intensive care unit (ICU). All four patients with severe hyponatraemia (<125 mmol/L) and renal failure between October 1, 2022, and September 30, 2023, were treated by CRRT with sterile water and regional citrate anticoagulation (RCA). Data on patient demographics, laboratory biochemical parameters, urine outputs and CRRT-related adverse events were collected. Laboratory parameters and urine outputs were compared by paired t-tests before and after CRRT. After CRRT, sodium levels were significantly increased (112.7 ± 6.7 vs. 141.9 ± 2.8 mmol/L, p = .005). Abnormal urine outputs, potassium, creatinine and bicarbonate were corrected (p for all <.05). Safe and gradual correction of hyponatraemia and internal environmental dysregulation was achieved in all patients without any complications related to CRRT, particularly ODS. It is a novel and simple strategy to correct severe hyponatraemia effectively while ensuring the safety of patients that can be easily implemented by experienced nurse staff. The sterile water-based protocol for postfilter dilution is safe to correct severe hyponatraemia with RCA and can be easily performed by experienced critical care nurses according to the precalculated formula. CRRT-trained, experienced ICU nurses are competent to initiate and adjust sterile water infusion discretely to prevent overcorrection of hyponatraemia.

Efficacy of Homoeopathic Medicine in Treating Gastritis: A Retrospective Case Series Study

Background:Gastritis is one of the commonest disease which affects all ages and sex. The prevalence rate also increases with the change in lifestyle. Aim: To analyse the effectiveness of homoeopathic medicine in treating gastritis. Methodology: Cases diagnosed to have gastritis visited OPD and IPD of Sarada Krishna Homoeopathic Medical College were considered in the study. Sample size selected was 40. Cases were selected based on inclusion and exclusion criteria. Pre structured case records of Sarada Krishna Homoeopathic Medical College were used in the study. Details were collected about age, sex, occupation, medicine selected and potency used. Follow up is added to assess the improvement of the patient. Result: Out of 44 patients, 23 were females and 17 were males. Majority comes between 48 and 58 years. 10 patients comes between 37 and 47 years,7 between 59 and 69 years. 5 each is seen between 15 to 25 years and 26 to 36 years and 2 patients are there between 70 and 80 years. 9 patients were treated with Lycopodium , 6 patients with Nux vomica, pulsatilla and sulphur has been used in 5 patients.3 patients were treated with silicea and 2 patients with cundurango., the other medicines used were Ignatia, Anacardium, Argentum nitricum,Calcarea Carbonicum, Sepia, Thuja, Arsenicum album, Bryonia, Ferrum Metallicum, Chelidonium. Most commonly used potencies is 200 by 23 patients.8 patients were treated with LM potency. 7 patients has taken 30 potency.1M potency was used in 2 patients. Conclusion: Homoeopathy has a better scope in treating such cases as long term use of modern medicine has shown an adverse effect in the health of patients.

Optical Coherence Tomography as a Diagnosis-Assisted Tool for Guiding the Treatment of Melasma: A Case Series Study.

Background/Objectives: Multiple underlying pathomechanisms may lead to melasma, but there has been no report on the use of optical coherence tomography (OCT) to reveal specific pathomechanisms in individual patients and provide individualized treatments accordingly. Using real-time OCT images, we studied the pathomechanisms of melasma in 12 female patients and the effects of individualized treatments. Methods: Patients were divided into good and bad improved groups according to the improvement in hyperpigmentation at month 4. Results: In the bad improved group, all melanin or confetti melanin had significantly decreased at month 2 or month 4 while granular melanin ratio at month or month 4 significantly increased, the most parameters of dendritic-sharped cells (DCs) before and after treatment were not significantly different, the collagen area or collagen density at month 4 significantly decreased. In the good improved group, there was slightly low all melanin/confetti melanin at month 4 and high granular melanin at month 4 in comparison to the bad improved group. Moreover, most of the parameters in the DCs at month 4 significantly increased while most parameters in collagen at month 4 significantly decreased. Conclusions: OCT is useful in revealing the involved pathomechanisms of melasma in individualized patients. Positive treatment results can be achieved through individualized therapy regimen targeting the pathomechanisms.

Accuracy of robotic computer‐assisted implant surgery for immediate implant placement: A retrospective case series study

Accuracy of robotic computer‐assisted implant surgery for immediate implant placement: A retrospective case series study

Outcomes of COVID-19 in 24 hospitalized liver transplant recipients: an observational study

BackgroundAlthough liver transplant (LT) recipients are considered a population at risk of severe features of coronavirus disease 2019 (COVID-19), data in this regard are scarce and controversial. In this study, we reported the outcome of 24 cases of LT recipients who were hospitalized due to COVID-19 and investigated the role-playing factors in the severity of the disease.MethodsIn this single-center, analytic case-series study, eligible patients were among LT recipients who were hospitalized due to the diagnosis of COVID-19 based on positive results of polymerase chain reaction. Participants were categorized as severe COVID-19 if they were admitted to the intensive care unit, experienced respiratory failure demanding mechanical ventilation, or eventually died. Demographic and clinical data, COVID-19 symptoms and specific treatments, laboratory biomarkers, and immunosuppressive regimens and their alteration during the admission were recorded. Analysis was done using SPSS software.ResultsTwenty-four hospitalized LT patients were included, of which nine had severe and fifteen had non-severe COVID-19. Out of 9 patients with severe COVID-19, four sadly died. The analysis and comparison between the two groups revealed longer hospital stays (P = 0.02), lower lymphocyte counts (P = 0.002), and higher levels of C-reactive protein (CRP) (P = 0.006) in patients with severe COVID-19. Patients with non-severe COVID-19 had higher doses of tacrolimus and mycophenolate in their baseline immunosuppressive regimen (both P = 0.02).ConclusionLymphopenia and high CRP levels are associated with more severe forms of COVID-19 in LT patients. Mycophenolate may have protective properties against severe COVID-19. The role of severity indicators in LT patients with COVID-19 needs to be systematically recognized.

Genotyping of oral Candida albicans and Candida tropicalis strains in patients with orofacial clefts undergoing surgical rehabilitation by MALDI-TOF MS: Case-series study

Patients with orofacial clefts are more likely to develop oral fungal diseases due to anatomo-physiological changes and surgical rehabilitation treatment. This case-series study evaluated the genetic diversity and dynamics of oral colonization and spread of C. albicans and C. tropicalis in four patients with orofacial clefts, from the time of hospital admission, perioperative and outpatient follow-up, with specialized physician. Candida biotypes previously identified by CHROMagar Candida and PCR methods were studied by MALDI-TOF MS assays and clustering analyses. Possible correlations with pathogenicity characteristics were observed, including production of hydrolytic exoenzymes and the antifungal sensitivity profiles. Amphotericin B-sensitive and fluconazole-resistant (low frequency) C. tropicalis and C. albicans, including clinically compatible MIC of nystatin, were found in the oral cavity of these patients. Clusters of isolates revealed phenomena of (i) elimination in the operative phase, (ii) maintenance or (iii) acquisition of oral C. tropicalis in the perioperative period and specialized outpatient and medical follow-up. For C. albicans, these phenomena included (i) elimination in the operative phase, (ii) acquisition in the operative phase and propagation from the hospital environment, and (iii) maintenance during hospitalization and operative phase. Amphotericin B and nystatin were shown to be effective in cases of clinical treatment and/or prophylaxis, especially considering the pre-existence of fluconazole-resistant strains. This study confirmed the phenomena of septic maintenance, septic neocolonization and septic elimination involving the opportunistic pathogens. MALDI-TOF MS associated with clustering analysis may assist the monitoring of clinical isolates or groups of epidemiologically important microbial strains in the hospital setting.